Perceived Barriers and Coping Strategies to Smoking Cessation in Patients with Osteoarticular Pathology in Spain
Main Article Content
Abstract
Introduction: the rising prevalence of chronic diseases and life expectancy highlights smoking as a critical factor. Tobacco exacerbates pain and impairs recovery in patients with osteoarticular diseases, making cessation a clinical priority.
Objective: to evaluate perceived difficulty, motivations, barriers, healthcare satisfaction risk awareness, and the effectiveness of coping strategies among individuals with osteoarticular disease and healthcare professionals.
Method: the study comprised two phases: a qualitative exploration using the nominal group technique with expert smoking patients, and a cross-sectional study via online surveys targeting current or former smokers (< 5 years) with osteoarticular disease and healthcare professionals.
Results: with over 100 participants per group, both cohorts reported high difficulty in quitting. Discrepancies were observed: professionals reported higher satisfaction with system support and perceived lower patient awareness of tobacco harms than patients themselves. Both groups reported low satisfaction with follow-up care. The primary motivation was personal health, while major barriers were nicotine dependence, perceived well-being/pleasure from smoking, easy access to tobacco, and social pressure. Proactivity, self-criticism, and cognitive restructuring were rated as the most effective coping strategies.
Discussion and conclusions: findings highlight the need for individualized, comprehensive cessation interventions integrating pharmacological and behavioral strategies with continuous follow-up. Incorporating smokers’ lived experience is essential for designing effective, patient-centered cessation programs.
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References
Al-Bashaireh, A. M., Haddad, L. G., Weaver, M., Kelly, D. L., Chengguo, X., & Yoon, S. (2018a). The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review. Journal of Environmental and Public Health, 2018(1). https://doi.org/10.1155/2018/4184190
Al-Bashaireh, A. M., Haddad, L. G., Weaver, M., Chengguo, X., Kelly, D. L., & Yoon, S. (2018b). The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. Journal of Osteoporosis, 2018(1). https://doi.org/10.1155/2018/1206235
Anhang, R., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., & Cleary, P. D. (2014). Examining the Role of Patient Experience Surveys in Measuring Health Care Quality. Medical Care Research and Review, 71(5), 522–554. https://doi.org/10.1177/1077558714541480
Baquero, J. L., Barrios, V., Bobes, J. B., Martínez, D., & Redondo, M. (2021). HABITA project to study smoking habits among patients and address their cessation. Abstract Book Supplement of the 3rd International Congress and XLVIII National Socio-Drug and Alcohol Conference.
Baquero, J. L., Vergès, J., Santiñà, M., Pallares, J. C., Martínez, N., Lin, S. J., Baquero, A., & Bachiller, R. (2024). Facing the process of quitting smoking. New Medical Economics, 194, 18–20. https://www.newmedicaleconomics.es/wp-content/uploads/2024/06/2024-06-17-NME194.pdf
Bonilla, S. A., Aucanshala, C. M., Telenchana, P. F., & Bucay, L. F. (2024). Identification of risk factors associated with knee osteoarthritis: A systematic review. Mediciencias UTA, 8(3), 66–75. https://doi.org/10.31243/mdc.uta.v8i3.2514.2024
Bull, C., Byrnes, J., Hettiarachchi, R., & Downes, M. (2019). A systematic review of the validity and reliability of patient-reported experience measures. Health Services Research, 54(5), 1023–1035. https://doi.org/10.1111/1475-6773.13187
Castillo, J. M. (2024). Risk factors for the development of osteoporosis in adults: A systematic review [Bachelor’s thesis, Catholic University of Cuenca]. Institutional repository. https://dspace.ucacue.edu.ec/items/1ff6b253-48e2-4d7a-a4c1-8dae224dd4fd
Delegación del Gobierno para el Plan Nacional sobre Drogas. (2024). Encuesta sobre alcohol y drogas en España (EDADES), 1995–2024. Ministerio de Sanidad. https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2025/2025_Informe_EDADES.pdf
Dewhirst, T. (2021). Co-optation of harm reduction by Big Tobacco. Tobacco Control, 30(e1), e1–e3. https://doi.org/10.1136/tobaccocontrol-2020-056059
Encinosa, W., Bernard, D., & Valdez, R. B. (2025). The association between smoking, chronic pain, and prescription opioid use: 2013–2021. Journal of Pain, 26, 104707.
