A proactive smoking cessation intervention with hospitalized smokers : a randomized controlled trial

Smoking interferes with the recovery and healing process for hospitalized patients. The Joint Commission on Accreditation of Hospital Organizations (JCAHO) requires that hospitals offer smoking cessation assistance, which involves brief bedside counseling for patients of certain diagnoses. It is generally recognized that hospitalization creates a "teachable moment" for smoking cessation. In fact, most smokers quit smoking while hospitalized. However, most of them relapse soon after discharge. There is a need to develop intervention programs that can increase the long-term quit rate of these patients post discharge. The present study is a small randomized controlled trial. It compares the usual-care condition, where smokers received bedside counseling from respiratory therapists, to an enhanced treatment condition, which included provision of eight weeks of nicotine patches at discharge plus proactive telephone counseling from a quitline up to two months post discharge. Hospitalized smokers of all diagnoses were included in the study, except those hospitalized for psychiatric reasons and pregnant women. A total of 126 smokers were recruited into the study. The sample size was not powered to find a statistically significant result on the long-term quit rate, but it is large enough to provide a good estimate of effect size for the intervention. Study participants were evaluated at two and six months for their smoking status. At two months 78.0% of the sample was contacted. In an intent-to-treat analysis in which all those not contacted are assumed to be smokers, 26.6% in enhanced-treatment (ET) group and 6.5% in usual-care (UC) group had quit smoking for at least 30 days (OR=5.2, p<0.01). At six months, 57.9% were contacted. An intent-to-treat analysis found 9.4% in ET and 6.4% in UC had quit for at least 180 days (OR=1.5, p=0.74). This study found that an intervention that combined nicotine replacement therapy (NRT) and telephone counseling had a significant effect, up to two months. There was substantial relapse between two and six months, but the odds ratio between the two conditions was still respectable. Future studies would include a larger sample size and would also investigate ways to reduce relapse rate in the long ter