Background: Hospitalization may be an opportune time to change smoking
behavior because it requires smokers to abstain from tobacco at the s
ame time that illness can motivate them to quit. A hospital-based inte
rvention may promote smoking cessation after discharge. Methods: We te
sted the efficacy of a brief bedside smoking counseling program in a r
andomized controlled trial at Massachusetts General Hospital, Boston.
The 650 adult smokers admitted to the medical and surgical services we
re 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 physici
ans to advise smoking cessation, and (4) up to 3 weekly counseling tel
ephone calls after discharge. Smoking status was assessed 1 and 6 mont
hs after hospital discharge by self-report and validated at 6 months b
y measurement of saliva cotinine levels. Results: One month after disc
harge, more intervention than control patients were not smoking (28.9%
vs 18.9%; P=.003). The effect persisted after multiple logistic regre
ssion 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, th
e 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 a
mong the 167 patients who had not previously tried to quit smoking (15
.3% vs 3.7%; P=.01). Conclusions: A low-intensity, hospital-based smok
ing cessation program increased smoking cessation rates for 1 month af
ter discharge but did not lead to longterm tobacco abstinence. A longe
r period of telephone contact after discharge might build on this init
ial success to produce permanent smoking cessation among hospitalized
smokers.