Effectiveness of smoking-cessation interventions for urban hospital patients

描述(由申请人提供)： 我们拟议的研究的目的是检查两家城市医院的患者戒烟干预的有效性和成本效益。住院患者的当前吸烟率高于普通人群(特别是精神病患者)；住院是强制戒烟的时间，也是激励患者并致力于改善其健康的机会之窗。这两家医院主要服务于低收入社区，那里的吸烟率特别高，在获得高质量的医疗保健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接受常规护理，外加通过医院内连接到州电话专线的简短电话咨询。出院时，患者将被随机分配到两组中的一组：由他们医院的戒烟工作人员进行多时段电话咨询，或通过传真转介到纽约州吸烟者专线。所有患者都将接受适当的尼古丁替代疗法。我们假设，强化的出院后干预(即当地辅导员的电话咨询)将导致比传真转介到州Quitline的戒烟率更高的12个月戒烟率。我们的主要结果将是出院后12个月的戒烟率(生化验证)。我们计划比较这两种干预措施的效果和成本效益。次要目标将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个月的戒烟结果。相关性(见说明)：烟草使用是一个严重的公共卫生问题；尽管过去几十年烟草使用有所减少，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疾病患者来说，这是一个特别重要的健康问题。我们的研究旨在确定一种针对这些社区住院人群的低强度、易推广的戒烟干预措施。

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.