SMOKING CESSATION IN THE CHEST PAIN OBSERVATION UNIT

每年大约有450万美国人因为胸痛的症状去急诊室就诊。超过90%的患者最终被排除心肌梗死和其他急性心血管事件。需要每隔8小时进行三次连续血液检查以排除心肌梗死，需要在急诊科观察室（OU）住院24小时。在这段时间里，病人大多卧床休息。虽然这些患者中约有25%是吸烟者，但目前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，但短暂的。这种经历对戒烟和戒烟动机的长期影响尚不清楚。这种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，并将他们随机分配到(a)常规治疗组或(b)强化戒烟治疗组。强化治疗包括主治医生的简短干预，训练有素的健康教育者进行30分钟的有动机的认知行为访谈，适当时尼古丁替代，并安排随访电话联系。将收集有关吸烟态度、动机和行为、尼古丁依赖、风险感知、心理应对方式等方面的数据。在入职后的第1、3、6个月将进行随访评估。在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实施指数将被统计创建，并分析对吸烟结果的影响以及与应对方式和风险感知的相互作用，并确定最佳成本效益比。主要结局分析将检查每次随访的7天点流行戒断和生存分析（到第一次复发的时间）。我们假设；(1)接受强化治疗的吸烟者在戒烟后6个月的戒烟率显著提高；(2)更大的改善变量介导戒烟准备（即戒烟意愿）。(3)应对方式和风险感知会调节干预对所有被试的效果。需要这项研究提供的信息来制定针对这一人群的具体吸烟干预措施。这些发现的广泛应用每年应惠及100多万吸烟者。

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.