Smoking-Cessation Interventions for Urban Hospital Patients A Randomized Comparative Effectiveness Trial
Smoking-Cessation Interventions for Urban Hospital Patients A Randomized Comparative Effectiveness Trial
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DOI：
10.1016/j.amepre.2016.06.023
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发表时间：
2016-10-01
影响因子：
5.5
通讯作者：
Grossman, Ellie
中科院分区：
文献类型：
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作者：
Sherman, Scott E.;Link, Alissa R.;Grossman, Ellie
住院治疗是一个独特的戒烟机会，但先前的干预措施在狭义人群中具有可测量的效果。本研究的目的是招募两家“安全网”医院的吸烟者，并比较两种出院后戒烟干预措施的有效性。设计：随机比较疗效试验。背景/参与者：在纽约市的两家公立医院，每个被确定为吸烟者的住院病人（基于入院记录）都被接触。纳入标准为：过去30天内吸烟；会说英语、西班牙语或普通话；有美国电话号码；未被送往限制随访或吸烟的机构；而不是怀孕或哺乳。在2011年7月至2014年4月期间确定为当前吸烟者的18,797例患者中，共有3,047例（16%）在接触前出院，3,273例（17%）不是当前吸烟者，4,026例（21%）没有美国电话号码，2,831例（15%）因其他原因不符合条件，3,983例（21%）拒绝参与。总共有1618名（9%）参与者参加了这项研究。在随访期间，69%的参与者在2个月和68%的参与者在6个月时得到了满足。干预：在出院时，参与者被随机分配到由研究人员提供的多时段电话咨询（n=804）或转介到州戒烟热线进行主动外展和咨询（n=814）。主要结果测量：测量6个月时自我报告的戒断。分析是在2015年底进行的。结果：四分之一的参与者无家可归或住在不稳定的房子里，60%的人有药物滥用史，43%的人报告目前有危险饮酒，一半的人有药物滥用以外的精神诊断。随访时，强化咨询组的戒断率（30天点患病率）在2个月时高于戒断线组（29.0% vs 20.7%；相对危险度=1.40;95% CI=1.13, 1.73）和6个月时（37.4% vs 31.5%；相对危险度=1.19;95% CI=1.01, 1.40）。结论：强化咨询比转介到国家戒烟热线更有效。两组的长期禁欲效果都很好。尽管有最低的排除标准，许多患者仍不符合入组条件。由爱思唯尔公司代表美国预防医学杂志出版。
Introduction: Hospitalization is a unique opportunity for smoking cessation, but prior interventions have measured efficacy with narrowly defined populations. The objective of this study was to enroll smokers admitted to two "safety net" hospitals and compare the effectiveness of two post-discharge cessation interventions.Design: A randomized comparative effectiveness trial was conducted.Setting/participants: At two New York City public hospitals, every hospitalized patient identified as a smoker (based on admission records) was approached. Inclusion criteria were: smoked cigarettes in the past 30 days; spoke English, Spanish, or Mandarin; had a U.S. phone number; not discharged to an institution where follow-up or smoking was limited; and not pregnant/breastfeeding. Of 18,797 patients identified as current smokers between July 2011 and April 2014, a total of 3,047 (16%) were discharged before being approached, 3,273 (17%) were not current smokers, 4,026 (21%) had no U.S. phone number, 2,831 (15%) were ineligible for other reasons, and 3,983 (21%) refused participation. In total, 1,618 (9%) participants enrolled in the study. During follow-up, 69% of participants were reached at 2 months and 68% at 6 months.Intervention: At discharge, participants were randomized to multisession telephone counseling from study staff (n=804) or referral to the state quitline for proactive outreach and counseling (n=814).Main outcome measures: Self-reported abstinence at 6 months was measured. Analyses were conducted in late 2015.Results: One quarter of participants were homeless or in unstable housing, 60% had a history of substance abuse, 43% reported current hazardous drinking, and half had a psychiatric diagnosis other than substance abuse. At follow-up, the rate of abstinence (30-day point prevalence) was higher in the intensive counseling arm than the quitline arm at 2 months (29.0% vs 20.7%; relative risk=1.40; 95% CI=1.13, 1.73) and 6 months (37.4% vs 31.5%; relative risk=1.19; 95% CI=1.01, 1.40).Conclusions: Intensive counseling was more effective than referral to the state quitline. Long-term abstinence was excellent in both groups. Many patients were not eligible for enrollment despite minimal exclusion criteria. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.