Institutional variation of smoking cessation success in Taiwan: A multi-level analysis of the National Second-Generation Tobacco Cessation Program Data

Mei-Tzu Huang; Jia-Ling Wu; Shang-Chi Lee; Chin-Wei Kuo; Chuan-Yu Chen; Esther Ching-Lan Lin; Ya-Hui Chang; Shu-Ying Lo; Santi Martin; Arief Hargono; Tung-Yao Tsai; Chung-Yi Li

doi:10.1016/j.josat.2024.209615

Institutional variation of smoking cessation success in Taiwan: A multi-level analysis of the National Second-Generation Tobacco Cessation Program Data

J Subst Use Addict Treat. 2024 Dec 24:209615. doi: 10.1016/j.josat.2024.209615. Online ahead of print.

Authors

Affiliations

¹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
⁵ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Emergency, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
⁶ Tobacco Control Division, Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
⁷ Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, Indonesia.
⁸ Emergency Department, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁹ Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Tobacco Control Division, Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address: [email protected].

PMID: 39725233
DOI: 10.1016/j.josat.2024.209615

Abstract

Introduction: Although the relationships between personal factors and smoking abstinence are well-documented, institutional variation in smoking abstinence remains underexplored. This study investigates institutional variation in the six-month smoking abstinence prevalence among institutions participating in Taiwan's Second-Generation Tobacco Cessation Program (SGTCP) and examines institutional characteristics associated with smoking cessation success.

Methods: The analysis included 304,757 pharmacotherapy and health education sessions from 160,336 participants who received smoking cessation services across 2420 institutions under the SGTCP between 2000 and June 2022. Institutional characteristics analyzed included type of institution, number of healthcare professionals, proportion of sessions with high utilization, and service volume. Binary logistic regression models with generalized estimation equations were used to assess associations with six-month smoking abstinence status.

Results: Substantial institutional variation was observed in six-month smoking cessation success, with prevalence ranging from 0.0 % to 100.0 % (mean = 37.84 %, SD = 25.74 %). After adjusting for ecological and personal factors, regional hospitals demonstrated the highest adjusted odds ratio (aOR) for success at 1.176 (95 % confidence interval [CI] = 1.136-1.216). Higher session utilization was positively associated with better outcomes, while institutions with a greater number of participating healthcare professionals showed reduced aORs.

Conclusions: Structural characteristics, such as healthcare setting type and resource availability, and process factors, including methodologies that enhance utilization, are critical determinants of the effectiveness of smoking cessation interventions.

Keywords: Cigarette smoking; Multilevel analysis; Smoking cessation.