title: Nicotine dependence, motivation to quit, and diagnosis among adult emergency department patients who smoke: a national survey.
abstract: Patients in hospital emergency departments smoke more than the general population. Smoking profiles of these patients have largely been characterized in small, single-institution cohorts. Our objective was to survey adult smokers visiting a sample of U.S. emergency departments, as part of a study examining the efficacy of an educational intervention on physicians' knowledge, attitudes, and behavior regarding tobacco control. A convenience sample of patients in eight academic emergency departments was surveyed from May to July 2006. Eligible patients were aged 18 years or older, were every- or some-day smokers, spoke English or Spanish, were able to provide written informed consent, and were not actively psychotic. Descriptive statistics are reported using parametric and nonparametric measures. A total of 1,168 patients were interviewed (mean age = 40.7 years); 46.5% were female, 54.4% were uninsured or had Medicaid, and 29.9% had no usual source of care. Patients smoked a median of 10 cigarettes daily, with a median score on the Fagerstrom Test for Nicotine Dependence of 4, and a median score of 5 on the nine-point contemplation ladder, indicating a desire to quit within 6 months. Smokers with a diagnosis of cardiovascular, respiratory, or malignant disease were more interested in quitting than others (median ladder score = 4 vs. 6, p<.001), were more likely to believe they had a smoking-related illness, and were more likely to believe their emergency department visit was related to smoking. Smokers with a presenting complaint of chest pain or dyspnea were more interested in quitting than others (median ladder score = 4 vs. 6, p = .002). Emergency department patients smoked at moderate amounts, with moderate levels of addiction and interest in quitting. Smokers with tobacco-related diagnoses, or who believed their emergency department visit was related to smoking, were more interested in quitting. These findings suggest that the emergency department visit may provide a teachable moment to reach smokers who have tobacco-related problems.
authors.affiliation: Albert Einstein College of Medicine, Albert Einstein Cancer Center, and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. sbernste@montefiore.org
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.forename: Lisa
authors.initials: L
authors.lastname: Cabral
authors.forename: Rita K
authors.initials: RK
authors.lastname: Cydulka
authors.forename: David
authors.initials: D
authors.lastname: Schwegman
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Larkin
authors.forename: Annette L
authors.initials: AL
authors.lastname: Adams
authors.forename: Lynne B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000453:epidemiology* / Q000523:psychology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D020377:Self Efficacy; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology