Smoking-Cessation Interventions for Urban Hospital Patients

Abstract

Introduction Hospitalization is a unique opportunity for smoking cessation, but prior interventions have measured efficacy with narrowly defined populations. The objective of this study was to enroll smokers admitted to two “safety net” hospitals and compare the effectiveness of two post-discharge cessation interventions. Design Randomized comparative effectiveness trial. Setting/participants At two New York City public hospitals, every hospitalized patient identified as a smoker (based on admission records) was approached. Inclusion criteria were: smoked cigarettes in the past 30 days; spoke English, Spanish, or Mandarin; had a U.S. phone number; not discharged to an institution where follow-up or smoking was limited; and not pregnant/breastfeeding. Of 18,797 patients identified as current smokers between July 2011 and April 2014, a total of 3,047 (16%) were discharged before being approached, 3,273 (17%) were not current smokers, 4,026 (21%) had no U.S. phone number, 2,831 (15%) were ineligible for other reasons, and 3,983 (21%) refused participation. In total, 1,618 (9%) participants enrolled in the study. During follow-up, 69% of participants were reached at 2 months and 68% at 6 months. Intervention At discharge, participants were randomized to multisession telephone counseling from study staff (n=804) or referral to the state Quitline for proactive outreach and counseling (n=814). Main outcome measures Self-reported abstinence at 6 months. Analyses were conducted in late 2015. Results One quarter of participants were homeless or in unstable housing, 60% had a history of substance abuse, 43% reported current hazardous drinking, and half had a psychiatric diagnosis other than substance abuse. At follow-up, the rate of abstinence (30-day point prevalence) was higher in the intensive counseling arm than the Quitline arm at 2 months (29.0% vs 20.7%; relative risk, 1.40; 95% CI=1.13, 1.73) and 6 months (37.4% vs 31.5%; relative risk, 1.19; 95% CI=1.01, 1.40). Conclusions Intensive counseling was more effective than referral to the state Quitline. Long-term abstinence was excellent in both groups. Many patients were not eligible for enrollment despite minimal exclusion criteria. Trial registration clinicaltrials.gov Identifier: NCT01363245.

Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial

“…Thus, the proportion of participants ultimately reached by quitline counseling was very small due to both low rates of referral and attrition across the phases of treatment initiation. These findings are similar to Sherman et al (2016), who reported similar difficulties in reaching hospitalized patients for post-discharge telephone counseling, with only 51% receiving at least one call. It is also possible that referral to the quitline, although evidence-based (Stead, Hartmann-Boyce, Perera, & Lancaster, 2013) and cost-effective (Hollis et al, 2007), may not be the optimal treatment approach for all hospitalized Veterans.…”

Accuracy of self‐reported smoking abstinence in clinical trials of hospital‐initiated smoking interventions

“…Each trial compared a post-discharge intervention to usual care. The interventions included a web-based program [14], interactive voice-response (IVR) support [15], staff-provided counseling [16], quitline counseling [17, 18], and provision of nicotine patches [18]. …”

“…Trials conducted in Birmingham, Alabama [14]; Boston, Massachusetts [15]; Kansas City, Kansas [17]; New York, New York [16]; and San Diego and Davis, California [18] used salivary cotinine to biochemically verify self-reported smoking abstinence at 6-months after randomization using a shared protocol. This shared protocol was designed to yield high return rates and collect comparable data for pooled analyses.…”

“…Only participants receiving high reimbursement (consistent with the range of reimbursement of other CHART studies) were included in the current analyses. A second trial collected saliva samples only during a 14 month period of their trial; no samples were collected for the remainder of the study [16]. …”

Comparison of the Substance Use Brief Screen (SUBS) to the AUDIT-C and ASSIST for detecting unhealthy alcohol and drug use in a population of hospitalized smokers

“…The design of the CHART study including recruitment, participants, clinical sites, and intervention has been described previously (Grossman et al, 2012; Sherman et al, 2016). Briefly, the study was a randomized trial of adult current tobacco smokers who were admitted (to medicine, psychiatry, surgery, neurology, rehabilitation, pediatrics, and gynecology services) at two urban hospitals in New York City (Bellevue Hospital Center and the VA New York Harbor Healthcare System).…”