Implementation and effectiveness of a brief smoking-cessation interventionfor hospital patients

OBJECTIVES. Previous research has documented that hospital-based smoking-ce ssation counseling is efficacious and cost-effective when delivered by rese arch staff. This study evaluated the implementation and effectiveness of th is intervention program when delivered by respiratory therapists chosen fro m the regular hospital staff. METHODS. A total of 1,173 hospitalized smokers were randomly assigned to ei ther usual care or a stage-based bedside counseling program supplemented wi th a videotape, self-help materials, and a follow-up telephone call. RESULTS. Using an intent-to-treat analysis and counting those lost to follo w-up as smokers, we did not find a significant difference in outcome betwee n intervention (14.2% reported being abstinent for greater than or equal to 6 months at the 1-year follow-up) and usual care conditions (13.6% abstine nce). Process analyses revealed that these results were due to a combinatio n of failure to reach many patients and reduced effectiveness of respirator y therapist interventionists compared with experienced professional counsel ors in a previous study conducted in the same hospitals. CONCLUSIONS. We recommend implementation of hospital-based smoking-cessatio n counseling by professional counselors whose primary responsibility is to deliver the intervention. Recommendations for future research and for innov ative ways to reach hospitalized smokers who are not receiving intervention are discussed.