Behavioral Patterns Behind Tobacco Smoking among Patients Admitted to a Tertiary Care Hospital of a Developing Nation.

BACKGROUND: Globally, more than one-fifth of smokers end up being hospitalized due to consequences. Hence, the study was designed to explore the behavioral pattern of smoking among patients admitted to a tertiary care hospital in North India. METHODS: A qualitative study was conducted among 50 patients admitted to a tertiary care hospital in North India. The participants were categorized into groups using the Heaviness of Smoking Index (HSI). In-depth interviews using an interview guide were conducted with participants from these groups. Inductive thematic analysis was performed to identify themes and subthemes. The natural history of tobacco addiction was presented using concept maps. RESULTS: All participants were male with a mean (SD) age of 51.0 (16.5) years, and the median (IQR) duration of smoking was 20.5 (5.9, 21.2) years. The majority (60%) of participants had moderate to severe addiction. Five major domains emerged drivers of smoking initiation (peer pressure, community norms, and individual curiosity), continuation of smoking (perceived benefits, normalization, concealment, and lack of familial regulation), consequences of smoking (progression to serious illnesses such as COPD, TB, and cancer, and social/familial conflict), thoughts of quitting (triggered by illness, medical advice, social disapproval, and family pressure), and failure to quit (nicotine dependence, withdrawal symptoms, and persistent peer influence). CONCLUSION: Smoking behavior among hospitalized male patients is shaped by complex interplay of their own willingness, peer and community influences, perceived benefits, and limited early awareness of harm. Medical illness and healthcare advice often initiate quitting intentions, but dependence and social pressures hinder cessation.