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Results of a Randomized Trial

Nancy Houston Miller, RN; Patricia M. Smith, PhD, MSc; Robert F. DeBusk, MD; David S. Sobel, MD, MPH; C. Barr Taylor, MD

Arch Intern Med. 1997;157(4):409-415.

Abstract
Background
Few research studies have evaluated the effectiveness of smoking interventions in hospitalized patients. This randomized controlled trial compared the efficacy of 2 smoking cessation programs in patients hospitalized in 4 community hospitals in a large health maintenance organization within the San Francisco Bay Area in California.

Methods
Patients were randomly assigned to usual care (n=990), nurse-mediated, behaviorally oriented in-patient counseling focused on relapse prevention with 1 postdischarge telephone contact (minimal intervention, n=473), or the same inpatient counseling with 4 postdischarge telephone contacts (intensive intervention, n=561). The main outcome measure, smoking cessation rate, was corroborated by plasma cotinine determination or family confirmation, 1 year after enrollment.

Results
At 1 year smoking cessation rates were 27%, 22%, and 20% for intensive intervention, minimal intervention, and usual care groups, respectively (P=.009 for intensive vs usual care). Subgroup analyses by diagnosis revealed that the odds of cessation among patients with cardiovascular disease or other internal medical conditions were greater among those receiving the intensive intervention than among their counterparts receiving usual care (odds ratios, 1.6 and 2.0, respectively).

Conclusions
A multicomponent smoking cessation program consisting of physician advice; in-hospital, nurse-mediated counseling; and multiple postdischarge telephone contacts was effective in increasing smoking cessation rates among hospitalized smokers. Hospital-wide smoking cessation programs could substantially increase the effectiveness of hospital smoking bans.

Arch Intern Med. 1997;157:409-415

Author Affiliations
From the Division of Cardiovascular Medicine, Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, Calif (Ms Miller and Drs Smith and DeBusk); Kaiser Permanente Medical Care Program of Northern California, Regional Health Education Department, Oakland (Dr Sobel); and Department of Psychiatry, Stanford University, Stanford, Calif (Dr Taylor).

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