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Dillinger JG, Pezel T, Delmas C, Schurtz G, Trimaille A, Piliero N, Bouleti C, Lattuca B, Andrieu S, Fabre J, Rossanaly Vasram R, Dib JC, Aboyans V, Fauvel C, Roubille F, Gerbaud E, Boccara A, Puymirat E, Toupin S, Vicaut E, Henry P. Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study. EClinicalMedicine 2024; 67:102401. [PMID: 38261914 PMCID: PMC10796965 DOI: 10.1016/j.eclinm.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Interpretation Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding Grant from Fondation Coeur & Recherche.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000, Toulouse, France
| | | | | | | | | | | | | | - Julien Fabre
- University Hospital of Fort de France, Fort De France, Martinique
| | | | - Jean-Claude Dib
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly Sur Seine, France
| | | | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, 76000, Rouen, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295, Montpellier, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and, Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | - Etienne Puymirat
- Université Paris Cité, Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Solenn Toupin
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Eric Vicaut
- Unité de recherche clinique – Hopital Lariboisiere, Paris, France
| | - Patrick Henry
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
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Bernstein EY, Chang Y, Levy DE, Baggett TP, Lee SS, Tindle HA, Rigotti NA. Tobacco-Related Disease, Health Beliefs, and Post-hospital Tobacco Abstinence. Am J Prev Med 2023; 65:792-799. [PMID: 37217039 PMCID: PMC10592560 DOI: 10.1016/j.amepre.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Most hospitalized patients who smoke resume after discharge. Associations of tobacco-related disease and health beliefs with post-hospitalization abstinence were examined. METHODS This was a cohort study using data from a 2018-2020 multicenter trial of hospitalized adults who smoked and wanted to quit. Tobacco-related disease was defined using primary discharge diagnosis codes. Baseline health beliefs included (1) smoking caused hospitalization, (2) quitting speeds recovery, and (3) quitting prevents future illness. Outcomes included self-reported 7-day point prevalence abstinence 1, 3, and 6 months after discharge. Separate logistic regression models for each of the three health beliefs were constructed. Models stratified by tobacco-related disease explored effect modification. Analysis was performed in 2022-2023. RESULTS Of 1,406 participants (mean age 52 years, 56% females, 77% non-Hispanic White), 31% had tobacco-related disease, 42% believed that smoking caused hospitalization, 68% believed that quitting speeds recovery, and 82% believed that quitting prevents future illness. Tobacco-related disease was associated with higher 1-month point prevalence abstinence in each health belief model (AOR=1.55, 95% CI=1.15, 2.10; 1.53, 95% CI=1.14, 2.05; and 1.64, 95% CI=1.24, 2.19, respectively) and higher 6-month point prevalence abstinence in models including health beliefs 2 and 3. Quitting speeds recovery was the only belief associated with higher 1-month point prevalence abstinence (AOR=1.39, 95% CI=1.05, 1.85). Among patients with tobacco-related disease, the belief that quitting prevents future illness was associated with higher 1-month point prevalence abstinence (AOR=2.00, 95% CI=1.06, 3.78). CONCLUSIONS Tobacco-related disease predicts abstinence 1 and 6 months after hospitalization independent of health beliefs. Beliefs that quitting speeds recovery and prevents future illness may serve as targets for smoking-cessation interventions.
