Inpatient Smoking Research Articles

A survey of the prevalence of smoking and smoking cessation advice received by in patients in two teaching hospitals in Ireland

Background The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit. Aims To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital. Methods Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital. Results Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe. Conclusions Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.

Evaluation and costs of volunteer telephone cessation follow-up counseling for Veteran smokers discharged from inpatient units: a quasi-experimental, mixed methods study.

BackgroundThe Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to evaluate the volunteer telephone smoking cessation counseling follow-up program implemented as part of the inpatient Tobacco Tactics intervention in a Veterans Affairs (VA) hospital.MethodsThis was a quasi-experimental, mixed methods design that collected data through electronic medical records (EMR), observations of telephone smoking cessation counseling calls, interviews with staff and Veterans involved in the program, and intervention costs.ResultsReach: Of the 131 Veterans referred to the smoking cessation telephone follow-up program, 19% were reached 0–1 times, while 81% were reached 2–4 times. Effectiveness: Seven-day point-prevalence 60-day quit rates (abstracted from the EMR) for those who were reached 2–4 times were 26%, compared to 8% among those who were reached 0–1 times (p = 0.06). Sixty-day 24-hour point-prevalence quit rates were 33% for those reached 2–4 times, compared to 4% of those reached 0–1 times (p < 0.01). Adoption and Implementation: The volunteers correctly followed protocol and were enthusiastic about performing the calls. Veterans who were interviewed reported positive comments about the calls. The cost to the hospital was $21 per participating Veteran, and the cost per quit was $92. Maintenance: There was short-term maintenance (about 1 year), but the program was not sustainable long term.ConclusionsQuit rates were higher among those Veterans that had greater participation in the calls. Joint Commission standards for inpatient smoking with follow-up calls are voluntary, but should these standards become mandatory, there may be more motivation for VA administration to institute a hospital-based, volunteer telephone smoking cessation follow-up program.Trial registrationClinicalTrials.Gov NCT01359371.

Comments on statistical issues in may 2015.

In this section, we explain the FIRTH option in SAS PROC LOGISTIC procedure which used to solve the numerical problems such as non-convergence in estimating regression coefficients, unreasonably large standard errors, and wide ranges of confidence intervals when there are some zero cells in contingency tables, which appeared in the article titled, Results of an inpatient smoking cessation program: 3-month cessation rate and predictors of success, published in March 2015 by Kim et al.1)

Results of an inpatient smoking cessation program: 3-month cessation rate and predictors of success.

BackgroundHospitalization presents smokers with an opportunity to initiate smoking cessation. We studied the effect of inpatient counseling and follow-up after discharge on smoking cessation and assessed predictors of successful cessation.MethodsThis study included a total of 125 patients (118 male and 7 female) who were admitted to departments of neurology, cardiology, and pulmonology. They were referred to the smoking cessation clinic, and participated between September 2011 and February 2013. A counseling service lasting about thirty minutes was provided by the third-year family medicine residents during hospitalization. The follow-up counseling services, which were either by telephone or in-person physician counseling were provided at 1 week, 4 weeks, and 3 months. Smoking habits and nicotine dependency data were gathered using questionnaires, and patient information was collected from electronic medical records.ResultsThe average age in the study was 57.9 ± 10.2 years and duration of smoking was 35.9 ± 11.7 years. Daily tobacco consumption was 23.5 ± 13.2 cigarettes. The smoking cessation rate after 3 months was 42.4%. The only differences between patients in the successful cessation and failed groups were cause of admission (P = 0.039) and total number of counseling sessions after discharge (P < 0.001). In a multivariate analysis, smoking cessation was more likely when patients experienced more instances of follow-up after discharge (1-2 visits: odds ratio [OR], 8.186; 95% confidence interval [CI], 1.060 to 63.239; ≥3 visits: OR, 121.873; 95% CI, 14.462 to 1,027.055).ConclusionSmoking cessation counseling during hospitalization and further follow-up by telephone or outpatient counseling after discharge contributed to an increased smoking cessation rate. The smoking cessation rate also tended to increase with total counseling numbers.

Inpatient Smoking Cessation Counseling and Treatment for Patients With Lung Cancer

Inpatient Smoking Cessation Counseling and Treatment for Patients With Lung Cancer

Effectiveness of the Tobacco Tactics program in the Department of Veterans Affairs

The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals. In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls. There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p < 0.001) compared to Indianapolis. Pre- versus post-intervention quit rates were 4 % compared to 13 % in Detroit, were similar (6 %) pre- and post-intervention in Ann Arbor, and dropped from 26 % to 12 % in Indianapolis. The Tobacco Tactics program, which meets the Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among Veterans.

Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs

The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals. In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls. There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p < 0.001) compared to Indianapolis. Pre- versus post-intervention quit rates were 4% compared to 13% in Detroit, were similar (6%) pre- and post-intervention in Ann Arbor, and dropped from 26% to 12% in Indianapolis. The Tobacco Tactics program, which meets the Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among Veterans.

Utilization of Evidence-Based Smoking Cessation Treatments by Psychiatric Inpatient Smokers With Depression

Although smoking is a major health issue among depressed psychiatric inpatients and interest in quitting is high, successful quit rates remain low among this population. We sought to understand preferences that depressed inpatient smokers may have for cessation treatments. Eighty smokers (60% women, mean age 38.75 ± 11.20) with major depressive disorder and nicotine dependence receiving psychiatric inpatient services provided information on current depressive symptoms, smoking status and nicotine dependence, quit attempts, perceived barriers to quitting, and smoking consequences. Almost half (46%) of participants endorsed a past-year quit attempt. Emotional barriers to quitting were uniquely associated with fewer past-year quit attempts, and depression severity was related to greater emotional barriers to quitting. Nicotine dependence severity was related to a variety of emotional, financial, weight concern, and self-efficacy barriers, but only weight gain concern was associated with decreased odds of making a past-year quit attempt. The number of lifetime quit attempts was positively associated with negative smoking consequences. With regard to interest in smoking cessation treatment, 86% and 92% of smokers reported a willingness to try behavioral counseling and nicotine replacement products, respectively, but fewer smokers reported a willingness to try medication, print or Web-based materials, or an unaided quit attempt. Although half of our sample reported recent quit attempts, many people did not make an attempt using an evidence-based treatment. On the basis of consumer preferences identified herein, clinical recommendations for reinforcing the use of evidence-based smoking cessation treatments for depressed psychiatric inpatient smokers are provided.

Nurses' delivery of the Tobacco Tactics intervention at a Veterans Affairs Medical Center

To determine (1) factors associated with nurses' perceived confidence in and importance of delivering cessation interventions to patients after receiving the Tobacco Tactics educational module, and (2) whether self-reported delivery of smoking cessation services increased after the Tobacco Tactics educational programme was implemented. Intensive nurse-based inpatient smoking cessation interventions are effective; however, due to a lack of nurse confidence, training and time, nurse-administered cessation interventions are seldom implemented. Two cross-sectional surveys among staff trained in the Tobacco Tactics programme, conducted at two months and 15months post-training. Surveys were conducted to determine whether self-reported delivery of smoking cessation services by nursing staff increased after delivery of the Tobacco Tactics training at a Midwestern Veterans Affairs Medical Center. All staff members who attended the training were eligible to complete the surveys at two and 15months post-training. Having a good understanding of the elements of smoking cessation interventions and satisfaction with training were associated with perceived confidence and importance of delivering smoking cessation interventions. Additionally, 86% of participants reported delivering cessation interventions 15months post-training compared with 57% prior to training (p<0·0001). Training nurses how to deliver tobacco cessation interventions increases delivery of cessation services. Nurse-delivered cessation interventions have the potential to increase quit rates and decrease morbidity and mortality among patient populations.

Predictors of Smoking Patterns After First Stroke

Persistent smoking following stroke is associated with poor outcomes including development of secondary stroke and increased mortality risk. This study uses longitudinal data from the U.S. Health and Retirement Study (1992–2008) to investigate whether depression and duration of inpatient hospital care impact smoking outcomes among stroke survivors (N = 745). Longer duration of care was associated with lower likelihood of persistent smoking. Depression was associated with greater cigarette consumption. Interaction effects were also significant, indicating that for survivors who experienced longer inpatient care there was a weaker association between depression and cigarette consumption. Implications for practice and research are discussed.

