HOSPITAL-BASED NURSE-MANAGED SMOKING INTERVENTIONS

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Approximately 10 million American smokers are hospitalized each year. Hospital smoking bans facilitate short term abstinence for hospitalized patients, but long-term cessation requires a relapse prevention strategy. The proposed project compares the efficacy of 2 hospital- based nurse-managed interventions for smoking cessation. Smokers admitted to 2 large Kaiser-Foundation hospitals in the San Francisco Bay Area whose responses to a standardized questionnaire reflect a moderate to high intention to quit and whose values of expired CO are less than 10ppm 48-72 hours after enrollment will be randomized to: GP1, usual care (n-1200), GP2, intervention with minimal followup (n-400), or GP3, intervention with intensive followup (n-400). Project nurses' in- hospital counseling of patients in groups 2 and 3 is augmented by a videotape and self help materials. Post -hospital followup in GP2 is through a single RN-initiated telephone contact at 1 week and in GP3 patients who relapse by 12 week receive 1 additional counseling visit and up to 2 additional followup phone contacts. The primary outcome, measured at 1 year, is smoking cessation rate confirmed by salivary cotinine measurements. Power calculations are based on 1 year cessation rates of 15%, 20% and 30% in patients of Groups 1, 2 and 3, respectively. At a cost of approximately $42 and an expected cessation rate of 30% the GP3 intervention has an estimated cost effectiveness ratio of $280/pt, compared to $480/pt for the GP2 intervention, which costs about $24 and has an expected cessation rate of 20%. Targeting the interventions to the needs of specific subgroups of patients may be facilitated by multivariate analysis of demographic, medical and smoking variables. End-products of the research that facilitate dissemination include 1) an efficient training program for nurses, 2) effective instructional materials for patients and 3) user-friendly computer software that enhances the efficacy and efficiency of the interventions.