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Qual Health Res. 2019 Jul;29(8):1145-1160. doi: 10.1177/1049732318817047. Epub 2018 Dec 14.

Tobacco Cessation Among Acute Coronary Syndrome Patients in Kerala, India: Patient and Provider Perspectives.

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1 Denver Health Medical Center, Denver, Colorado, USA.
2 Ball State University, Muncie, Indiana, USA.
3 Cardiological Society of India, Kerala Chapter, Trivandrum, India.
4 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
5 Centre for Chronic Disease Control & Public Health Foundation of India, Gurgaon, Haryana, India.
6 Northwestern University, Chicago, Illinois, USA.
7 Indian Institute of Public Health-Delhi, Gurgaon, Haryana, India.


Tobacco cessation is an important intervention to reduce mortality from ischemic heart disease, the leading cause of death in India. In this study, we explored facilitators, barriers, and cultural context to tobacco cessation among acute coronary syndrome (ACS, or heart attack) patients and providers in a tertiary care institution in the south Indian state of Kerala, with a focus on patient trajectories. Patients who quit tobacco after ACS expressed greater understanding about the link between tobacco and ACS, exerted more willpower at the time of discharge, and held less fatalistic beliefs about their health compared to those who continued tobacco use. The former were motivated by the fear of recurrent ACS, strong advice to quit from providers, and determination to survive and financially provide for their families. Systemic barriers included inadequate training, infrequent prescription of cessation pharmacotherapy, lack of ancillary staff to deliver counseling, and stigma against mental health services.


India; South Asia; cardiac events; framework analysis; heart attacks; qualitative; qualitative research; quitting; smoking; tobacco cessation


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