Smoking Cessation Initiatives Research Articles

Lady health workers smoking cessation initiative in rural Pakistan

Abstract Background In Pakistan, tobacco smoking and indoor smoke from cooking fires pose significant health risks. Lady Health Workers (LHWs) play a crucial role in improving healthcare access, particularly in rural areas. This study aimed to explore the practicality of training LHWs to deliver health education aimed at reducing household exposure to tobacco smoke and indoor biomass smoke, while also documenting baseline exposure levels and assessing the immediate impact on household awareness and intentions to reduce exposure. The Program Over 170 LHWs were trained and equipped with health education resources to raise awareness about the risks of tobacco and biomass smoke exposure. The training was designed to be integrated into their routine duties. Results Over 24 weeks, the program was delivered to 25,760 households in Gujranwala district. Approximately half of these households had at least one person who smoked, with 90% smoking indoors. Many (85%) households used indoor cooking fires. Only 24% of household head-women were aware of the health risks associated with indoor smoke exposure. Awareness of less harmful alternatives to smoking was low. Most households had someone who wanted to stop smoking and 51 women and 146 men agreed to try a tobacco harm reduction (THR) product. Primary health units’ staff appreciated the project, especially the training provided. They believed the program could be sustainable, and LHWs expressed interest in continuing it. Conclusion The study demonstrated the practicality of training LHWs to deliver health education on reducing tobacco and biomass smoke exposure in rural settings. The program effectively raised awareness and showed potential for sustainable integration into existing healthcare structures, highlighting the value of community-centric approaches in low-resource settings.

Tobacco smoking-attributable mortality in Kenya, 2012-2021.

Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.

The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders.

Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.

Impact of Alcohol Use, Traumatic Stress, and Cigarette Smoking on Cognitive Functioning in Veterans With Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder.

Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one's ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD. U.S. Veterans with co-occurring AUD and PTSD (n = 162) completed a comprehensive cognitive assessment covering various domains: working memory, processing speed, mental switching, cognitive inhibition, auditory-verbal learning, auditory-verbal memory, and verbal fluency. To examine the impact of alcohol use, traumatic stress, and cigarette smoking on cognitive function, we conducted a three-way interaction examining the moderated effects of smoking status on the association between alcohol use and PTSD symptoms on a composite domain of global cognition. Smoking status in Veterans with co-occurring AUD and PTSD moderated the relationship between alcohol use and global cognition (P = .042), such that higher levels of alcohol use in the past week were related to worse global cognitive function among Veterans cigarette smokers (P = .015) but not among nonsmokers (P = .833). On follow-up analyses of individual cognitive domains, greater alcohol use in the past week was associated with lower cognitive inhibition in smokers but not nonsmokers, with traumatic stress symptoms moderating this effect (P = .039). Additionally, smoking status moderated the relationship between alcohol use and auditory-verbal learning, such that there was a differential relationship between alcohol use and auditory-verbal learning between smokers and nonsmokers. Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran's ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.

A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby

BackgroundQuit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative.MethodsA mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact.ResultsQFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96–1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients.ConclusionQFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

Assisted versus referred pharmacy smoking interventions for patients with thoracic malignancies or pulmonary nodules

BackgroundTobacco use is the foremost preventable cause of death, disease, and disability in the United States. Continued tobacco use in malignant disease contributes to treatment failure and disease progression. Pharmacists are pivotal to tobacco cessation counseling, management, and follow up. MethodsThis retrospective, observational, single-center, cohort study of ambulatory cancer patients was designed to assess the impact of assisted versus “Ask, Advise, Refer” (AAR) pharmacy-driven smoking cessation interventions on patient-reported quit rates at 30- and 90-days. Those included were currently smoking or recently quit adults with a thoracic malignancy or nodule. Those in the assisted intervention were offered nicotine replacement therapy (NRT) for free according to a personalized quit plan. After July 1, 2020, patients were enrolled in the AAR intervention, whereby participants were referred to obtain NRT through insurance or external resources. Both clinical interventions were provided as standard of care. Results129 participants were included (assisted n = 83; AAR n = 46) with baseline characteristics evenly matched. After excluding those unable to be reached at 30-days, 30 (44.8%) in the assisted intervention quit smoking versus 11 (27.5%) in the AAR intervention, p = 0.08. Lung cancer patients were more likely to report quitting at 30-days in the assisted intervention, 16 (64.0%) versus 5 (29.4%) in the AAR intervention, p = 0.03. After excluding those unable to be reached at 90-days, 30 (45.5%) in the assisted intervention quit versus 11 (35.5%) in the AAR intervention, p = 0.35. ConclusionsPharmacy-led smoking cessation initiatives that include providing NRT are especially impactful on smoking cessation in lung cancer patients.