European Citizen Initiative. (2024). European Citizen Initiative – Tobacco Free Europe. European Citizen Initiative. https://tfe.ensp.network/
European Commission. (2024). Eurobarometer survey: Attitudes of Europeans towards tobacco and related products. European Commission. https://europa.eu/eurobarometer/surveys/detail/2995
Fagerström, K., Mravčík, V., Fal, A., Gervasini, G., & Robles, N. R. (2025). Two decades of global tobacco control: time for a rethink. Internal and Emergency Medicine, 20(8), 1–5. https://doi.org/10.1007/s11739-025-04131-x
Felson, D., & Zhang, Y. (2015). Smoking and osteoarthritis: a review of the evidence and its implications. Osteoarthritis and Cartilage, 23(3), 331–333. https://doi.org/10.1016/j.joca.2014.11.022
Fowles, J., Bates, M., & Noiton, D. (2000). The Chemical Constituents in Cigarettes and Cigarette Smoke: Priorities for Harm Reduction. New Zealand Ministry of Health. https://www.industrydocuments.ucsf.edu/docs/zrgw0073/
Fundación Española de Reumatología. (2019). Cerca de 11 millones de españoles padecen alguna enfermedad reumática. https://inforeuma.com/cerca-11-millones-espanoles-padecen-alguna-enfermedad-reumatica/
GBD 2019 Tobacco Collaborators. (2021). Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis. The Lancet, 397(10292), 2337–2360.
Gupta, K., Walton, R., Ghani, N., & Vasudevan, V. (2021). Multi-Dimensional Assessment and Interdisciplinary Care to Reduce Asthma Readmissions in Safety Net Hospitals. Respiratory Care, 66(11), 1768–1776. https://doi.org/10.4187/respcare.08646
Hedman, L., Katsaounou, P. A., Filippidis, F. T., Ravara, S. B., Lindberg, A., Janson, C., & Vardavas, C. I. (2019). Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases. Tobacco Induced Diseases, 16(2), A14. https://doi.org/10.18332/tid/102787
Instituto Nacional de Estadística. (2023). Esperanza de vida. https://www.ine.es/ss/Satellite?L=es_ES&c=INESeccion_C&cid=1259926380048&p=1254735110672&pagename=ProductosYServicios%2FPYSLayout¶m1=PYSDetalle¶m3=1259924822888
Jeunen, O. (2025). t-Testing the Waters: Empirically Validating Assumptions for Reliable A/B-Testing. Cornell University. https://arxiv.org/abs/2502.04793?utm_source=chatgpt.com
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping (2nd ed.). Springer.
Lindson, N., Theodoulou, A., Ordóñez-Mena, J. M., Fanshawe, T. R., Sutton, A. J., Livingstone-Banks, J., & Hartmann-Boyce, J. (2023). Pharmacological and electronic cigarette interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews, 9(9). https://doi.org/10.1002/14651858.CD014984.pub2
Martínez, C., Castellano, Y., Fu, M., Riccobene, A., Feliu, A., Tigova, O., & ETHIF Research Group. (2020). Patient perceptions of tobacco control after smoke-free hospital grounds legislation. International Journal of Nursing Studies, 102. https://doi.org/10.1016/j.ijnurstu.2019.103485
McMillan, S. S., Kelly, F., Sav, A., Kendall, E., King, M. A., Whitty, J. A., & Wheeler, A. J. (2014). Using the Nominal Group Technique: how to analyse across multiple groups. Health Services and Outcomes Research Methodology, 14(3), 92–108. https://doi.org/10.1007/s10742-014-0121-1
Miller, W. R., Sorensen, J. L., Selzer, J. A., & Brigham, G. S. (2006). Disseminating evidence-based practices in substance abuse treatment. Journal of Substance Abuse Treatment, 31(1), 25–39. https://doi.org/10.1016/j.jsat.2006.03.005
Ministerio de Salud español. (2024). El Consejo de Ministros aprueba el Plan Nacional para la Prevención y el Control del Tabaquismo 2024–2027. https://www.sanidad.gob.es/en/gabinete/notasPrensa.do?id=6412
Netquest. (2024). Free sample calculator online. https://www.netquest.com/es/panel/calculadora-muestras/calculadoras-estadisticas
Nishikawa-Pacher, A. (2022). Research Questions with PICO: A Universal Mnemonic. Publications, 10(3). https://doi.org/10.3390/publications10030021
O’Leary, R., & Polosa, R. (2020). Tobacco harm reduction in the 21st century. Drugs and Alcohol Today, 20(3), 219–234. https://doi.org/10.1108/DAT-02-2020-0008
Parks, M. J., Blanco, C., Creamer, M. R., Kingsbury, J. H., Everard, C. D., Marshall, D., & Compton, W. M. (2025). Cigarette Smoking During Recovery From Substance Use Disorders. JAMA Psychiatry, 82(10), 1002–1008. https://doi.org/10.1001/jamapsychiatry.2025.1256
Perkins, K. A., Conklin, C. A., & Levine, M. D. (2013). Cognitive-Behavioral Therapy for Smoking Cessation: A Practical Guidebook to the Most Effective Treatments. Routledge.
