The relation of tobacco use during hospitalization to post-discharge smoking cessation among US veterans
Introduction
Although smoking rates among veterans have decreased from 33% to 22.2% in recent years (Office of Quality and Performance, 2001, Department of Veterans Affairs, Veterans Health Administration, Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, 2006), smoking remains a problem in the Department of Veterans Affairs (VA) among subgroups of veterans, many of whom are hospitalized. As a result, veterans tend to suffer from poorer health status and multiple medical conditions compared to the general population, placing them at higher risk for hospitalizations and inpatient medical treatment. Studies have shown quit rates among hospitalized smokers ranged from 15 to 78% (McBride et al., 2003). In addition, quit rates have been shown to be higher after discharge for those patients admitted with smoking-related diagnoses. Although randomized clinical trials show the potential effectiveness of inpatient smoking cessation programs in VA hospitals (Simon et al., 2003), which are now part of the Veterans Administration/Department of Defense Clinical Practice Guideline for the Management of Tobacco Use (VA/DoD Clinical Practice Guideline Working Group, 2004), our prior work has shown that inpatient cessation interventions have not been well integrated into practice (Duffy et al., 2008).
Section snippets
Methods
In order to prepare for the implementation of an inpatient cessation program in the VA, this prospective cohort study determined spontaneous 6-month quit rates among hospitalized smokers during 2006–2008. Veteran smokers from three large VA hospitals in the Midwest (Ann Arbor, MI, Detroit, MI, and Indianapolis, IN) were recruited to the study. Veteran smokers were surveyed while they were in the hospital and again 6 months after discharge (n = 354). Veterans were also asked to return a urine
Results
On average, patients smoked 19 cigarettes per day (prior to admission) in the past month. Nearly 60% of patients reported not using tobacco while hospitalized (n = 210). Among those patients who did use tobacco products during hospitalization, the vast majority smoked cigarettes, about 6–7 per day. Forty-three percent (n = 142) of patients screened positive for nicotine dependence. Nearly 41% (n = 140) of patients were able to quit smoking for at least 24 h or more and the median time quit was 29
Discussion
The most interesting finding was that veterans who refrained from smoking during their hospitalization had almost 3–4 times the odds of quitting smoking compared to those who continued to smoke while in the hospital. This is similar to a study by Rigotti et al. (2000) that concluded that those who smoke during an inpatient stay are more than five times more likely to continue smoking after discharge. Moreover, 37% of hospitalized veterans smoked while in the hospital which is higher than the
Conclusions
This study shows that many veterans quit smoking while in the hospital and those that continue to smoke, cut down substantially. Furthermore, smoking while in the hospital predicted 6-month quit rates. State-of-the-art cessation interventions need to be provided to smokers hospitalized in the VA.
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowledgments
This study was supported by the Department of Veterans Affairs (SDP 06-003). This paper was written in partial fulfillment of the requirement for the degree of Master of Science, Community Health Nursing, from the University of Michigan received by Rachel L. Scholten, BSN, RN in April 2009. The authors would like to thank the veterans that participated in this study and selected research staff including Lee Ewing, Pamela Reeves, Christopher Hermann, Elizabeth Jones, Carmelite Dalmacy, Thomas
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