Smoking cessation among patients in an emergency chest pain observation unit: Outcomes of the Chest Pain Smoking Study (CPSS)

Abstract

This study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking. Participants were adult smokers (N = 543) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infarction. Participants were randomly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up. All individuals choosing to quit were offered nicotine patch therapy. Follow-up assessments were conducted at 1, 3 and 6 months. Abstinence (7-day point prevalence) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care (OR = 1.62, 95% CI [1.05-2.50]). The largest difference occurred at 1 month: 16.8% of usual care and 27.3% of the tailored intervention group were abstinent, with differences decreasing over time. One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up. In addition to treatment assignment, psychosocial variables including motivation to quit, confidence, reduced temptation to smoke in response to negative affect, and the perception that their chest pain was related to their smoking, were significant predictors of cessation. Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit. Additional intervention may be needed to assist late quitters and to prevent relapse.

Emergency department-initiated tobacco control: a randomised controlled trial in an inner city university hospital

“…Patients’ motivation to quit was a strong predictor of smoking cessation at follow-up as previously reported 11. Concerning unmotivated smokers, our approach does not seem to have any advantages over usual care.…”

“…In an RCT with 74 adolescents aged 14 to 19 years old in a university-affiliated hospital ED, no differences in quit rates were found between on-site motivational interviewing plus stage-based take-home material compared with usual care during the 60 month follow-up 9 10. Bock et al 11 randomised 543 adult smokers in an observation unit of a university-based ED to either on-site motivational interviewing in combination with 2 telephone booster sessions or a control condition receiving a printed referral sheet with information on local smoking cessation resources. In a per-protocol analysis the odds ratio for a 7-day abstinence at 1, 3 and 6 months was 1.62 (95% confidence interval (CI) 1.05 to 2.50) in the intervention group versus the control group.…”

Smoking cessation: Next steps for special populations research and innovative treatments.

“…Studies have shown that smoking cessation can be effectively integrated into medical treatment, such as medical home care (Borrelli et al, 2005a;Borrelli et al, 2001), emergency rooms (Bock et al, 2008;Colby et al, 2005), hospitalizations (Froelicher et al, 2004;Smith & Taylor, 2006), diabetes treatment (Hokanson, Anderson, Hennrikus, Lando, & Kendall, 2006), dental care (Stevens, Severson, Lichtenstein, Little, & Leben, 1995), cancer treatment (Gritz et al, 1993;Wewers, Jenkins, & Mignery, 1997), primary care (Goldstein et al, 2003), and prenatal clinics (Heil et al, 2008), to name a few. In this issue, Borrelli et al (2010) targeted Latino caregivers who smoke by integrating smoking cessation into home-based pediatric asthma treatment, thus helping Latino smokers (typically light smokers) better connect their smoking to their child's health, and getting a "foot in the door" with smokers who are unmotivated to quit.…”

Smokers’ Knowledge About Smoking-Related Health Problems in Lebanon

“…to quit smoking (Attebring et al, 2004;Bernestein et al, 2008;Boudreaux et al, 2010;Kristeller, Rossi, Ockene, Goldberg, & Prochaska, 1992;Lando, Hennrikus, Mc-Carty, & Vessey, 2003). These studies also demonstrated the presence of a correlation between the level of knowledge and perception of smoking effect on physical status and the degree of motivation to quit smoking (Bock et al, 2001;Bock et al, 2008;Hay et al, 2007;West, McEwen, Bolling, & Owen, 2001). Lebanon is a Middle East country where cigarettes are relatively not expensive, smoking is not forbidden in public places and waterpipe smoking is an important mean of nicotine consumption.…”