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Affiliation(s)
- Eden Y Bernstein
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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Kuo CW, Chen CY, Wu CH, Chen CW, Guo FR, Yang SC. Multiple in-hospital counseling increases six-month smoking abstinence among individuals participating in a hospital-initiated smoking cessation program. Addict Sci Clin Pract 2022; 17:29. [PMID: 35597973 PMCID: PMC9123762 DOI: 10.1186/s13722-022-00310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/28/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A cessation program for hospitalized smokers is an effective strategy to achieve smoking abstinence. The effects of multiple in-hospital counseling sessions on 6-month smoking abstinence require further investigation. METHODS We retrospectively analyzed the data of smokers who participated in hospital-initiated cessation programs at a medical center between 2017 and 2019. Data on age, sex, comorbidities, daily number of cigarettes, cessation motivation, nicotine dependence, cessation medications, discharge diagnosis, length of hospitalization, and intensive care unit admission were collected. We conducted multiple logistic regression analysis to investigate the effect of multiple in-hospital counseling sessions on 6-month sustained smoking abstinence. Sensitivity analyses were carried out excluding participants who underwent post-discharge cessation programs and assuming that the loss to follow-up participants had failure in 6-month smoking abstinence. RESULTS A total of 1943 participants aged ≥ 20 years were analyzed. Compared with single in-hospital counseling session, the adjusted odds ratios (ORs) for 2 and ≥ 3 counseling sessions were 1.44 (95% confidence interval [CI] 1.05 to 1.98) and 2.02 (95% CI 1.27 to 3.22), respectively, with a significant trend for increasing the number of counseling sessions (P < 0.001). The results remained significant after excluding participants who underwent a post-discharge cessation program or when assuming that lost to follow-up participants had failure in smoking abstinence. CONCLUSION Multiple in-hospital counseling sessions were associated with a higher 6-month sustained smoking abstinence rate. This strategy could be used to reduce the prevalence of smoking.
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Affiliation(s)
- Chin-Wei Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chuan-Yu Chen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Health Promotion Association, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Wen Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fei-Ran Guo
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Szu-Chun Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Feliu A, Ravara S, Papadakis S, Enriquez M, Antón L, Saura J, Company A, Romero O, Ripoll R, Ruz A, Precioso J, Pascoal I, Videira L, Correia C, Ferreira S, Fernández E, Martínez C. Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study. J Nurs Scholarsh 2021; 54:332-344. [PMID: 34755457 DOI: 10.1111/jnu.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Sofia Ravara
- CICS-UBI, Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marta Enriquez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Antón
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Catalan Network for Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Assumpta Company
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Romero
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruth Ripoll
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angels Ruz
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Precioso
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Ivone Pascoal
- Serviço de Pneumologia. Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Lídia Videira
- Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Claudia Correia
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Soraia Ferreira
- CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Laochai W, Preechawong S. Quit rates and predictors of smoking abstinence in Thai Buddhist monks with noncommunicable diseases. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-08-2020-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this study is to calculate the smoking quit rate and to examine the factors influencing smoking abstinence among Thai Buddhist monks with noncommunicable diseases (NCDs).
Design/methodology/approach
This was a cross-sectional study of 136 Buddhist monks with NCDs purposively sampled from the Priest Hospital. The participants were between 20 and 59 years of age, smoked at least one cigarette a day and received cessation advice from nurses or other health professionals. The dependent variable was self-reported 7-day point-prevalence smoking abstinence assessment at a three-month follow-up. Independent variables were age, schooling level, nicotine dependence, intention to quit, physical activity and perceived self-efficacy in quitting cessation. Logistic regression was performed to evaluate the factors influencing smoking cessation.
Findings
50 of the 136 Thai Buddhist monks (36.8%) reported the 7-day point prevalence abstinence at a three-month follow-up. About two-thirds of the participants indicated health concern as the motivation to quit smoking. Perceived self-efficacy of abstinence (odds ratio 1.04; 95% confidence interval 1.014–1.074) and intention to quit smoking (odds ratio 1.34; 95% confidence interval 1.129–1.599) were significant predictors of abstinence.
Originality/value
This is the first study of its kind to investigate the predictors of smoking cessation in Thai Buddhist monks with NCDs. The findings will be of help to healthcare counselors seeking to motivate monks to quit smoking.
