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December 8, 1997

Efficacy of a Smoking Cessation Program for Hospital Patients

Author Affiliations

From the Tobacco Research and Treatment Center Unit (Dr Rigotti and Ms Wood-Reid), General Internal Medicine (Drs Rigotti, Arnsten, and Singer), and Preventive Cardiology, Cardiac Unit, Department of Medicine (Ms McKool and Dr Pasternak), Massachusetts General Hospital and Harvard Medical School, Boston.

Arch Intern Med. 1997;157(22):2653-2660. doi:10.1001/archinte.1997.00440430135016

Background:  Hospitalization may be an opportune time to change smoking behavior because it requires smokers to abstain from tobacco at the same time that illness can motivate them to quit. A hospital-based intervention may promote smoking cessation after discharge.

Methods:  We tested the efficacy of a brief bedside smoking counseling program in a randomized controlled trial at Massachusetts General Hospital, Boston. The 650 adult smokers admitted to the medical and surgical services were randomly assigned to receive usual care or a hospital-based smoking intervention consisting of (1) a 15-minute bedside counseling session, (2) written self-help material, (3) a chart prompt reminding physicians to advise smoking cessation, and (4) up to 3 weekly counseling telephone calls after discharge. Smoking status was assessed 1 and 6 months after hospital discharge by self-report and validated at 6 months by measurement of saliva cotinine levels.

Results:  One month after discharge, more intervention than control patients were not smoking (28.9% vs 18.9%; P=.003). The effect persisted after multiple logistic regression analyses adjusted for baseline group differences, length of stay, postdischarge smoking treatment, and hospital readmission (adjusted odds ratio, 2.19; 95% confidence interval, 1.34-3.57). At 6 months, the intervention and control groups did not differ in smoking cessation rate by self-report (17.3% vs 14.0%; P=.26) or biochemical validation (8.1% vs 8.7%; P=.72), although the program appeared to be effective among the 167 patients who had not previously tried to quit smoking (15.3% vs 3.7%;P=.01).

Conclusions:  A low-intensity, hospital-based smoking cessation program increased smoking cessation rates for 1 month after discharge but did not lead to long-term tobacco abstinence. A longer period of telephone contact after discharge might build on this initial success to produce permanent smoking cessation among hospitalized smokers.Arch Intern Med. 1997;157:2653-2660