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

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 1.202 (95 % confidence interval [CI] = 1.159-1.246). 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.