Racial Disparities in Biopsychosocial Predictors of Short-Term Smoking Cessation Following Acute Coronary Syndrome Hospitalization

Background: Smoking cessation after an acute coronary syndrome (ACS) event is critical for reducing cardiovascular risk and mortality. However, most patients continue smoking post-hospitalization. Prior research with limited racial and sex diversity has overlooked how biopsychosocial factors may influence cessation outcomes in this high-risk group. Purpose: The current study aimed to identify biopsychosocial predictors of 7-day smoking abstinence post-discharge in a diverse cohort of hospitalized ACS patients. Methods: Pre-randomization data from the Post-Acute Cardiac Event Smoking (PACES) trial, a randomized controlled trial of integrated smoking cessation and mood management treatment, were analyzed (N = 203, 69% male, 41% BIPOC [Black, Indigenous, and People of Color]). Univariate models identified potential predictors, which were subsequently evaluated in multivariable logistic regression models. Stratified analyses were conducted due to significant differences in abstinence rates between White and BIPOC participants. Results: Among White participants, predictors of abstinence included being male, older, in a committed relationship, having higher confidence in quitting, fewer depressive symptoms, better health-related quality of life, and no prior ACS. These factors explained 58% of the variance in abstinence. Among BIPOC participants, the only predictors of abstinence were higher cigarettes smoked per day and lower motivation to quit, collectively explaining 21% of the variance, significantly less than for White participants (p =.01). Conclusions: Predictors of cessation for White participants aligned with prior literature, while those for BIPOC participants were inconsistent with the prior literature and explained less variance. Future research should identify meaningful predictors of abstinence in BIPOC post-ACS patients to guide culturally relevant, equity-focused cessation interventions.