Challenges associated with quitting smoking and nicotine dependence among hospitalized patients with selected chronic illness

Smoking cessation is particularly challenging among patients with chronic diseases because nicotine dependence and established smoking behaviors may hinder successful quitting. Hospitalization provides an important opportunity to identify tobacco use and initiate cessation support. However, limited evidence exists regarding nicotine dependence and cessation challenges among hospitalized patients with chronic diseases in Saudi Arabia. This study assessed nicotine dependence and perceived cessation challenges and examined their associations with demographic, clinical, and tobacco-use characteristics. A cross-sectional study was conducted among 120 hospitalized patients with hypertension, diabetes, cardiovascular disease, or chronic respiratory disease at Al-Qurayyat General Hospital, Saudi Arabia, from July to August 2025. Data were collected using a structured questionnaire, the Fagerström Test for Nicotine Dependence (FTND), and the 21-item Challenges of Stopping Smoking Scale (CSS-21). Data were analyzed using SPSS version 23. Descriptive statistics, chi-square tests, independent-samples t -tests, ANOVA, and Pearson’s correlation were performed. Most participants were men (71.7%), with a mean age of 49.2 years. Traditional cigarettes were the most commonly used tobacco product (43.3%), followed by waterpipe (30.8%) and e-cigarettes (10.0%). Moderate nicotine dependence predominated (65.8%), while 14.2% had high dependence. Nicotine dependence was significantly higher among men (5.51), p = 0.028) and participants with diabetes (mean 6.78), p = 0.00 or chronic respiratory disease (mean 6.8), p = 0.00 .Traditional cigarette use was significantly associated with greater intrinsic cessation challenges 0.214, p = 0.025, whereas waterpipe use was significantly associated with both intrinsic and extrinsic challenges (r, 0.140 P,0.037 – r, 0.180 P,0.049). No significant associations were observed between e-cigarette use and nicotine dependence or perceived cessation challenges (p > 0.05). Smoking cessation challenges among hospitalized patients with chronic diseases are multidimensional and vary according to tobacco-product use and clinical characteristics. The predominance of moderate nicotine dependence and the significant associations between specific tobacco products and cessation challenges support tailored, hospital-based cessation interventions. This study adds Saudi hospital-based evidence by simultaneously examining nicotine dependence and perceived cessation challenges across different tobacco products and chronic disease groups. Routine assessment of nicotine dependence and individualized psychological, social, and behavioral barriers, with continued support after discharge, may strengthen cessation care.