Roles, experiences and perspectives of the stakeholders of "10,000 Lives" smoking cessation initiative in Central Queensland: Findings from an online survey during COVID-19 situation.

Issue addressedThe “10,000 Lives” initiative was launched in Central Queensland in November 2017 to reduce daily smoking prevalence to 9.5% by 2030 by promoting available smoking cessation interventions. One of the main strategies was to identify and engage possible stakeholders (local champions for the program) from hospitals and community organisations to increase conversations about smoking cessation and referrals to Quitline. We aimed to understand the roles, experiences and perceptions of stakeholders (possible champions for delivering smoking cessation support) of the “10,000 Lives” initiative in Central Queensland, Australia.MethodsWe conducted a mixed‐method online survey during the COVID‐19 situation (23 June 2020 to 22 August 2020) with a cross‐section of possible stakeholders who were targeted for involvement in “10, 000 Lives” using a structured questionnaire with mostly closed‐ended questions. Questions were asked regarding their roles, experiences and perceptions about smoking cessation and “10,000 Lives”.ResultsAmong the 110 respondents, 52 (47.3%) reported having provided smoking cessation support, including referral to Quitline, brief intervention and promoting existing interventions. Among them (n = 52), 31 (59.6%) were from hospitals and health services, 14 (26.9%) were from community services and three (5.8%) were from private medical practices while four of them did not report their setting. Twenty‐five respondents (22.7%) self‐identified as being directly involved with the “10, 000 Lives” initiative, which significantly predicted provision of smoking cessation support (OR 6.0, 95% CI: 2.1‐19.8). However, a substantial proportion (63.5%) of those (n = 52) who reported delivering cessation support did not identify as contributing to “10,000 Lives”.ConclusionsStakeholders from hospitals, health services and community services are the main providers of smoking cessation support in Central Queensland. More could be done to support other stakeholders to feel confident about providing cessation support and to feel included in the initiative.So what?Engaging with a range of stakeholders is critical for health promotion program success, to further develop the program and to ensure its sustainability. As such, funding needs to be allocated to the activities that enable this process to occur.

The Effectiveness of a Smoking Cessation Initiative Among Employees in a Textile Factory.

In this study, we aimed to investigate the effectiveness of a smoking cessation initiative for workers who are smokers in a textile factory located in Denizli, Turkey. This retrospective cohort was conducted by using the occupational health and safety unit records of 821 workers who are smokers. All participants underwent cognitive behavioral therapy, and in case of need, a suitable pharmacological treatment was initiated. The status of smoking cessation was checked at the end of the third month with a carbon monoxide breath monitor. A chi-square test was performed to make comparisons between categorical variables. Logistic regression analysis (backward) was used to evaluate the factors related to the smoking cessation status. The ratio of participants who gave up smoking was 74.3%, and 63% of them used a pharmaceutical aid to quit smoking. Working in the department of finishing and using a pharmaceutical aid to quit smoking were related to increased success in smoking cessation. Outcomes of our study emphasize that workplace-based smoking cessation programs may create a huge impact on smoking cessation among workers. Pharmacological aid and cognitive behavioral therapy have been associated with success in quitting smoking.

Understanding health disparities affecting utilization of tobacco treatment in low-income patients in an urban health center in Southern California

Tobacco use disproportionately affects low-income communities. Prevalence among patients in Federally Qualified Health Centers (FQHCs) is higher (29.3%) than the general population (20%). Little is known about the rates of referrals to cessation services and cessation pharmacotherapy practices in FQHCs. This study will examine referral and prescribing patterns based on patient characteristics at a large FQHC in Southern California. We conducted a retrospective analysis of EHR data from 2019. Patients who were ≥ 18 years old and had “tobacco use” as an active problem were included in analyses. We characterized the proportion of 1) those who were referred to California Smokers’ Helpline (CSH), 2) referred to smoking cessation counseling (SCC) at the FQHC clinic, or 3) received pharmacotherapy. Associations of demographic characteristics and comorbidities with referral types and uptake of services were evaluated using mixed-effects multinomial and logistic regressions. Of the 20,119 tobacco users identified, 87% had some cessation intervention: 66% were advised to quit and given information to contact CSH, while 21% were referred to SCC. Patients were least likely to get referred to cessation services if they had more medical, psychiatric, or substance use comorbidities, were in the lowest income group, were uninsured or were Hispanic. Although EHR systems have enhanced the ease of screening, most patients do not receive more than brief advice to quit during a PCP visit. Most (70%) low-income smokers see their PCPs at least once a year, making FQHCs excellent settings to promote smoking cessation initiatives in low-income populations.

