Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement: a randomized trial.
OBJECTIVE
To determine whether an intensive cognitive-behavioral intervention begun during hospitalization when combined with transdermal nicotine replacement therapy is more effective than a minimal counseling intervention combined with transdermal nicotine replacement therapy in helping inpatients to quit smoking.


METHODS
A total of 223 patients who smoked were enrolled in a hospital-based randomized smoking cessation trial at the San Francisco Veterans Affairs Medical Center. One hundred and seven participants (48%) received intensive counseling and outpatient telephone follow-up; 116 participants (52%) received minimal counseling. All study participants received 2 months of transdermal nicotine replacement therapy. We determined 6-month quit rates by self-report and measured saliva cotinine levels or obtained proxy reports to confirm self-reported smoking cessation at 12 months. Analyses adjusted for baseline differences in the distribution of coronary disease.


RESULTS
At 6 months, 35% (36/103) of the intensive intervention group reported quitting, compared with 21% (23/109) of the comparison group (relative risk [RR] = 1.7; 95% confidence interval [CI]: 1.1 to 2.7). At 12 months, the self-reported quit rate was 33% (33/99) in the intensive intervention group versus 20% (21/103) in the comparison group (RR = 1.7; 95% CI: 1.1 to 2.7). Based on biochemical or proxy confirmation, 29% (30/102) in the intensive intervention group versus 20% (21/107) in the comparison group quit smoking at 12 months (RR = 1.6; 95% CI: 0.96 to 2.5).


CONCLUSIONS
Hospital-initiated smoking cessation interventions that include transdermal nicotine replacement therapy can improve long-term quit rates.
Simon
Joel A
JA
General Internal Medicine Section, Department of Veterans Affairs Medical Center, San Francisco, California 94121, USA. jasimon@itsa.ucsf.edu
Carmody
Timothy P
TP
Hudes
Esther S
ES
Snyder
Elizabeth
E
Murray
Jana
J
D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000008:administration & dosage* / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D016540:Smoking Cessation; D014029:Tobacco Use Disorder / Q000628:therapy*
D018722:Nicotinic Agonists; D009538:Nicotine