Effectiveness of smoking-cessation interventions for urban hospital patients

描述（由申请人提供）： 本研究的目的是检验两所城市医院对患者进行戒烟干预的有效性和成本效益。住院患者人群目前吸烟的流行率高于一般人群（特别是精神病患者）;住院代表了强制戒烟的时间，也是促使患者积极参与改善健康的机会之窗。这两家医院主要为低收入社区服务，这些社区的吸烟率特别高，在接受高质量的医疗服务和实现良好的医疗保健结果方面存在许多障碍。在住院期间，所有登记的吸烟者将通过医院内与州电话戒烟热线的连接接受常规护理和简短的电话咨询。出院时，患者将被随机分配到两组之一：由医院戒烟人员进行多时段电话咨询，或传真转介到纽约州吸烟者戒烟热线。所有患者将接受适当的尼古丁替代治疗。我们假设，加强出院后干预（即当地辅导员的电话咨询）将导致更大的12个月戒烟率比传真转介到国家戒烟热线。我们的主要结果是出院后12个月的戒烟率（经生化验证）。我们计划比较这两种干预措施的有效性和成本效益。次要目的包括探索特定患者亚组的有效性差异，以及检查出院后3个月和6个月的戒烟结局。相关性（参见说明）：烟草使用是一个关键的公共卫生问题;尽管过去几十年来使用有所减少，但减少的速度似乎已经放缓。对于社会经济地位较低的群体和精神病患者来说，这是一个特别重要的健康问题。我们的研究旨在确定一种低强度，易于推广的戒烟干预措施，针对这些社区的住院人群。

DESCRIPTION (provided by applicant): The purpose of our proposed study is to examine the effectiveness and cost-effectiveness of a smoking- cessation intervention for patients at two urban hospitals. The population of hospitalized patients has a higher prevalence of current smoking than the general population (especially among psychiatric patients); hospitalization represents a time of enforced abstinence and a window of opportunity to get patients motivated and engaged in improving their health. These two hospitals serve primarily low-income communities, where there are particularly high rates of smoking and many barriers to receiving high-quality health cai'e and achieving good health care outcomes. During hospitalization, all enrolled smokers will receive usual care plus brief telephone counseling via an in- hospital connection to the state telephone Quitline. At the time of discharge, patients will be randomized to one of two arms: multisession telephone counseling by their hospital's smoking cessation staff, or faxed referral to the New York State Smokers' Quitline. All patients will receive appropriate nicotine replacement therapy. We hypothesize that the enhanced post-discharge intervention (i.e. telephone counseling by local counselors) will result in greater 12-month smoking abstinence rates than the faxed referral to the state Quitline. Our primary outcome will be smoking abstinence rate (biochemically verified) at 12 months post-discharge. We plan to compare the effectiveness and the cost-effectiveness of these two interventions. Secondary aims will involve explorations of differences in effectiveness in specific patient subgroups, and examination of smoking abstinence outcomes at 3-months and 6-months post-discharge. RELEVANCE (See instructions): Tobacco use is a critical public-health issue; despite a decrease in use over the past decades, the rate of this decrease seems to have slowed. It is a particularly important health issue for groups of lower socioeconomic status and patients with mental illness. Our study aims to determine a low-intensity, easily generalizable smoking-cessation intervention targeting hospitalized populations from these communities.