Smoking Cessation Initiatives in Total Joint Arthroplasty: An Evidence-Based Review.

As smoking increases the risk of adverse events and leads to increased hospital costs following total joint arthroplasty (TJA), many institutions have introduced perioperative smoking cessation initiatives. Although such programs have been demonstrated to improve outcomes for smokers undergoing TJA, the optimal approach, duration, and timing of smoking cessation models have not been well-defined. Overall, initiating a smoking cessation program 4 weeks preoperatively is likely adequate to provide clinically meaningful reductions in postoperative complications for smokers following TJA, although longer periods of cessation should be encouraged if feasible. Patients brought in for emergency surgical treatment who cannot participate in a preoperative intervention may still benefit from an intervention instituted in the immediate postoperative period. Cotinine testing may provide some benefit for encouraging successful smoking cessation and validating self-reported smoking status, although its utility is limited by its short half-life. Further study is needed to determine the value of other measures of cessation such as carbon monoxide breath testing. Smoking cessation programs instituted prior to TJA have been demonstrated to be cost-effective over both the short and long term.

The impact of a regional smoking cessation program on referrals and use of Quitline services in Queensland, Australia: a controlled interrupted time series analysis

BackgroundThe prevalence of smoking in Central Queensland (CQ), Australia was higher than the state and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote available interventions (e.g., Quitline). We investigated the impact of “10,000 Lives” on referral to and use of Quitline services. MethodsWe conducted an interrupted time series analysis using a segmented Poisson regression model to measure the impact of “10,000 Lives” on monthly referrals to, and use of Quitline services (counselling sessions and nicotine replacement therapy (NRT) dispatched by Quitline), in CQ compared to other areas in the state (control population). The control population included all regional areas in Queensland with a comparable smoking prevalence to CQ and similar access to Quitline's Intensive Quit Support Program. We calculated the changes in level and trend of outcomes in CQ relative to the change in the control area during the post-launch period of “10,000 Lives”. The models were checked for autocorrelation and seasonality and adjusted accordingly. FindingsAfter the introduction of “10,000 Lives”, the mean monthly rate per 1,000 smoking population increased in the intervention area for each outcome; e.g., from 3.3 to 10.8 for referrals to Quitline, from 1.6 to 4.4 for initial counselling session completed. These results were validated by the controlled interrupted time series analysis which showed relative increases for each of these outcomes (238•5% for monthly rate of referral to Quitline per 1,000 smoking population and 248•6% for monthly rate of initial counselling sessions completed per 1,000 smoking population). InterpretationOur study demonstrates a locally coordinated health promotion initiative can promote and boost the referral to, and use of Quitline smoking cessation services. FundingThe research is funded by a collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907). The lead author (AK) is supported by a University of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship.

Variability in outcomes and quality-of-care indicators across clinics participating in a large smoking-cessation program

BackgroundThe effectiveness of care for substance-related problems varies across providers. Best-known treatments are rarely universally applied, and various process differences can affect participant outcomes. Measuring and understanding this variability can suggest changes that will improve system performance. MethodsWe measure variability in 7-day cigarette abstinence at a six-month follow-up; return for a second clinical visit; and receipt of combination nicotine replacement therapy across 223 primary care clinics participating in the Smoking Treatment for Ontario Patients program, a large smoking cessation initiative in Ontario, Canada. We include 41,992 enrolments from April 11, 2016 and May 31, 2019. We risk adjust for demographic and clinical case-mix differences and characterize variability using funnel plots and measures based on clinic-level variance explained. The abstinence outcome is missing for 38% of participants. We adjust for missingness using multiple imputation and inverse probability weighting. ResultsAbstinence was achieved by 28.0% (95% CI = 27.5%–28.5%) of participants, 63.2% (62.8%–63.7%) received combination NRT, and 72.9% (72.4%–73.3%) returned for a second clinical visit. Variability was moderate for abstinence (median odds ratio (MOR) = 1.16) and pronounced for return visit (MOR = 1.29) and combination therapy (MOR = 1.89). ConclusionOutcomes and processes vary significantly across clinics within a program with shared guidelines and standards. Differences across providers may be greater in other contexts. Results underscore the importance of measuring and understanding variability, and of ongoing maintenance and improvement. The existence of high outliers holds out the possibility of identifying practices that might be more widely adopted.

