Helping Hospitalized Smokers

A Factorial RCT of Nicotine Patches and Counseling

Sharon E. Cummins, Anthony C. Gamst, Kendra Brandstein, Gregory B. Seymann, Hillary Klonoff-Cohen, Carrie A. Kirby, Elisa Tong, Edward Chaplin, Gary J. Tedeschi, Shu Hong Zhu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e., nicotine patches and telephone counseling) in helping these patients stay quit after discharge from the hospital, and assesses a model of hospital−quitline partnership. Study design This study had a 2×2 factorial design in which participants were stratified by recruitment site and smoking rate and randomly assigned to usual care, nicotine patches only, counseling only, or patches plus counseling. They were evaluated at 2 and 6 months post-randomization. Setting/participants A total of 1,270 hospitalized adult smokers were recruited from August 2011 to November 2013 from five hospitals within three healthcare systems. Intervention Participants in the patch condition were provided 8 weeks of nicotine patches at discharge (or were mailed them post-discharge). Quitline staff started proactively calling participants in the counseling condition 3 days post-discharge to provide standard quitline counseling. Main outcome measures The primary outcome measure was self-reported 30-day abstinence at 6 months using an intention-to-treat analysis. Data were analyzed from September 2015 to May 2016. Results The 30-day abstinence rate at 6 months was 22.8% for the nicotine patch condition and 18.3% for the no-patch condition (p=0.051). Nearly all participants (99%) in the patch condition were provided nicotine patches, although 36% were sent post-discharge. The abstinence rates were 20.0% and 21.1% for counseling and no counseling conditions, respectively (p=0.651). Fewer than half of the participants in the counseling condition (47%) received counseling (mean follow-up sessions, 3.6). Conclusions Provision of nicotine patches proved feasible, although their effectiveness in helping discharged patients stay quit was not significant. Telephone counseling was not effective, in large part because of low rates of engagement. Future interventions will need to be more immediate to be effective. Trial Registration This study is registered at www.clinicaltrials.gov NCT01289275.

Original languageEnglish (US)
Pages (from-to)578-586
Number of pages9
JournalAmerican Journal of Preventive Medicine
Volume51
Issue number4
DOIs
StatePublished - Oct 1 2016

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Tobacco Use Cessation Products
Counseling
Telephone
Smoking
Outcome Assessment (Health Care)
Intention to Treat Analysis
Random Allocation
Hospitalization

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Cummins, S. E., Gamst, A. C., Brandstein, K., Seymann, G. B., Klonoff-Cohen, H., Kirby, C. A., ... Zhu, S. H. (2016). Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling. American Journal of Preventive Medicine, 51(4), 578-586. https://doi.org/10.1016/j.amepre.2016.06.021

Helping Hospitalized Smokers : A Factorial RCT of Nicotine Patches and Counseling. / Cummins, Sharon E.; Gamst, Anthony C.; Brandstein, Kendra; Seymann, Gregory B.; Klonoff-Cohen, Hillary; Kirby, Carrie A.; Tong, Elisa; Chaplin, Edward; Tedeschi, Gary J.; Zhu, Shu Hong.

In: American Journal of Preventive Medicine, Vol. 51, No. 4, 01.10.2016, p. 578-586.

Research output: Contribution to journalArticle

Cummins, SE, Gamst, AC, Brandstein, K, Seymann, GB, Klonoff-Cohen, H, Kirby, CA, Tong, E, Chaplin, E, Tedeschi, GJ & Zhu, SH 2016, 'Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling', American Journal of Preventive Medicine, vol. 51, no. 4, pp. 578-586. https://doi.org/10.1016/j.amepre.2016.06.021
Cummins SE, Gamst AC, Brandstein K, Seymann GB, Klonoff-Cohen H, Kirby CA et al. Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling. American Journal of Preventive Medicine. 2016 Oct 1;51(4):578-586. https://doi.org/10.1016/j.amepre.2016.06.021
Cummins, Sharon E. ; Gamst, Anthony C. ; Brandstein, Kendra ; Seymann, Gregory B. ; Klonoff-Cohen, Hillary ; Kirby, Carrie A. ; Tong, Elisa ; Chaplin, Edward ; Tedeschi, Gary J. ; Zhu, Shu Hong. / Helping Hospitalized Smokers : A Factorial RCT of Nicotine Patches and Counseling. In: American Journal of Preventive Medicine. 2016 ; Vol. 51, No. 4. pp. 578-586.
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abstract = "Introduction Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e., nicotine patches and telephone counseling) in helping these patients stay quit after discharge from the hospital, and assesses a model of hospital−quitline partnership. Study design This study had a 2×2 factorial design in which participants were stratified by recruitment site and smoking rate and randomly assigned to usual care, nicotine patches only, counseling only, or patches plus counseling. They were evaluated at 2 and 6 months post-randomization. Setting/participants A total of 1,270 hospitalized adult smokers were recruited from August 2011 to November 2013 from five hospitals within three healthcare systems. Intervention Participants in the patch condition were provided 8 weeks of nicotine patches at discharge (or were mailed them post-discharge). Quitline staff started proactively calling participants in the counseling condition 3 days post-discharge to provide standard quitline counseling. Main outcome measures The primary outcome measure was self-reported 30-day abstinence at 6 months using an intention-to-treat analysis. Data were analyzed from September 2015 to May 2016. Results The 30-day abstinence rate at 6 months was 22.8{\%} for the nicotine patch condition and 18.3{\%} for the no-patch condition (p=0.051). Nearly all participants (99{\%}) in the patch condition were provided nicotine patches, although 36{\%} were sent post-discharge. The abstinence rates were 20.0{\%} and 21.1{\%} for counseling and no counseling conditions, respectively (p=0.651). Fewer than half of the participants in the counseling condition (47{\%}) received counseling (mean follow-up sessions, 3.6). Conclusions Provision of nicotine patches proved feasible, although their effectiveness in helping discharged patients stay quit was not significant. Telephone counseling was not effective, in large part because of low rates of engagement. Future interventions will need to be more immediate to be effective. Trial Registration This study is registered at www.clinicaltrials.gov NCT01289275.",
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