Smoking and Opioid Detoxification: Behavioral Changes and Response to Treatment

The relevance of tobacco use in opioid addiction (OA) has generated a demand for available and more effective interventions. Thus, further analysis of less explored nicotine-opioid clinical interactions is warranted. A post-hoc analysis of OA participants in a double-blind, randomized very low dose naltrexone (VLNTX) inpatient detoxification trial evaluated measures of opioid withdrawal and tobacco use. Intreatment smokers were compared with nonsmokers, or smokers who were not allowed to smoke. A total of 141 (81%) of 174 OA participants were smokers, all nicotine-dependent. Inpatient smoking was a predictor of opioid withdrawal discomfort. Intreatment smokers (n = 96) showed significantly higher opioid craving (F = 3.7, p < .001) and lower detoxification completion rate (χ(2) = 7.9, p < .02) compared with smokers who were not allowed to smoke (n = 45) or nonsmokers (n = 33). Smoking during treatment was associated with more elevated cigarette craving during detoxification (F = 4.1, p < .001) and a higher number of cigarettes smoked at follow-up (F = 3.6, p < .02). Among intreatment smokers, VLNTX addition to methadone taper was effective in easing opioid withdrawal and craving more than other treatments, whereas the combination VLNTX-clonidine was associated with significantly reduced cigarette craving and smoking during detoxification. Failure to address tobacco use may negatively affect pharmacologically managed opioid discontinuation. Opioid detoxification may offer a window of opportunity to expand smoking cessation treatment, hence improving OA outcomes. The observed effects support testing of VLNTX-clonidine in smoking cessation trials among individuals with or without substance abuse.

Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs

Research on the validity of self-report tobacco use has varied by the population studied and has yet to be examined among smokers serviced by the Department of Veterans Affairs (VA). The purpose of this study was to determine the predictors of returning a biochemical urine test and the specificity and sensitivity of self-reported tobacco use status compared to biochemical verification. This was a sub-analysis of the larger Tobacco Tactics research study, a pre-/post-non-randomized control design study to implement and evaluate a smoking cessation intervention in three large VA hospitals. Inpatient smokers completed baseline demographic, health history and tobacco use measures. Patients were sent a follow-up survey at six-months to assess tobacco use and urine cotinine levels. A total of 645 patients returned six-month surveys of which 578 also returned a urinary cotinine strip at six-months. Multivariate analysis of the predictors of return rate revealed those more likely to return biochemical verification of their smoking status were younger, more likely to be thinking about quitting smoking, have arthritis, and less likely to have heart disease. The sensitivity and specificity of self-report tobacco use were 97% (95% confidence interval=0.95–0.98) and 93% (95% confidence interval=0.84–0.98) respectively. The misclassification rate among self-reported quitters was 21%. The misclassification rate among self-reported tobacco users was 1%. The sensitivity and specificity of self-report tobacco use were high among veteran smokers, yet among self-report quitters that misclassification rate was high at 21% suggesting that validating self-report tobacco measures is warranted in future studies especially in populations that are prone to misclassification.

Tailored tobacco dependence support for mental health patients: a model for inpatient and community services

AbstractAimsAlthough smoking prevalence among people with severe mental illness is high, it remains largely unaddressed. This pragmatic pilot project aimed to develop and implement a tailored tobacco dependence service in mental health settings and to assess its impact, as well as barriers and facilitators to implementation.DesignAn integrative service model, spanning acute, rehabilitation and community services, including the design of tailored instruments and referral pathways, delivered by two mental health professionals.Setting and participantsFour adult acute and two rehabilitation wards (129 beds), and the community recovery team (2038 cases) of the United Kingdom's largest Mental Health Trust.MeasurementsAudit of smoking information in patient notes; service uptake; quit attempts; smoking cessation and reduction; qualitative data on implementation barriers/facilitators.FindingsA total of 110 patients attended at least one support session: 53 inpatients (23% of inpatient smokers) and 57 community (of unknown number of community smokers, as recording of smoking status is not mandatory). Thirty‐four of these (31%) made a quit attempt; 17 (15%) stopped smoking and 29 (26%) reduced cigarette consumption by up to 50% at the final contact. Barriers to service implementation related to: (i) trust policy, systems and procedures, (ii) staff knowledge and attitudes and (iii) illness‐related factors.ConclusionsDespite the strong anti‐smoking climate in the United Kingdom, including a law requiring smoke‐free policies in mental health settings, establishing a smoking cessation treatment service for people with mental illness proved difficult, due to complex systemic barriers. However, there is clearly a demand, by patients, for such a service.

Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility

To test the transportability and implementation of the Tobacco Tactics intervention using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, for inpatient units at the Jesse Brown Veterans Affairs Medical Center. Smoking rates are high among veterans. While the Department of Veterans Affairs has standardised outpatient cessation clinics, inpatient cessation services, known to be efficacious, are only sporadically provided. This was a phase 4, pre and postimplementation study of the Tobacco Tactics intervention. A unique convenience sample of inpatient veteran smokers was recruited both before (n = 54) and after (n = 50) implementation of the Tobacco Tactics programme. Participants completed baseline and 30-day follow-up surveys along with urine cotinine test kits. In addition, staff completed anonymous surveys during the preintervention period (n = 158) and two months after (n = 81) the Tobacco Tactics training. Bivariate analyses compared preintervention vs. postintervention patient and staff characteristics using Chi-square, Fisher's Exact or Student's t-test. p-values <0·05 were considered significant. Patient-reported receipt of services and satisfaction was 10% higher in the postintervention compared to the preintervention group. Quit rates were 3% higher in the postintervention than in the preintervention group. The mean number of cigarettes smoked per day increased from 13 to 15 in the preintervention group, while the mean number of cigarettes smoked per day decreased from 14 to 9 in the postintervention group. Staff's confidence in their ability to provide cessation services improved greatly posttraining (p = 0·0017) as did self-reported delivery of cessation services (p = 0·0154). With as little as one-hour training for nurses, the Tobacco Tactics intervention has the potential to be widely disseminated in the Department of Veterans Affairs. The implementation of inpatient smoking interventions has the potential to improve quit rates and decrease morbidity and mortality in the Department of Veterans Affairs.

All Vets Aren’t Treated Equally When It Comes to Smoking Cessation

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAll Vets Aren’t Treated Equally When It Comes to Smoking CessationMark MoranMark MoranSearch for more papers by this authorPublished Online:15 Jun 2012https://doi.org/10.1176/pn.47.12.psychnews_47_12_18-bAbstractA majority of patients with psychiatric disorders served by the Department of Veterans Affairs (VA) reported receiving smoking-cessation services, yet their smoking rates remained high.Certain patient subgroups, however, were at risk for receiving fewer smoking-cessation services, suggesting that more education about these services needs to be done.Those were findings from a study published in the April Psychiatric Services assessing use and outcome of smoking-cessation services among veterans with mental illness.In the study, researchers at the Veterans Affairs Ann Arbor Center for Clinical Management Research and the departments of psychiatry at the University of Michigan and University of Colorado schools of medicine conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients.Patients with psychiatric disorders had greater odds of smoking, compared with veterans without such disorders. Those with schizophrenia, bipolar disorder, or unipolar depression had, respectively, a 1.8, 1.5, and 1.2 greater odds of being a current smoker than those without a mental disorder, while veterans with a substance use disorder had a 2.6 greater odds of being a smoker.Between 60 percent and 80 percent of VA patients with mental illness reported receiving some kind of smoking-cessation services through a physician who advised quitting, recommended medication, or discussed methods for quitting. But patients with schizophrenia had more than 30 percent lower odds of receiving advice on quitting smoking from their physicians.In addition, those diagnosed with posttraumatic stress disorder (PTSD) or a substance use disorder had significantly greater odds of reporting that they received advice to quit, recommendations for medications, or physician discussions of quitting methods, compared with those without one of these two disorders.“Several programs are currently being implemented in the VA to assist veterans with smoking cessation, including telephone counseling implementation of a nurse-administered Tobacco Tactics intervention for all inpatient smokers, and smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians,” the researchers indicated.“Moreover, the VA has implemented practices to change the culture of smoking in VA hospitals. Indoor smoke-free policies have been in effect since 1992, and most VA facilities have discontinued the practice of selling cigarettes. Although most VA facilities have offered behavioral counseling to employees who smoke, a recent 2010 VA directive made it possible to offer free, over-the-counter nicotine replacement therapy to employees who smoke. These cultural changes, along with continued efforts to improve implementation of smoking cessation interventions for at-risk veterans, have the potential to decrease smoking rates and reduce smoking-related morbidity and mortality among veterans.”In an editorial accompanying the article, Seth Himmelhoch, M.D., M.P.H., a psychiatrist and associate professor at the University of Maryland School of Medicine, said that health care clinicians must come to terms with the fact that smoking has reached epidemic proportions among their patients. “They must recognize that there is a clear confluence of evidence and policy that makes smoking-cessation interventions affordable, accessible, and effective for their patients who smoke,” he wrote. “The risk associated with maintaining the status quo is no longer acceptable, and bold steps are needed to ensure that smoking-cessation interventions are consistently provided to patients with mental illness who smoke. The lives of our patients depend on it.” “Risk of Smoking and Receipt of Cessation Services Among Veterans With Mental Disorders” is posted at http://ps.psychiatryonline.org/article.aspx?articleid=564841. ISSUES NewArchived

