Factors Associated With Successful Smoking Cessation Among Younger and Older Smokers Attending a Tunisian Smoking Cessation Clinic: A 15-Year Retrospective Cohort Study

Background Long-term smoking cessation is influenced by behavioral, psychological, clinical, and treatment-related factors. However, patterns of factors associated with cessation across age groups remain insufficiently characterized in low- and middle-income settings. Objectives To identify factors associated with 12-month continuous smoking abstinence among younger and older smokers attending a specialized smoking cessation clinic in Tunisia and to explore patterns of association within the two age strata. Design Retrospective cohort study. Methods Medical records of smokers attending the Smoking Cessation Clinic of Sahloul University Hospital, Tunisia, between January 2009 and December 2023 were reviewed. Participants were stratified into those aged <60 years and ≥60 years. Sociodemographic, smoking-related, psychological, motivational, and treatment-related characteristics were extracted. The primary outcome was continuous abstinence for at least 12 months. Age-stratified exploratory multivariable logistic regression models were used to identify factors associated with abstinence. Results The cohort comprised 1,389 participants, including 1,134 (81.6%) aged <60 years and 255 (18.4%) aged ≥60 years. Twelve-month smoking status was available for 1,269 participants, of whom 66 (5.2%) achieved continuous abstinence. Among participants aged <60 years, attendance at ≥3 follow-up visits was associated with higher odds of abstinence (aOR=2.77, 95% CI 1.44–5.30; p=0.002). Among participants aged ≥60 years, attendance at ≥3 visits was associated with higher odds of abstinence (aOR=6.17, 95% CI 1.60–23.73; p=0.008), whereas previous quit attempts (aOR=0.12, 95% CI 0.02–0.60; p=0.010) and depressive symptoms (aOR=0.18, 95% CI 0.04–0.93; p=0.040) were associated with lower odds of abstinence. Conclusion Twelve-month continuous abstinence was uncommon in this real-world cohort. Greater follow-up attendance was associated with abstinence in both age strata, whereas additional exploratory associations were observed among older smokers. Because cessation events were limited, particularly in older participants, and formal interaction testing was not performed, these results should not be interpreted as evidence that predictor effects statistically differed according to age.