BACKGROUND: A hospital admission for a serious cardiac event offers a unique opportunity for smoking cessation. Understanding the factors that predict and enhance cessation among smoking cardiac inpatients is important for hospital physicians and clinical staff.
STUDY OBJECTIVE: To determine factors that predict smoking cessation, relapse, or continued smoking among posthospitalized cardiac patients who were smoking at the time of admission.
SAMPLE: Patients hospitalized with acute coronary syndrome (ACS) were recruited from 5 hospitals in Michigan to participate in a study assessing hospital quality improvement plus at-home health behavior change counseling.
MEASUREMENTS: Patient interview data were collected shortly after discharge and 3 and 8 months later to describe patient demographics, clinical characteristics, tobacco use, and other behaviors. Multinomial logit regression was used to predict smoking cessation, relapse, and continued smoking.
RESULTS: Of patients smoking at hospitalization who completed both follow-up interviews, 56.8% (n = 111) were not smoking at 8 months. A significant predictor of successful cessation was higher household income (odds ratio [OR] = 4.72; P = 0.003), while having other smokers in the household decreased the odds of cessation (OR = 0.20; P = 0.001). History of depression increased the odds of relapse (OR = 6.38; P = 0.002) and being a lighter smoker decreased the odds (OR = 0.16; P = 0.026).
CONCLUSIONS: Although approximately one-half of the smokers in this study reported successful cessation, interventions are still needed to assist all smokers to successfully quit smoking after an ACS hospitalization. Our data suggest targeting follow-up programs to include other family members and using specialized methods for heavy smokers.
BACKGROUND: Reactive telephone helplines for smoking cessation (where all calls to counselors are smoker initiated) are increasingly used in the United States. However, limited data from randomized controlled trials are available on their effectiveness. The study objective was to evaluate the real-world effectiveness of reactive telephone counseling for smoking cessation using a randomized controlled trial study design.
METHODS: The study was implemented during a period from 2003 to 2006 to evaluate a reactive telephone helpline run by the American Lung Association chapter of Illinois-Iowa. The 990 new callers, all adult current smokers who called the helpline, were randomized on their first call into one of the two following groups: a control group that received only mailed self-help literature (n = 496); and a study group that received supplemental live reactive telephone counseling (n = 494). Telephone follow-up was completed at 1, 3, 6, and 12 months after study enrollment by interviewers blinded to group assignment. Seven-day point prevalence rates of self-reported abstinence at follow-up evaluations were compared between the two groups using an intent-to-treat design.
RESULTS: The two groups did not differ significantly in baseline demographics and smoking-related behavior. The abstinence rates (ranging between 0.09 and 0.15) were not significantly different between the two groups at 1-, 3-, 6-, and 12-month follow-up evaluations. Post hoc subgroup analysis showed that black callers had lower abstinence rates at the 3- and 12-month follow-up evaluations as compared with white callers.
CONCLUSION: Supplemental live, reactive telephone counseling does not provide greater success in smoking cessation than self-help educational materials alone.
BACKGROUND: Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.
OBJECTIVE: To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.
DESIGN: Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.
PARTICIPANTS: Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.
MEASUREMENTS: We measured secondary prevention behaviors, physical functioning, and quality of life.
RESULTS: QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.
CONCLUSIONS: Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.
OBJECTIVE: To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care.
STUDY DESIGN: Randomized comparison trial testing the effectiveness of four smoking cessation benefits.
SETTING: Seven states that best represented the national population in terms of the proportion of those > or = 65 years of age and smoking rate.
PARTICIPANTS: There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed-up for 12 months.
INTERVENTION(S): (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch.
MAIN OUTCOME MEASURE: Seven-day self-reported cessation at 6- and 12-month follow-ups.
PRINCIPAL FINDINGS: Unadjusted quit rates assuming missing data=smoking were 10.2 percent (9.0-11.5), 14.1 percent (11.7-16.5), 15.8 percent (14.4-17.2), and 19.3 percent (17.4-21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450.
CONCLUSIONS: A telephone Quitline in conjunction with low-cost Pharmacotherapy was the most effective means of reducing smoking in the elderly.
Radon and cigarette smoking have synergistic effects on lung cancer risk. Electric utility company bill stuffers offered free radon test kits to households with at least one smoker. Participating households (n = 1364) were randomized within a 2 x 2 design to evaluate the main effects of brief telephone counseling and a targeted video on smoking cessation and the establishment of new household smoking bans. Phone counseling was associated with cessation at 3-month follow-up but neither intervention led to 12-month or sustained cessation. While neither intervention had a significant effect on new bans, there were trends in the predicted direction and the combination of the two significantly increased new bans compared with no intervention. The presence of children in the household was associated with new bans. While few households had high levels of radon, such levels were associated with radon mitigation behaviors. Together with a previous study, these results suggest radon risk is a useful and inexpensive way to engage smoking households in risk reduction behaviors, especially the institution of household smoking bans.
