EFFICACY OF A SMOKING CESSATION PROGRAM FOR HOSPITAL PATIENTS

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.