The Impact of a Regional Smoking Cessation Program on Referrals and Use of Quitline Services in Queensland, Australia: A Controlled Interrupted Time Series Analysis

Background: Prevalence of smoking in Central Queensland (CQ), Australia was higher than state and national averages. A regional smoking cessation initiative (“10,000 Lives”) was launched to promote available interventions (e.g. Quitline). We investigated the impact of “10,000 Lives” on referral to and use of Quitline services. Methods: We conducted interrupted time series analysis using a segmented Poisson regression model to measure the impact of “10,000 Lives” on monthly referrals to and use of Quitline services (program participation, Quitline calls and nicotine replacement therapies dispatched by Quitline), in CQ compared to other areas in the state (control population). The control population was regional areas in Queensland with a comparable smoking prevalence and similar access to Quitline’s Intensive Quit Support Program. We calculated the level and trend changes of outcomes in CQ relative to control after “10,000 Lives” commenced. The models were checked for autocorrelation and seasonality and adjusted accordingly. Findings: Mean monthly numbers of referral to, participation in, and interaction with Quitline, and NRT gum, lozenge and patch dispatches from Quitline in CQ increased by 277·2%, 154·9% and 242·7% and, 573·9%, 1170·6% and 740·9% respectively after “10,000 Lives” introduction. The result was validated by the controlled interrupted time series analysis which showed 238·5%, 248·6% and 251·6% and, 93·6%, 141·4% and 121.6% relative increase in CQ compared to control for the monthly rates of these outcomes. Interpretation: Our study demonstrates a low-cost health promotion initiative can promote and boost the referral to and use of Quitline smoking cessation services. Funding Statement: The research is funded by the collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907). Declaration of Interests: Lead author (AK) is supported by a University of Queensland Research Training Scholarship and a Research Higher Degree Top-up Scholarship; Dr. Gartner reports grants from Central Queensland Hospital and Health Service, during the conduct of the study; Dr. Green reports grants from Central Queensland Hospital and Health Service, during the conduct of the study; Dr. Lawler reports a collaborative research grant between School of Public Health at University of Queensland and Central Queensland Public Health Unit which is awarded by the Central Queensland Hospital and Health Service (CQHHS93907), Australia, for the conduct of the study; r. Khandaker reports grants from Central Queensland Hospital and Health Service, during the conduct of the study. Ethics Approval Statement: The study was approved by the CQHHS Human Research Ethics Committee (HREC) approved (HREC/2019/QCQ/50602) which was subsequently ratified by the HREC of the University of Queensland (Clearance Number: 2019001760).

How can a coordinated regional smoking cessation initiative be developed and implemented? A programme logic model to evaluate the ‘10,000 Lives’ health promotion initiative in Central Queensland, Australia

ObjectiveThis study used a programme logic model to describe the inputs, activities and outputs of the ‘10,000 Lives’ smoking cessation initiative in Central Queensland, Australia.DesignA programme logic model provided the...

Characteristics of tobacco consumption among cancer patients at a tertiary cancer hospital in South India-A cross-sectional study.

IntroductionCancer patients commonly present with antecedent addiction to tobacco consumption. Our study describes the characteristics of this substance use. Following the diagnosis of cancer, continued consumption of tobacco results in reduced tolerance to treatment, failure of treatment, tumor progression, other primary tumors, secondary cancers, and poor quality of life. The aim of our study is to enumerate the clinico-social aspects of tobacco consumption among cancer patients.MethodsThis cross-sectional study includes 100 cancer patients admitted to Healthcare Global cancer hospital, Bangalore, India. The study subjects were assessed for tobacco consumption, as well as other substance use such as intake of alcohol. We assessed various dimensions of exposure to tobacco consumption such as duration, intensity, and cumulative dose as independent risk factors for cancer.ResultsAmong the study subjects, 46.2% were found to smoke filter cigarettes. The mean duration of tobacco consumption among beedi users was found to be longer (25.9 years, SD: 14.4). When stratified for exclusive consumption, the mean durations were as follows: beedis (29 ± 14.4 years), cigarettes (23.8 ± 13.3 years), and chewing (15.9 ± 9.6 years). Along with tobacco, a large proportion (59.3%) of patients consumed alcohol as well. After attempts to quit, 89.01% patients had reversal of tobacco substance use. The data did not show significance for duration, intensity, and cumulative dose of tobacco consumption.ConclusionThe diagnosis of cancer is a life-altering event, which results in higher motivation to quit the use of tobacco. Smoking cessation initiatives can reduce the risk of developing tobacco-related malignancies.

