SMOKING CESSATION IN THE CHEST PAIN OBSERVATION UNIT

每年约有450万美国人带着胸痛的症状去急诊科就诊。超过90%的患者最终被排除了心肌梗塞和其他急性心血管事件的可能性。需要每隔8小时进行三次系列血液测试以排除MI，这需要在急诊科观察单元(OU)住24小时。在这段时间的大部分时间里，患者都在卧床休息。虽然这些患者中约有25%是吸烟者，但目前还没有采取任何措施来解决这些患者的戒烟问题。因胸痛住院的经历是强烈的，但却是短暂的。这一经历对戒烟和戒烟动机的长期影响尚不清楚。这一经历对个人对吸烟风险的感知的影响，以及个人应对方式如何与OU经历相互作用也是未知的。我们将招募722名吸烟者，并随机将他们分配到(A)常规治疗或(B)强化戒烟治疗。强化治疗包括由主治医生进行简短的干预，与训练有素的健康教育人员进行30分钟的动机量身定做的认知行为访谈，适当时更换尼古丁，以及安排后续电话联系。将收集有关吸烟态度、动机和行为、尼古丁依赖、风险认知和心理应对方式的数据。在招聘后3个月、6个月对L进行跟踪评估。在这两种情况下提供的所有吸烟干预措施的数量和持续时间的执行指数将被统计出来，并分析其对吸烟结果的影响以及与应对方式和风险认知的相互作用，并确定最佳成本效益比。初步结果分析将检查每一次随访时的7天点戒酒患病率和生存分析(首次复发时间)。我们假设：(1)接受强化治疗的吸烟者在TX治疗后6个月将表现出显著更高的戒烟率，(2)与常规治疗相比，更大的改善变量调节戒烟意愿(即决策、自我效能)，(3)应对方式和风险感知将缓和所有受试者的干预效果。这项研究提供的信息是制定针对这一人群的具体吸烟干预措施所必需的。这些发现的广泛应用将达到L每年超过100万的吸烟者。

Approximately 4.5 million Americans visit the emergency department each year with symptoms of chest pain. Over 90% are eventually ruled out for myocardial infarction and other acute cardiovascular events. Three serial blood tests taken at 8 hour intervals are needed to rule out MI, requiring a 24-hour stay in the emergency department Observation Unit (OU). During most of this time patients are at bed rest. While approximately 25% of these patients are smokers, nothing is currently being done to address smoking cessation with these patients. The experience of hospitalization for chest pain is intense, but transient. The long term impact of this experience on smoking cessation and motivation to quit is unknown. The effects of this experience on the individual's perception of risk from smoking, and how personal coping style may interact with the OU experience are also unknown. We will recruit 722 smokers and randomly assign them to either (a) Usual Treatment, or (b) Enhanced Treatment for smoking cessation. Enhanced Treatment consists of a brief intervention by the attending physician, a 30 minute motivationally tailored cognitive behavioral interview with a trained health educator, nicotine replacement when appropriate, and scheduled follow-up phone contacts. Data will be collected on smoking attitudes, motivation and behaviors, nicotine dependence, risk perception, psychological coping style. Follow- up assessments will be conducted at l, 3, and 6 months after recruitment. An implementation index of the amount and duration of all smoking interventions delivered in both conditions will be created statistically, and analyzed for effects on smoking outcomes and interactions with coping style and risk perception, and determination of optimal cost-benefit ratios. Primary outcome analyses will examine 7-day point prevalence abstinence at each follow-up and survival analysis (time to 1st relapse). We hypothesize that; (1)smokers given the Enhanced Treatment will show significantly higher abstinence rates at 6 months post-tx, and (2) greater improvement variables mediating readiness to quit (ie., decision making, self-efficacy), compared to Usual Care and, (3) coping style and risk perception will moderate the efficacy of the intervention for all subjects. Information provided by this study is needed to develop specific smoking interventions targeted to this population. Broad application of these findings should reach over l million smokers per year.