Predicting smoking stage of change among emergency department patients and visitors.
OBJECTIVE
Little is known about whether emergency department (ED) patients or those who accompany them (visitors) are interested in smoking cessation. The authors hypothesized that several variables would be associated with stage of change, including nicotine dependence, self-efficacy, presence of a smoking-related illness, and anticipated cessation-related health improvement.


METHODS
For two 24-hour periods, consecutive patients and visitors aged 18 years and older presenting to four Boston EDs were interviewed. The authors assessed a range of smoking-related constructs. Exclusion criteria included severe illness, cognitive insufficiency, and acute distress.


RESULTS
One thousand ten subjects were screened (56% patients, 44% visitors). Two hundred thirty-seven (23%) subjects were current smokers, with 57% being in precontemplation, 31% in contemplation, and 12% in preparation stages. When ordinal regression was used, the variables most strongly associated with stage of change were as follows: self-efficacy (odds ratio [OR] = 5.1; p < 0.001), anticipated cessation-related health improvement (OR = 2.7; p = 0.02), and having a smoking-related health problem (OR = 1.9; p = 0.08).


CONCLUSIONS
Because many disenfranchised Americans use the ED as a regular source of health care, increased attention to smoking in the ED setting holds tremendous public health potential. This study's results reinforce the validity of the stage-of-change model within the ED setting. Developers of ED-initiated interventions will have to consider the heterogeneity in stage of change when designing their treatments.
Boudreaux
Edwin D
ED
Department of Emergency Medicine, MDNJ-Robert Wood Johnson Medical School, Cooper Hospital, Camden, NJ, USA. boudreaux-edwin@cooperhealth.edu
Hunter
Gabrielle C
GC
Bos
Karen
K
Clark
Sunday
S
Camargo
Carlos A
CA
D000328:Adult; D001900:Boston; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D009042:Motivation; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D020377:Self Efficacy; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D014789:Visitors to Patients / Q000706:statistics & numerical data*