Effectiveness of Smoking-cessation Interventions for Urban Hospital Patients

Conditions

Smoking Cessation

Keywords

cost effectiveness, behavioral health counseling

Brief summary

The investigators plan to compare the effectiveness and cost effectiveness of an inpatient smoking cessation intervention for all smokers hospitalized at two urban public hospitals.

Detailed description

Our sites are: Bellevue Hospital Center (a New York City public hospital) and the Manhattan campus of the VA New York Harbor Healthcare System. During hospitalization, all smokers will receive usual care. At the time of discharge, patients will be randomized to one of two arms: multisession telephone counseling by their hospital's smoking cessation staff, or faxed referral to the state Quitline (which will then perform phone outreach as per Quitline protocol). All patients enrolled in the study will receive nicotine replacement therapy. The primary aims are: Aim 1: To compare the effectiveness of the intervention (proactive multisession telephone counseling by in-hospital staff) versus control ('fax-to-quit' Quitline referral). Aim 2: To evaluate and compare the cost-effectiveness of these interventions from a societal perspective and from a payer perspective. The secondary aims are: Secondary Aim 1: To compare outcomes by race/ethnicity, immigrant status, inpatient diagnosis, and location of patient hospitalization Secondary Aim 2: To compare outcomes of the interventions at 6 and 12 months post-discharge Secondary Aim 3: To compare biochemically-verified abstinence rates at 6 months post-discharge Secondary Aim 4: To compare cessation outcomes between those who are known HIV-seropositive and those who are not, and explore possible mediators of cessation in HIV-seropositive patients

Virginia A. Triant, Ellie Grossman, Nancy A. Rigotti, Rekha Ramachandran, Susan Regan et al. (9 authors)

Nicotine & Tobacco Research2019-09-137 citations

10.1093/ntr/ntz168

Characteristics of Urban Inpatient Smokers With and Without Chronic Pain: Foundations for Targeted Cessation Programs.

Cody GR, Wang B, Link AR, Sherman SE.

2019-02-014 citations

10.1080/10826084.2018.1563186

Smoking-Cessation Interventions for Urban Hospital Patients: A Randomized Comparative Effectiveness Trial.

Sherman SE, Link AR, Rogers ES, Krebs P, Ladapo JA, Shelley DR, Fang Y, Wang B, Grossman E.

2016-10-0138 citations

10.1016/j.amepre.2016.06.023

Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART)

Sonia A. Duffy, Sharon E. Cummins, Jeffrey L. Fellows, Kathy Harrington, Carrie Kirby et al. (9 authors)

Tobacco Induced Diseases2015-09-0119 citations

10.1186/s12971-015-0056-5

Effectiveness of smoking-cessation interventions for urban hospital patients: study protocol for a randomized controlled trial.

Grossman E, Shelley D, Braithwaite RS, Lobach I, Goffin A, Rogers E, Sherman S.

2012-08-0121 citations

10.1186/1745-6215-13-126

Interventions

BEHAVIORALTelephone Counseling

Telephone counseling: 7 calls over 6 weeks

BEHAVIORALFax-to-quit

referral to state smoking cessation 'quitline' for counseling - 1 call over 2 weeks

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* age ≥ 18 years * smoked tobacco during the prior 30 days * have an active phone number * provide consent in English, Spanish or Mandarin

Exclusion criteria

* Patients will be excluded if they use only smokeless tobacco or products such as betel (since there is not yet efficacy data for treating use of these tobacco products in the inpatient setting) * are pregnant or breastfeeding * are discharged to an institution (e.g. jail/prison, nursing home, long-term psychiatric facility).

Design outcomes

Primary

Measure	Time frame	Description
Effectiveness of counseling intervention vs. control intervention on smoking cessation rates of participants enrolled in study	4 yrs	To compare the effectiveness of a phone counseling intervention (proactive multisession telephone counseling by in-hospital staff) versus control intervention ('fax-to-quit' Quitline referral)

Secondary

Measure	Time frame	Description
Comparison of cessation rates at 6 and 12 months post-discharge	4yrs	To compare smoking abstinence rates in the two arms at 6 months and 12 months post-discharge
Comparison of biochemically-verified smoking cessation	4 years	To compare rates of biochemically-verified smoking abstinence measured at 6 months post-discharge
Comparison of cessation outcomes by sociodemographic subgroups	4yrs	To compare smoking abstinence rates by race/ethnicity, immigrant status, inpatient diagnosis, and location of patient hospitalization
Comparison of cessation outcomes between participants who are HIV-seropositive vs. those who are not	2 years	To compare cessation outcomes between those who are known HIV-seropositive and those who are not, and explore possible mediators of cessation in HIV-seropositive patients.
Cost Effectiveness comparison of two smoking cessation interventions.	4 yrs	Evaluate and compare the cost-effectiveness of these interventions from a societal perspective and from a payor perspective. Our hypotheses are that the intervention will have incremental cost-effectiveness ratios consistent with current standards of healthcare value in the United States.

Countries

United States

Outcome results

None listed