Supplementary Material for: Improving care delivery to increase smoking cessation after a stroke : a 2023 nationwide cross-sectional study of stroke units in France.

Introduction
Although guidelines recommend smoking cessation after stroke, smoking cessation may not be adequately prioritized in stroke units. This study evaluated the practices of French stroke neurologists with respect to smoking cessation and sought to identify barriers to their involvement.
Methods
All French stroke units were invited by email to fill an online questionnaire, with reminders sent every 15 days. Questions quantified the implementation in stroke units of practices derived from the Ask, Advise, Assess, Assist, Arrange model of tobacco treatment clinical guidelines on Likert scales, and were summed in an ad-hoc total interventionism summary indicator (range 0 to 45). Associations were analyzed using multivariable mixed models adjusting for workplace clustering.
Results
Between September 2022 and July 2023, responses were received from 453 neurologists (42% of an estimated 190) across 103 stroke units (82% of 126 units). 60 % of them declared having had no training about smoking cessation care. Most frequent obstacles identified to ideal care were patient reluctance to stop smoking (66%) and limited access to tobacco specialists (55%). Seniority (attending/teaching physician status), high self-rated familiarity with smoking cessation management, and availability of a tobaccologist, were all independently associated with more interventions (adjusted on workplace effect) (Bonferroni-corrected p≤0.02 for all).
Conclusion and perspectives
The survey suggests that most French neurologists provide incomplete smoking cessation care to stroke unit patients. Stroke physician self-assessment/retraining and on-site availability of tobacco specialists seem to be promising interventions.