Feasibility of m-Health Smoking Cessation Initiative in a Metropolitan Rapid Access Cardiology Clinic (RACC)

Feasibility of m-Health Smoking Cessation Initiative in a Metropolitan Rapid Access Cardiology Clinic (RACC)

Abstract TP385: Using a Learning Collaborative Model in Metro Chicago to Identify Best Practice Strategies for Emerging Topics: E-Cigarette Use in Stroke Patients

Background: While learning collaborative models have been shown to aid implementation of published national guidelines, less is known about their role in informing health care providers about emerging topics not yet written into guidelines. National guidelines state that stroke patients who have a history of smoking should receive smoking cessation intervention prior to hospital discharge. However, guidelines do not include recommendations related to e-cigarette use. Launched July 2018, the Metro Chicago Smoking Cessation Initiative was a one-year pilot aimed at improving understanding of smoking cessation interventions provided at discharge, smoking behavior post-discharge, and best practices for reducing smoking rates at 20 Chicago area hospitals. While hospital practices and patient behavior around e-cigarettes was not an aim, the learning collaborative model enabled hospital participants to report their experiences and enact practice changes related to e-cigarettes. Methods: The pilot used a Learning Collaborative model that included a quality improvement leader, health behavior content experts, reporting of experiences and data, and sharing of best practices. Pilot participating hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Hospitals documented smoking cessation intervention provided at time of discharge and contacted patients via phone at 30 days post-discharge to gather data on current smoking use, quit attempts, and therapies used. Hospitals completed a baseline questionnaire reporting current smoking cessation practices and a mid-point questionnaire reporting changes to practice and experiences as a pilot participant. Responses were reviewed for themes related to e-cigarettes. Results: See Table 1 Conclusions: A Learning Collaborative Model may be a method for identifying strategies for practice changes prior to guideline recommendations.

Abstract TP313: A Metro Chicago Learning Collaborative Model to Improve Smoking Cessation Rates in Stroke Patients

Background: National guidelines for stroke care recommend that patients discharged with a stroke who have a history of smoking receive smoking cessation intervention prior to hospital discharge. However, less is known about the types of intervention provided and subsequent outcomes post-discharge. The Metro Chicago Smoking Cessation Initiative Pilot aimed to improve understanding of smoking cessation interventions provided at discharge, smoking behavior at 30 days post-discharge, and best practices and barriers for reducing smoking rates in stroke patients discharged from 20 Chicago area hospitals. Methods: A review of smoking cessation interventions provided at discharge and smoking cessation outcomes post-discharge for stroke patients discharged between August 1, 2018 and July 31, 2019 at 20 Chicago area participating hospitals was conducted using Get With The Guidelines® Stroke. The pilot used a Learning Collaborative model that included a quality improvement leader, smoking cessation/health behavior content experts, reporting of experiences and data, and sharing of best practices. All hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Results: Preliminary results from the 20 participating hospitals suggest smoking cessation counseling is the most commonly delivered intervention at discharge. Of the patients reached at 30 days post-discharge, 75% of those who reported at history of smoking at the time of their stroke were still using tobacco products. However, nearly 50% of those patients reported having made at least one attempt to quit. Conclusions: Preliminary results from this pilot project highlight the need for improved tracking of smoking cessation interventions provided at discharge and associated smoking behavior post-discharge, as well as the benefits of regional collaboration for identifying and implementing best practices.

United States prevalence of pediatric asthma by environmental tobacco smoke exposure, 2016–2017

Objectives We sought to update the prevalence estimates of parent-reported asthma diagnosis by Environmental Tobacco Smoke (ETS) exposure in the United States (US) pediatric population. Methods This cross-sectional study included 71,811 families with children who participated in the 2016–2017 National Survey of Children’s Health (NSCH). Weighted asthma prevalence estimates were calculated for ETS-exposed and non-exposed children. Chi-square analysis compared asthma prevalence between the two exposure groups and logistic regression analysis generated adjusted odds ratios (aORs) of asthma diagnosis by ETS exposure by sex, race/ethnicity, and household education and income level. Results Asthma prevalence estimates were significantly higher in ETS-exposed vs. non-exposed children (10.7% vs. 7.8%, p < 0.001). Children with a smoker in the house are 30% more likely to have an asthma diagnosis vs. children with no smokers in the house (aOR 1.29, 95% Confidence Interval [CI] 1.09–1.52). Significant predictors for ETS exposure included < high school education and lower family income. Conversely, non-Hispanic black and Hispanic children were less likely to have ETS exposure vs. non-Hispanic white children. Conclusions ETS exposure is a significant risk factor for asthma in the US pediatric population. Smoking cessation initiatives targeting non-Hispanic white parents from lower socioeconomic may improve children’s chronic pulmonary health risk.