Approximately 10 million American smokers are hospitalized each year. Hospital smoking bans facilitate short term abstinence for hospitalized patients, but long-term cessation requires a relapse prevention strategy. The proposed project compares the efficacy of 2 hospital- based nurse-managed interventions for smoking cessation. Smokers admitted to 2 large Kaiser-Foundation hospitals in the San Francisco Bay Area whose responses to a standardized questionnaire reflect a moderate to high intention to quit and whose values of expired CO are less than 10ppm 48-72 hours after enrollment will be randomized to: GP1, usual care (n-1200), GP2, intervention with minimal followup (n-400), or GP3, intervention with intensive followup (n-400). Project nurses' in- hospital counseling of patients in groups 2 and 3 is augmented by a videotape and self help materials. Post -hospital followup in GP2 is through a single RN-initiated telephone contact at 1 week and in GP3 patients who relapse by 12 week receive 1 additional counseling visit and up to 2 additional followup phone contacts. The primary outcome, measured at 1 year, is smoking cessation rate confirmed by salivary cotinine measurements. Power calculations are based on 1 year cessation rates of 15%, 20% and 30% in patients of Groups 1, 2 and 3, respectively. At a cost of approximately $42 and an expected cessation rate of 30% the GP3 intervention has an estimated cost effectiveness ratio of $280/pt, compared to $480/pt for the GP2 intervention, which costs about $24 and has an expected cessation rate of 20%. Targeting the interventions to the needs of specific subgroups of patients may be facilitated by multivariate analysis of demographic, medical and smoking variables. End-products of the research that facilitate dissemination include 1) an efficient training program for nurses, 2) effective instructional materials for patients and 3) user-friendly computer software that enhances the efficacy and efficiency of the interventions.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL046260-03
Application #
2222765
Study Section
Health Systems Research (HSR)
Project Start
1991-08-01
Project End
1995-07-31
Budget Start
1993-08-01
Budget End
1995-07-31
Support Year
3
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
800771545
City
Stanford
State
CA
Country
United States
Zip Code
94305
Smith, P M; Kraemer, H C; Miller, N H et al. (1999) In-hospital smoking cessation programs: who responds, who doesn't? J Consult Clin Psychol 67:19-27
Miller, N H; Smith, P M; DeBusk, R F et al. (1997) Smoking cessation in hospitalized patients. Results of a randomized trial. Arch Intern Med 157:409-15
Taylor, C B; Miller, N H; Herman, S et al. (1996) A nurse-managed smoking cessation program for hospitalized smokers. Am J Public Health 86:1557-60