"Hospitalization can offer smokers a chance to improve their health in a way they might not have anticipated," says Nancy Rigotti, MD, director of the MGH Tobacco Research and Treatment Center and first author of the report. "We believe that turning this short-term success into permanent smoking cessation will require more support after hospital discharge than we offered in this trial."
The study, carried out over one year at the MGH, enrolled 650 adult smokers admitted to the hospital's medical and surgical services. Participants were randomly assigned either to a control group, whose members received usual hospital care, or to a counseling group, whose members received a 15-minute bedside counseling session designed to motivate and assist them in stopping smoking, along with written self-help materials. Notices were placed in their hospital charts reminding their physicians to advise smoking cessation. After discharge, counseling group members received three weekly phone calls from the counselor for extra support. Members of both groups were inter?viewed at one and six months after discharge regarding their smoking status.
The researchers found that, one month after discharge, 29 percent of the counseling group members were not smoking, compared with 19 percent of the control group: a 50 percent increase in nonsmoking. Six months after discharge, 17 percent of the counseling group reported not smoking, compared with 14 percent of the control group, a difference that was not statistically significant. However, the intervention did appear to make a long-term difference in one group of patients: those who had not previously tried to quit smoking. In that group, 15 percent of the counseling group were not smoking 6 months after discharge, compared with about 4 percent of the control group.
Rigotti notes that additional patient supports could help improve long-term success. "We know that people are at greatest risk of relapsing during the first three months after quitting smoking. That suggests that additional counseling during that period could be helpful. In a similar study by a group from California, participants received more counseling calls after discharge and had greater success in remaining smoke-free for a sustained period.
"We also could considering offering nicotine replacement options, which were not among the interventions tested in this study," she adds. "A lot of our participants reported craving cigarettes during their hospitalization, when they were not allowed to smoke. Making nicotine gum or patches available to appropriate patients could help them be more comfortable in the hospital and more successful in staying smoke-free after discharge."
Co-authors of the Archives paper are Julia Arnsten, MD, MPH, Kathleen McKool, RN, MSN, Kristen Wood-Reid, Richard Pasternak, MD, and Daniel Singer, MD. The study was supported by grants from the American Cancer Society, Massachusetts Division, and from the National Cancer Institute.
Journal
Archives of Internal Medicine