Clinical study
Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement: a randomized trial

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Abstract

Purpose

To determine whether an intensive cognitive-behavioral intervention begun during hospitalization when combined with transdermal nicotine replacement therapy is more effective than a minimal counseling intervention combined with transdermal nicotine replacement therapy in helping inpatients to quit smoking.

Methods

A total of 223 patients who smoked were enrolled in a hospital-based randomized smoking cessation trial at the San Francisco Veterans Affairs Medical Center. One hundred and seven participants (48%) received intensive counseling and outpatient telephone follow-up; 116 participants (52%) received minimal counseling. All study participants received 2 months of transdermal nicotine replacement therapy. We determined 6-month quit rates by self-report and measured saliva cotinine levels or obtained proxy reports to confirm self-reported smoking cessation at 12 months. Analyses adjusted for baseline differences in the distribution of coronary disease.

Results

At 6 months, 35% (36/103) of the intensive intervention group reported quitting, compared with 21% (23/109) of the comparison group (relative risk [RR] = 1.7; 95% confidence interval [CI]: 1.1 to 2.7). At 12 months, the self-reported quit rate was 33% (33/99) in the intensive intervention group versus 20% (21/103) in the comparison group (RR = 1.7; 95% CI: 1.1 to 2.7). Based on biochemical or proxy confirmation, 29% (30/102) in the intensive intervention group versus 20% (21/107) in the comparison group quit smoking at 12 months (RR = 1.6; 95% CI: 0.96 to 2.5).

Conclusion

Hospital-initiated smoking cessation interventions that include transdermal nicotine replacement therapy can improve long-term quit rates.

Section snippets

Patients

Between October 1997 and March 2000, we enrolled 217 men and 6 women who had been hospitalized at the San Francisco Veterans Affairs Medical Center for at least 2 days (Figure). Participants were current smokers (≥20 cigarettes during the prehospitalization week). Patients hospitalized for a psychiatric or terminal illness, or who had a contraindication to nicotine replacement, were excluded. We assessed readiness to quit using the Stages of Change model (19) and recruited participants at the

Results

There were no significant differences in baseline characteristics between the two treatment groups (all P >0.05), although slightly more participants with coronary heart disease were assigned to the comparison group (Table 1). Participants were predominantly unmarried, white, and middle-aged. Alcohol and drug abuse and a history of depression were common. Smoking histories were also similar in the two groups. Participants were moderate-to-heavy smokers with a mean of 45 pack-years of smoking,

Discussion

We found that a hospital-initiated smoking cessation intervention that included 3 months of follow-up telephone counseling and 2 months of transdermal nicotine therapy increased long-term smoking cessation rates compared with a hospital-initiated minimal counseling intervention that included 2 months of transdermal nicotine therapy. We employed several definitions of smoking cessation. Our findings, which were based on self-reported cessation, were statistically significant, and the findings

Acknowledgements

We gratefully acknowledge the help provided during the early part of the study by Sharon Solkowitz, MPH, and Ying Mei Tcheou, MPH.

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  • Cited by (0)

    This study was funded by the California Tobacco-Related Disease Research Program (Grant 6RT-0002).

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