Exploring barriers of quitting smokeless tobacco among coronary artery disease patients of India: A qualitative study

Background Cessation of all forms of tobacco is necessary for controlling mortality associated with coronary artery diseases (CADs). In India, smokeless tobacco (SLT) is the most used form of tobacco. With around 60% of the world's smokeless tobacco users living in India, the task of tobacco cessation has become daunting and complicated for Indian researchers and policy makers. Objective We conducted the present study to understand CAD patients' perspectives towards their SLT use and to identify barriers of SLT cessation. Methods Using a semi-structured interview method, we obtained data from 12 CAD patients who were currently using some form of SLT. Results Thematic analysis suggests that CAD patients were unable to quit SLT addiction due to (a) certain socio-environmental factors that support SLT, (b) prevalence of misconceptions about the link between SLT use and their cardiac condition, (c) perceived lower self-efficacy to quit, (d) fatalistic attitude towards health outcomes and (e) substituting addiction with perceived lesser harmful products. Discussion The findings reveal that factors responsible for the continuation of SLT usage are multipronged. Current SLT users' perspectives can facilitate the development of effective intervention and rehabilitation programs aimed at de-addiction of cardiac patients.