Factors associated with willingness to quit smoking in a hospital-based smoking cessation programme

Hospital admissions provide an important opportunity for smoking cessation interventions. However, factors associated with willingness to quit smoking among hospitalised smokers remain underexplored, particularly in the multi-ethnic Asian population.

In this cross-sectional study of hospitalised smokers referred to an inpatient smoking cessation service between 2021 and 2025, enrolment data on willingness to quit, demographics, and clinical characteristics were analysed using multivariable logistic regression. A clinical feature score was developed to assess dose-response associations.

Of 953 smokers (median age 57 years; 92% male), 49% reported willingness to quit smoking. In the multivariable analysis, ischaemic heart disease (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.50-3.24, P<0.001), cerebrovascular accident (OR 2.30, 95% CI 1.30-4.12, P=0.005), chronic obstructive pulmonary disease assessment score ≥10 (OR 2.16, 95% CI 1.10- 4.38, P=0.03), modified Medical Research Council dyspnoea score ≥2 (OR 1.87, 95% CI 1.06-3.31, P=0.03), post-secondary education (OR 13.47, 95% CI 5.51- 38.75, P<0.001), and primary/secondary education (OR 3.49, 95% CI 1.45-9.85, P=0.01) relative to no formal education and respiratory admission or visit in the past year (OR 3.55, 95% CI 1.43-9.87, P=0.009) remained associated with willingness to quit smoking. A graded association was observed between accumulation of these clinical features and readiness to quit, with each additional feature associated with higher odds of willingness to quit (OR 2.79, 95% CI 2.18-3.57, P<0.001).

Greater clinical burden was associated with willingness to quit smoking among referred hospitalised smokers. Accumulated clinical risk factors may help identify patients with greater readiness to quit and guide targeted counselling although longitudinal studies are needed to assess clinical utility.