Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial

BACKGROUND

Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.

OBJECTIVE

We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.

DESIGN

Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.

PARTICIPANTS

Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking.

INTERVENTION

A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.

MAIN MEASURES

The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.

KEY RESULTS

Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001).

CONCLUSIONS

Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.

TRIAL REGISTRATION

URL: http://www.

CLINICALTRIALS

gov . Unique identifier: NCT03521466.

Tobacco cessation in India-Current status, challenges, barriers and solutions

The attention to tobacco cessation (TCs) has increased globally by WHO through the Framework Convention on Tobacco Control (FCTC) and MPOWER. In India, NTCP (National Tobacco Control Program), the National and three Regional Quitlines and mCessation, some apex national institutes, and professional dental bodies and others have eased an access to quit, the proportion of the former users has been dismally low-below 2% at population level. The challenges of not having: (1) TCCs at secondary and tertiary care as well as in the larger private healthcare setups; (2) participatory health system and healthcare professionals; (3) motivated tobacco users to quit even in short-term; (4) focused NTCP due to convergent NHM (National Health Mission); and, (5) optimal coverage to the health-insured "need a priority attention". Also, there is need to eliminate the barriers existing: (a) at all levels in the governance, health system and other stake-holding sectors; and, (b) due to the interference of the tobacco industry. Overall, (i) setting the norm of quitting since all tobacco users are actually patients; (ii) increasingthe awareness of benefits of quitting and incentivizing it; (iii) establishing a systems approach in all health facilities of screening, treatment and follow-up of the treated tobacco users besides coding them; plus (iv) amending COTPA (the Cigarettes and Other Tobacco Products Act of 2003) can increase the quit rates in India and LMICs.

Impact of a Comprehensive Anti-Smoking Program at a Regional University Hospital and Predictive Variables of Being a Smoker among Hospital Workers

The objective of this study was to evaluate the impact of a comprehensive anti-smoking health program conducted over twelve years at a regional university hospital in southern Spain. Prevalence of tobacco was compared retrospectively using data collected during occupational health assessments (n = 4291). Bivariate and logistic regression analyses were carried out to evaluate tobacco consumption differences according to age, sex, professional category, and workplace building. The results show a reduction in the active smoking rate among hospital staff evaluated (from 22.8% to 19.8%) with significant differences between non-health and health workers. Accumulated smoking consumption fell to 13.45 ± 14.60 packs/year with men presenting a higher consumption (p < 0.001). The predictive variables of tobacco use were sex (greater consumption among men, p = 0.021), number of cigarettes (greater consumption among professionals who smoked less than 1 pack/day, p < 0.001), and time smoking (greater use among professionals with more than 10 years smoking, p < 0.001). There was a higher rate of staff smokers at the hospital building with a majority of mental health inpatients. This study provides a practical example of making the optimum use of digital medical records in the evaluation of a comprehensive anti-smoking health program.