Effects of post-discharge counseling and medication utilization on short and long-term smoking cessation among hospitalized patients

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.Numerous studies have tested the effect of multicomponent post-discharge smoking cessation interventions on post-discharge smoking cessation, and many are effective. However, little is known regarding the relative efficacy of the different intervention components on short or long-term cessation. The present study is a secondary analysis (n = 984) of a randomized controlled trial for hospitalized smokers that took place at two large hospitals in Kansas from 2011 to 2014. All study participants were offered post-discharge quitline services. Pharmacotherapy was recommended during bedside tobacco treatment. The study outcomes were self-reported cessation at 1-month and biochemically verified cessation at 6-months post-randomization. During the post-discharge period, 69% of participants completed at least one quitline call and 28% of participants reported using cessation pharmacotherapy. After controlling for known predictors of cessation among hospitalized smokers, both the number of total quitline calls completed post-discharge and use of cessation pharmacotherapy post-discharge were predictive of cessation at 1-month. After accounting for predictors of cessation and quitting at 1-month, total post-discharge quitline calls was associated with cessation at 6-months (OR [95% CI] = 1.23 [1.12, 1.35], p < 0.001) while post-discharge cessation pharmacotherapy use was not. The results suggest that both engagement in quitline services and use pharmacotherapy independently facilitate cessation beyond the influence of known clinical characteristics associated with cessation. Over the longer term, the effect of engaging in quitline services persists while the effect of pharmacotherapy diminishes. To optimize outcomes, future research should investigate methods to increase utilization of medications and promote sustained counseling engagement in order to sustain the effects of treatment during the post-discharge period.NIH National Heart, Lung, and Blood Institute (U01 HL105232

An Evaluation of SmokeFree for Kansas Kids: An Intervention to Promote Tobacco Cessation in Pediatric Clinics

Introduction. Smokefree for Kansas Kids is a program designedto train pediatric clinic staff to assess for tobaccoexposure and provide brief smoking cessation interventionsto caregivers and patients. The purpose of this studywas to evaluate the impact of this program and improvefuture tobacco intervention efforts in pediatric clinics. Methods. Eighty-six pediatric physicians and staff attendedat least one of three training sessions. A randomsample of pediatric medical records was selected pre-intervention(n = 49) and post-intervention (n = 150). Electronicmedical records were reviewed to assess for documentationof tobacco use intervention implemented in the clinic. Results. Of the 199 pediatric clinic visits reviewed, 197 metthe study criteria. All but one visit documented an assessmentof tobacco exposure. Among children exposed to tobacco (n= 42), providers were more likely to discuss tobacco use withcaregivers post-intervention (35.7%) compared to pre-intervention(7.1%; p &lt; 0.05). One in five caregivers in the postinterventiongroup were advised to quit (21.4%) compared tothe pre-intervention group (7.1%). In the post-interventiongroup, 14.3% were referred to the state quitline compared tono referrals in the pre-intervention group. The difference inrates for providing advice and referral between pre-interventionand post-intervention were not statistically significant. Conclusions. Implementation of the Smoke Free for Kansas Kidsintervention was associated with modest improvements in clinictobacco intervention efforts, but many patients still failed toreceive optimal assessments or interventions. Additional effortsmay be needed to enhance this program. KS J Med 2017;10(1):7-11

The Role of Neighborhood Experiences in Psychological Distress among African American and White Smokers

Residential area characteristics and discrimination have been associated with psychological distress. Differences in these relationships across racial groups are not well understood. We examined the relative role of perceived discrimination, neighborhood problems, and neighborhood cohesion/trust in explaining differences in psychological distress (indicated by anxiety and depressive symptoms) between 224 African American and 225 white smokers (income ≤ 400% federal poverty level) in a smoking cessation intervention study. Surveys were linked to US census tract data. We conducted random intercept Poisson multilevel regression models and examined interactions between race and neighborhood experiences. African Americans had greater risk of anxiety and depressive symptoms and greater individual and neighborhood disadvantage than whites. Controlling for objective neighborhood characteristics, when perceived discrimination and perceived neighborhood characteristics were added to the regression models, the association between anxiety symptoms and race were no longer statistically significant; the association between depressive symptoms and race decreased, but remained statistically significant. Lower neighborhood social cohesion/trust and greater neighborhood problems increased depressive symptoms for African Americans, but not for whites. Perceived discrimination and neighborhood social cohesion/trust outweighed the importance of race in explaining anxiety symptoms. These findings underscore the need for multilevel interventions addressing social and environmental contexts

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

Background This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. Methods Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. Results Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. Conclusions While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. Trial registration - Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217. - Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275. - Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928. - Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250. - Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245. - Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176. - Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079

Enhancing partner support to improve smoking cessation.

Authors' conclusions: Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified

Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment

Abstract Background Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps. Methods Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis. Results Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge. Conclusions To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes. Trial registration Number: NCT01305928. Date registered: February 24, 2011