title: Emergency department initiated treatments for tobacco (EDITT): a pilot study.
abstract: BACKGROUND
  Emergency departments (EDs) have strong potential to initiate tobacco interventions with economically disadvantaged populations.
  
  
  OBJECTIVE
  We piloted three ED-initiated tobacco interventions and derived parameter estimates for future trials.
  
  
  METHODS
  The study enrolled adult patients being treated in an urban ED who were daily smokers. Exclusion criteria included severe illness or pain, isolation (for contagion), altered mental status, an insurmountable language barrier, temporary residence, and lack of telephone access. Subjects in the Bedside + Booster group received motivational counseling by a trained counselor at the bedside, up to three telephone sessions post-visit, and a self-help guide. Subjects in the Faxed Referral group had their personal contact information faxed to the hospital's tobacco dependence clinic, whereupon they received identical treatment as the Bedside + Booster group, but all sessions occurred over the telephone (i.e., no bedside counseling). The Standard Referral group received the self-help guide and a referral to the hospital's tobacco dependence clinic. We used a 2:2:1 randomization schedule to maximize our experience with the motivational interventions. Outcomes were assessed at 1 and 3 months.
  
  
  RESULTS
  We enrolled 90 subjects. Of the 36 subjects assigned to the Bedside + Booster condition, 31 (87%) completed bedside counseling and at least one booster session, while 22 (61%) completed the maximum four sessions. Of the 37 subjects assigned to the Faxed Referral group, 28 (76%) completed at least one telephone session, while 19 (51%) completed the maximum four sessions. Quit attempts over the 3 months ranged from 18% (Standard Referral) to 57% (Faxed Referral). Seven-day abstinence was attained by 8% (Bedside + Booster), 14% (Faxed Referral), and 6% (Standard Referral) at 3 months.
  
  
  CONCLUSIONS
  Motivational cessation counseling can be feasibly initiated during the ED encounter with minimal medical staff involvement. Adequately powered trials are needed to study ED-initiated interventions that include post-visit follow-up.
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, NJ, USA. boudreaux-edwin@cooperhealth.edu
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.forename: Jeneva
authors.initials: J
authors.lastname: Perry
authors.forename: Donald
authors.initials: D
authors.lastname: Marks
authors.forename: Susanna
authors.initials: S
authors.lastname: Francies
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Douglas
authors.initials: D
authors.lastname: Ziedonis
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital; D006801:Humans; D009042:Motivation; D010353:Patient Education as Topic; D010865:Pilot Projects; D016540:Smoking Cessation / Q000379:methods*