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

Smitha S. Bhaumik, Caitlyn Placek, R. Kochumoni, T. R. Lekha, Dorairaj Prabhakaran, Brian Hitsman, Mark D. Huffman, Sivadasanpillai Harikrishnan, Shifalika Goenka*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1145-1160
Number of pages16
JournalQualitative Health Research
Issue number8
StatePublished - Jul 1 2019


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

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Tobacco Cessation Among Acute Coronary Syndrome Patients in Kerala, India: Patient and Provider Perspectives'. Together they form a unique fingerprint.

Cite this