Strategies to Help Adult ER Patients Quit Smoking

描述（由申请人提供）： 在城市社区，前往医院急诊室（ER）就诊的成年人吸烟率接近40%，远远超过普通人群25%的吸烟率。这些患者中的许多人缺乏容易获得的初级保健，这表明ER可能是一个有吸引力的位点，开始戒烟的努力。美国急诊室每年就诊人数超过1亿，有可能让数百万吸烟者参与戒烟工作。本研究的主要目的是检查是否由外行教育者在急诊室向有戒烟兴趣的成年吸烟者提供的多组分干预比常规护理更有可能导致戒烟。第二个目标是测试患有烟草相关疾病（如ICD 9代码所示）的ER患者是否比患有非烟草相关疾病的ER吸烟者更容易戒烟。这将使我们能够测试“可教时刻”的有效性，作为让患者考虑行为改变的适当时机。 这项研究是一项随机试验，对吸烟的急诊室患者进行动机性访谈，提供文献，访视后随访（加强护理）与转诊到戒烟诊所（最低护理）。资格标准：年龄>= 21岁，考虑或准备阶段的变化，未入院。所有患者将接受标准化阶段的变化评估，并测量尼古丁依赖和呼出的一氧化碳。所有人都将收到一份戒烟情况说明书和戒烟诊所的转介卡;加强护理组的卡将有一个具体的预约日期和时间。加强护理组将收到一本讨论戒烟的语言适当的小册子。我们将记录与每次访视相关的ICD 9代码。主要结局指标：ER访视后3个月内停止，按治疗组分层。次要结局指标：ER访视后3个月内戒烟，按访视是否与吸烟相关分层。如果接受加强护理的吸烟者更有可能戒烟，那么ER可以被认为是一个新的，有效的烟草控制场所，可能会达到数百万吸烟者。如果在ER访视时诊断为吸烟相关的患者比非吸烟相关ICD患者更有可能戒烟9，则这支持了可教时刻的构建。

DESCRIPTION (provided by applicant): In urban communities, the prevalence of tobacco use among adults visiting a hospital emergency room (ER) nears 40%, well in excess of the 25% smoking prevalence rate of the general population. Many of these patients lack easy access to primary care, suggesting the ER may be an attractive locus to initiate tobacco cessation efforts. With over 100 million annual visits to U.S. ERs, it may be possible to engage millions of smokers in tobacco cessation efforts. The major purpose of this study is to examine whether a multicomponent intervention delivered in the ER by a Lay Educator to adult smokers interested in quitting is more likely to result in cessation than usual care. A secondary goal is to test whether patients who present to the ER with a tobacco-related illness (as indicated by ICD9 code) are more likely to quit than ER smokers with a non-tobacco-related condition. This will allow us to test the validity of the "teachable moment" as an opportune time to engage patients in considering a behavioral change. The proposed study is a randomized trial of a motivational interview, provision of literature, and post-visit follow-up (Enhanced Care) vs. referral to a cessation clinic (Minimal Care) for ER patients who smoke. Eligibility criteria: age >= 21 years, contemplation or preparation stage of change, not admitted to hospital. All patients will undergo a standardized stage of change assessment, and measurements of nicotine dependence and exhaled carbon monoxide. All will receive a cessation fact sheet and referral card to the smoking cessation clinic; the cards of those in the Enhanced Care group will have a specific appointment date and time. The Enhanced Care group will receive a language-appropriate pamphlet discussing smoking cessation. We will record the ICD9 codes associated with each visit. Major outcome measure: cessation within 3 months of the ER visit, stratified by treatment group. Secondary outcome measure: cessation within 3 months of the ER visit, stratified by whether the visit was smoking-related. If smokers receiving Enhanced Care are more likely to quit, then the ER could be considered a new, effective locus for tobacco control, potentially reaching several million smokers. If patients with a smoking-related diagnosis for the ER visit are more likely to quit than those with nonsmoking-related ICD9, then this supports the construct of the teachable moment.