OBJECTIVE: Smoking is a major cardiovascular risk factor; however, the relationship between illness perceptions and smoking among congenital heart disease (CHD) survivors is unknown. The present study aimed to: 1) compare the prevalence of smoking among CHD survivors to a nationally representative U.S. sample, 2) characterize the demographic and clinical profile of smokers with CHD, and 3) identify the association between illness perceptions and smoking status.

METHODS: Adult CHD survivors (N=744) from 6 U.S. sites across 5 states participated in a survey of patient-reported outcomes. Participants reported their smoking status, perceived NYHA functional class, and demographic profile. Clinical status information (e.g., number of catheter interventions) was abstracted from medical records. The Brief Illness Perceptions Questionnaire (BIPQ) measured illness perceptions, including concern about and perceived control over illness. Scores on the BIPQ ranged from 0 (positive) to 10 (negative). Data from the National Adult Tobacco Survey were analyzed to estimate the smoking prevalence among the general population, accounting for regional variation in smoking.

RESULTS: The smoking prevalence among CHD survivors (9%) was lower than the general population (15%, p<.001). CHD smokers were younger (p=.045), had less education (p=.016), fewer catheter interventions (p=.007), and were more likely to have a history of psychiatric disorder (p<.001) than non-smokers. Smoking status differed by NYHA functional class (p=.002), such that more participants with Class IV limitations (23%) were smokers. Smokers (4.9±1.9) reported more negative illness perceptions than non-smokers (4.2±1.7, p< .001). Negative illness perceptions were associated with smoking, adjusting for demographic and clinical factors (OR=1.37 [95% CI 1.11,1.70]).

CONCLUSIONS: The overall prevalence of smoking among CHD survivors was comparatively low, but a higher rate of smoking was observed among those with greater functional limitations. Differences in illness perceptions may enhance our understanding of smoking among CHD survivors and guide interventions to promote positive health behaviors.