Smoking cessation interventions among hospitalized patients: What have we learned?

Background. We conducted a structured review of controlled studies on inpat ient hospital-based smoking cessation interventions. Methods. Electronic searches were conducted with two different search engin es, and reference sections of articles located were also reviewed. The RE-A IM framework was used to organize the review around the issues of reach, ef ficacy, adoption, implementation, and maintenance of interventions. Results. Thirty-one intervention articles were located, 20 of which include d a comparison condition and were included in the review. Overall, a modera te number of studies (13/20) reported on reach, which was highly variable a nd limited (30-50% in most studies), while few reported on implementation ( 7/20). Longer term cessation results produced relative risk ratios of 0.9-2 .3, with a median of 1.5. Increases in quit rates above the control conditi on ranged from -1 to 10% (median 4%) among general admission patients and f rom 7 to 36% (median 15%) among cardiac admission patients. Studies with a dedicated smoking cessation counselor and 3-5 months of relapse prevention had a significant impact on cessation rates. Study settings (adoption) were limited to university, Veterans affairs, and HMO hospitals. Maintenance at the individual level was variable and related to the presence of a relativ ely intensive initial intervention and a sustained relapse prevention inter vention. Conclusions. Efficacious inpatient smoking programs have been developed and validated. The challenge now is to translate these interventions more wide ly into practice, given changing hospitalization patterns. (C) 2001 America n Health Foundation and Academic Press.