Social Smoking Environment and Associations with Cardiac Rehabilitation Attendance

Hypatia A. Bolívar, Rebecca J. Elliott, William Middleton, Jin H. Yoon, Chizimuzo T.C. Okoli, Ilana Haliwa, Charles C. Miller, Philip A. Ades, Diann E. Gaalema

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients. Methods: Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2tests (P <.05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up. Results: Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P <.01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant. Conclusion: Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.

Original languageEnglish
Pages (from-to)46-51
Number of pages6
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number1
StatePublished - Jan 2021

Bibliographical note

Funding Information:
Drs Bolívar and Gaalema were supported by the National Institutes of Drug Abuse (NIDA)/Food and Drug Administration (FDA) grant U54DA036114. Drs Gaalema and Ades were also supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award R33HL143305 and Centers of Biomedical Research Excellence P20GM103644 award from the National Institute on General Medical Sciences. Mr Middleton was supported by NIDA Institutional Training Grant award T32DA007242. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.


  • cardiac rehabilitation
  • enrollment
  • smoking

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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