Tobacco Use and Subsequent Cessation Among Hospitalized Patients in Mumbai, India: A Longitudinal Study.

Introduction: Hospitalization is an important setting to address tobacco use. Little is known about post-discharge cessation and treatment use in low- and middle-income countries. Our objective was to assess tobacco use after hospital discharge among patients in Mumbai, India. Methods: Longitudinal observational study of inpatients (>= 15 years) admitted at one hospital from November 2015 to October 2016. Patients reporting current tobacco use were surveyed by telephone after discharge. Results: Of 2894 inpatients approached, 2776 participated and 15.7% (N = 437) reported current tobacco use, including 5.3% (N = 147) smokers, 9.1% (N = 252) smokeless tobacco (SLT) users, and 1.4% (N = 38) dual users. Excluding dual users, SLT users, compared to smokers, were less likely to report a plan to quit after discharge (42.6% vs. 54.2%, p =.04), a past-year quit attempt (38.1% vs. 52.7%, p =.004), to agree that tobacco has harmed them (57.9% vs. 70.3%, p =.02) or caused their hospitalization (43.4% vs. 61.4%, p <.001). After discharge, 77.6% of smokers and 78.6% of SLT users reported trying to quit (p =.81). Six-month continuous abstinence after discharge was reported by 27.2% of smokers and 24.6% of SLT users (p =.56). Nearly all relapses to tobacco use after discharge occurred within 30 days and did not differ by tobacco type (log-rank p =.08). Use of evidence-based cessation treatment was reported by 6.5% (N = 26). Conclusions: Three-quarters of tobacco users in a Mumbai hospital attempted to quit after discharge. One-quarter reported continuous tobacco abstinence for 6 months despite little use of cessation treatment. Increasing post-discharge cessation support could further increase cessation rates and improve patient outcomes.