PROMOTING SMOKING CESSATION IN HOSPITAL PATIENTS

吸烟是一个极其重要的公共健康问题。这是一个 心血管疾病的主要贡献者和主要原因之一 癌症和呼吸道疾病。过去一段时间内的初级保健研究 二十年来的研究表明，戒烟干预在医学上 设置可以是有效的。然而，发表的报告很少。 检查戒烟干预措施有效性的研究 在医院环境中。住院戒烟干预可以 有可能接触到大量的吸烟者。住院治疗也可以是 一个有效的戒烟建议的“可教时刻”。禁烟令 在医院的适当位置使之成为强制禁欲的时间， 因此，有机会克服身体上瘾的症状。 患者被从他们通常的吸烟环境线索中剔除， 让最初的戒烟变得更容易，他们可能会特别容易接受 在健康状况不佳的时候传递预防性健康信息。最后，还有 更多地接触到患者认为有效和 知识渊博的健康信息来源。拟议中的项目 在实验中测试促进长期戒烟的方法 住院病人。所有吸烟者在27岁以上住进了三家医院- 一个月的时间将被确定为录取过程的一部分。那些 符合资格要求(n=4177)的人将被随机分配到 三种治疗条件之一：最低限度的护理；低强度 干预措施，其核心是医疗保健部门的简短而坚定的建议 吸烟者图表的提供者和标签(PA干预)；以及 PA干预加上更密集的咨询和随访 由研究护士出院(PA+NC干预)。干预 内容包括提供戒烟手册和培训 卫生保健提供者(所有条件)；对健康的结构性提醒 护理人员须提供戒烟意见和提供吸烟 各种医疗保健提供者在以下几个方面提供的戒烟建议 不同场合(PA和PA+NC)；以及住院咨询，即 根据患者特征量身定做，关于生物标记物的反馈 吸烟，循序渐进的护理方法，以及事后的电话咨询 放电(仅限PA+NC)。所有参与者将被跟踪12个月 出院后检查相对疗效 以及戒烟计划的成本效益。此外, 向研究患者提供的戒烟建议的信息，由 出院后12个月内的初级保健医生 将被收集以评估建议可能的协同效应 在住院和门诊环境中提供。

Cigarette smoking is a vitally important public health problem. It is a major contributor to cardiovascular disease and one of the leading causes of cancer and respiratory disease. Research in primary care over the last two decades has indicated that smoking cessation interventions in medical settings can be effective. However, there have been few published reports of research examining the effectiveness of smoking cessation interventions in hospital settings. In-patient smoking cessation interventions can potentially reach a large number of smokers. A hospital stay can also be an effective "teachable moment" for smoking cessation advice. Smoking bans in place in hospitals make it a time of enforced abstinence and, therefore, an opportunity to overcome the symptoms of physical addiction. Patients are removed from their usual environmental cues for smoking, making initial cessation easier, and they might be particularly receptive to preventive health messages at a time of ill-health. Finally, there is increased access to health care providers whom patients see as valid and knowledgeable sources of health information. The proposed project experimentally tests methods to promote long-term smoking cessation in hospitalized patients. All smokers admitted to three hospitals over a 27- month period will be identified as part of the admissions process. Those who meet eligibility requirements (n=4l77) will be randomly assigned to one of three treatment conditions: minimal care; a low intensity intervention whose centerpiece is brief firm advice by health care providers and labelling of the smokers' charts (PA intervention); and the PA intervention plus more intensive counseling and follow-up after discharge performed by a research nurse (PA+NC intervention). Intervention components include provision of smoking cessation manuals and training of health care providers (all conditions); structural reminders to health care providers to give smoking cessation advice and provision of smoking cessation advice by a variety of health care providers on several different occasions (PA and PA+NC); and in-hospital counseling that is tailored to patient characteristics, feedback about a biological marker of smoking, a stepped care approach, and follow-up telephone counseling after discharge (PA+NC only). All participants will be followed for l2 months after discharge from the hospital to examine the relative effectiveness and cost-effectiveness of the smoking cessation programs. In addition, information about smoking cessation advice given to study patients by primary care physicians in the 12 months after discharge from hospital will be gathered to assess the possible synergistic effects of advice provided in in-patient and out-patient settings.