Abstract
BackgroundThe emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling.MethodsED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling.ResultsThree hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p < 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling.ConclusionsIn this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.
Highlights
The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation
Subject demographics Of the 3662 patients considered for the study, 2132 (58%) were nonsmokers; 590 (16%) had a medical, psychological, or mental status problem preventing approach; 192 (5%) refused to be screened; 92 (3%) had an insurmountable language barrier; 106 (3%) were not able to be followed over time; and 172 (5%) were not enrolled for other reasons
Of the 378 patients originally enrolled in the study, three were removed because of missing data on more than five of 10 items considered critical for the study, leaving 375 participants for analysis
Summary
The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. Little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. Tobacco remains the leading preventable cause of morbidity and mortality in the United States (US), increasing the risk of coronary artery disease, stroke, lung cancer, and chronic obstructive pulmonary disease and accounting for 443,000 deaths (nearly 1 in 5) each year [1]. Tobacco use and tobacco-related illnesses are providing smoking counseling has not traditionally been a function of emergency-care services, the field is increasingly recognizing the necessity and practicality of assuming such functions. The ED remains an episodic but frequent point of health-care contact for much of the population, making the visit itself the ideal, and possibly only, opportunity to provide behavioral interventions
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