Piasecki, T. M., Fiore, M. C., McCarthy, D. E., & Baker, T. B. (2002). Have we lost our way? The need for dynamic formulations of smoking relapse proneness. Addiction, 97(9), 1093–1108. https://doi.org/10.1046/j.1360-0443.2002.00216.x
Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal, 10(1). https://doi.org/10.1186/1477-7517-10-19
Ramon-Torrell, J. M. (2025). New Nicotine Delivery Devices and Their Role in Smoking Cessation and Tobacco Harm Reduction Strategies. IntechOpen. https://www.intechopen.com/chapters/1209192
Ravikoti, S., Bhatia, V., & Mohanasundari, S. K. (2025). Approaches for cessation and elimination of tobacco to attain sustainable development goal. Journal of Family Medicine and Primary Care, 14(5), 1589–1596. https://doi.org/10.4103/jfmpc.jfmpc_2287_24
Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J. (2022). Treatment of Tobacco Smoking: A review. JAMA, 327(6), 566–577. https://doi.org/10.1001/jama.2022.0395
Roelsgaard, I. K., Esbensen, B. A., Østergaard, M., Rollefstad, S., Semb, A. G., Christensen, R., & Thomsen, T. (2019). Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database of Systematic Reviews, 2019(9). https://doi.org/10.1002/14651858.CD012958.pub2
Seo, Y. G., Jo, M. W., Paek, Y. J., & Choi, J. (2021). Effects of morbidity on smoking cessation: a national smoking cessation program. Addictive Science & Clinical Practice, 16(1). https://doi.org/10.1186/s13722-021-00257-3
Soler, P. A., Mellinas, G. P., Sánchez, E. M., & Jiménez, E. L. (2010). Evaluación de la comorbilidad en la población anciana: utilidad y validez de los instrumentos de medida. Revista Española de Geriatría y Gerontología, 45(4), 219–228. https://doi.org/10.1016/j.regg.2010.05.0
Spanakis, P., Peckham, E., Young, B., Heron, P., Bailey, D., & Gilbody, S. (2022). A systematic review of behavioural smoking cessation interventions for people with severe mental ill health—what works? Addiction, 117(6), 1526–1542. https://doi.org/10.1111/add.15760
Van Boekel, L. C., Brouwers, E. P., van Weeghel, J., & Garretsen, H. F. (2015). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence, 131(1-2), 23-35. https://doi.org/10.1016/j.drugalcdep.2013.02.018
Vergatti, A., Abate, V., D’Elia, L., De Filippo, G., Piccinocchi, G., Gennari, L., & Rendina, D. (2024). Smoking habits and osteoporosis in community-dwelling men subjected to dual-X-ray absorptiometry: a cross-sectional study. Journal of Endocrinological Investigation, 47(12), 3129–3135. https://doi.org/10.1007/s40618-024-02402-6
Wang, R., Jiang, Y., Yao, C., Zhu, M., Zhao, Q., Huang, L., & Zhao, G. (2019). Prevalence of tobacco related chronic diseases and its role in smoking cessation among smokers in a rural area of Shanghai, China: a cross sectional study. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7110-9
World Health Organization (1946). Preamble to the Constitution of the World Health Organization. https://www.infectedbloodinquiry.org.uk/sites/default/files/001-200%20copy%205_0/001-200%20copy%205/COLL0000020%20-%20Summary%20Report%20on%20Proceedings%20Minutes%20and%20Final%20Acts%20of%20the%20International%20Health%20Conference%20Held%20in%20New%20York%20from%2019%20June%20to%2022%20July%201946%20-%2019%20Jun%201946.pdf
World Health Organization. (2013). WHO framework convention on tobacco control: Guidelines for implementation. WHO. https://books.google.es/books?hl=es&lr=&id=XrEXDAAAQBAJ&oi=fnd&pg=PP1&dq=WHO+Framework+Convention+on+Tobacco+Control&ots=FnFNY9hzvs&sig=RbNePdzczmQfCa3ij3mcDsO0AGw#v=onepage&q=WHO%20Framework%20Convention%20on%20Tobacco%20Control&f=false
World Health Organization. (2023). Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco
World Health Organization. (2025). Tobacco.
Xiao, Q., Dong, S., Tan, Y., Zhang, X., Yao, L., Li, Q., & Wang, T. (2025). The causal impact of smoking behavior on osteoarthritis: a Mendelian randomization analysis. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1437443
Yokota, S., Ishizu, H., Miyazaki, T., Takahashi, D., Iwasaki, N., & Shimizu, T. (2024). Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines, 12(4). https://doi.org/10.3390/biomedicines12040843