Development of a Brief Motivational Intervention to Facilitate Engagement of Smoking Cessation Treatment Among Inpatient Depressed Smokers

Inpatient smokers with major depressive disorder (MDD) have high rates of relapse to smoking after hospital discharge. The risk of health consequences that may contribute to increased morbidity and mortality among this population underscores the need to develop a program for psychiatric inpatient cigarette smokers with MDD. Using a motivational interviewing (MI) intervention, we sought to facilitate engagement of smokers with elevated depression symptoms in an outpatient treatment with demonstrated efficacy for nicotine dependence. In Phase 1 of this program, we recruited 15 smokers with MDD who were receiving inpatient psychiatric services. This preliminary report focuses on the development of the intervention, and explores perceived barriers to quitting, methods of quitting, and interest in smoking cessation treatment following discharge from an inpatient stay. Understanding inpatient cigarette smokers’ interests in making changes in smoking, and in willingness to attempt cessation and engage in cessation treatment can inform efforts to curb smoking in this high-risk population.

A pilot study to investigate the scope for an inpatient smoking cessation programme

Many Australian hospitals have recently introduced smoke-free policies. The aim of this study was to determine the smoking habits of hospital inpatients and to investigate the scope for an inpatient smoking cessation programme. A cross-sectional survey of adult inpatients of a tertiary-referral hospital who were smoking just before admission. The questionnaire contained items on general demographics, views on quitting, past quit attempts and validated scales - Fagerström test of nicotine dependence, Biener's contemplation ladder and Velicer's smoking decisional balance. Participants' (n= 125) median age was 53 years and had smoked for 35.0 ± 17.2 years. The majority were male (n= 84; 67.2%) and 45 (36.3%) lived with someone who smoked. Participants self-reported 4.5 ± 7.3 past attempts to quit. Only 61 (49.6%) said that their health professionals ever discussed options to assist quitting. Forty-nine (39.2%) reported accessing smoking areas during their hospital stay. Participants scored 4.5 ± 2.5 on the Fagerström test. Forty-two (33.8%) ranked themselves very high (9 or 10) on the contemplation ladder. The mean difference between the Velicer's subscales -'cons' (α= 0.81) and 'pros' (α= 0.80) was 3.2 ± 10.6 in favour of quitting. Fifty-four (43.9%) participants were interested in starting smoking cessation therapy during their hospital stay. Nicotine patches (31; 25.4%) were the preferred dosage forms to assist quitting followed by oral tablets (23; 18.9%) and chewing gum (20; 16.4%). Our findings could guide the design of inpatient smoking cessation interventions. Greater efforts from health professionals are essential for informing people about smoking cessation options, promoting their uptake, potentially resulting in higher quit rates.

Do hospital treatments represent a ‘teachable moment’ for quitting smoking? A study from a stage-theoretical perspective

Hospital treatments are assumed to be a ‘teachable moment’. This phenomenon, however, is only poorly conceptualised and untested. A stage-theoretical perspective implies that a cueing event such as hospital treatments is a teachable moment if a stage progression, change of cognitions, or both occur. This concept is examined in a cross-sectional study by comparing smokers in two treatment settings, an emergency department (ED) and inpatient treatment after elective surgery, with smokers in a control setting. Setting differences were hypothesised in stage distribution, and levels of and stage differences in social-cognitive factors under control for possible confounders. Stage, social-cognitive factors and possible confounders were assessed in 185 ED smokers, 193 inpatient smokers and 290 control smokers. Compared to control smokers, ED and inpatient smokers were in higher stages; they perceived fewer risks and cons; inpatient smokers reported more concrete plans. Stage differences in self-efficacy among ED and inpatient smokers differed from those among control smokers, but the former corresponded more strongly to the theoretical stage assumptions. The results suggest that hospital treatments lead to a stage progression and change of corresponding cognitions, and thus represent a ‘teachable moment’. Stage-matched interventions should be provided but consider differences in cognitions to be effective.

The Effects of the Brief Inpatient Smoking Cessation Counseling on Quit Success and Stage of Change

The Effects of the Brief Inpatient Smoking Cessation Counseling on Quit Success and Stage of Change

A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland

The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit. To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital. Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital. Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe. Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.