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Ladapo JA, Tseng CH, Sherman SE. Financial Incentives for Smoking Cessation in Hospitalized Patients: A Randomized Clinical Trial. Am J Med 2020; 133:741-749. [PMID: 31982494 PMCID: PMC7293955 DOI: 10.1016/j.amjmed.2019.12.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Financial incentives for smoking cessation and use of evidence-based therapy may increase quitting rates and reduce health and economic disparities. METHODS We randomized a low-income population of 182 hospitalized patients (mean age 58 years, 45% with high school education or less) to enhanced usual care, which included hospital-directed cessation care and Quitline referral or enhanced usual care plus financial incentives. All patients received enhanced usual care, while participants randomized to the financial incentives group were also eligible to receive up to $550 for participation in Quitline counseling ($50), participation in a community-based cessation program ($50), use of pharmacotherapy ($50), and biochemically confirmed smoking cessation at 2 months ($150) and 6 months ($250). Primary outcome was biochemically confirmed smoking cessation at 6 months after hospital discharge. RESULTS Total mean payment was $84 (standard deviation [SD] = $133) in the incentive group. The 6-month rate of biochemically confirmed smoking cessation was 19.6% in the incentive group and 8.9% in the enhanced usual care group (odds ratio [OR] 2.56; 95% confidence interval [CI] 0.84 to 7.83, P = 0.10). Participants in the incentive group had higher rates of nicotine replacement therapy use (57.3% vs 31.3%, P = 0.002). Financial incentives did not improve subjective social status but did increase financial stress. CONCLUSIONS Rates of bioconfirmed smoking cessation were higher among hospitalized patients randomized to financial incentives compared to usual care alone, but the difference was not significant. Considering the frequency of low payouts and the importance of assistance for successful quitting, future studies should explore the effectiveness of financial incentives sufficiently large to overcome barriers to evidence-based therapy.
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Affiliation(s)
- Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles; Department of Population Health, New York University School of Medicine, New York.
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles
| | - Scott E Sherman
- Department of Population Health, New York University School of Medicine, New York; Department of Medicine, VA New York Harbor Healthcare System, New York; Department of Medicine, New York University School of Medicine, New York
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Ramsey AT, Prentice D, Ballard E, Chen LS, Bierut LJ. Leverage points to improve smoking cessation treatment in a large tertiary care hospital: a systems-based mixed methods study. BMJ Open 2019; 9:e030066. [PMID: 31270124 PMCID: PMC6609123 DOI: 10.1136/bmjopen-2019-030066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To generate system insights on patient and provider levers and strategies that must be activated to improve hospital-based smoking cessation treatment. DESIGN Mixed methods study including a series of in-depth group model building sessions, which informed the design of an online survey completed by healthcare providers and a structured interview protocol administered at the bedside to patients who smoke. SETTING Large, tertiary care hospital in the Midwestern United States. PARTICIPANTS Group model building: 28 healthcare providers and 22 previously-hospitalised patients; Online survey: 308 healthcare providers; Bedside interviews: 205 hospitalised patients. PRIMARY AND SECONDARY OUTCOME MEASURES Hypothesis-generating, participatory qualitative methods informed the examination of the following quantitative outcomes: patient interest versus provider perception of patient interest in smoking cessation and treatment; patient-reported receipt versus provider-reported offering of inpatient smoking cessation interventions; and priority ratings of importance and feasibility of strategies to improve treatment. RESULTS System insights included patients frequently leaving the floor to smoke, which created major workflow disruption. Leverage points included interventions to reduce withdrawal symptoms, and action ideas included nurse-driven protocols for timely administration of nicotine replacement therapy. Quantitative data corroborated system insights; for instance, 80% of providers reported that patients frequently leave the floor to smoke, leading to safety risks, missed assessments and inefficient use of staff time. Patients reported significantly lower rates of receiving any smoking cessation interventions, compared with provider reports (mean difference=17.4%-33.7%, p<0.001). Although 92% of providers cited patient interest as a key barrier, only 4% of patients indicated no interest in quitting or reducing smoking. CONCLUSIONS Engaging hospital providers and patients in participatory approaches to develop an implementation strategy revealed discrepant perceptions of patient interest and frequency of hospital-based treatment for smoking. These findings spurred adoption of standardised point-of-care treatment for cigarette smoking, which remains highly prevalent yet undertreated among hospitalised patients.
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Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Donna Prentice
- Department of Research for Patient Care Services, Barnes-Jewish Hospital, Saint Louis, Missouri, USA
| | - Ellis Ballard
- Brown School of Social Work and Public Health, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
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Streck JM, Bergeria CL, Parker MA, Davis DR, DeSarno M, Sigmon SC, Hughes JR, Gaalema DE, Heil SH, Tidey JW, Stitzer ML, Rothman M, Higgins ST. Response to reduced nicotine content cigarettes among smokers with chronic health conditions. Prev Med Rep 2018; 12:321-329. [PMID: 30416951 PMCID: PMC6224320 DOI: 10.1016/j.pmedr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Matthew Rothman
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
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