title: The effect of removing cost as a barrier to treatment initiation with outpatient tobacco dependence clinics among emergency department patients.
abstract: OBJECTIVE
  The campaign against tobacco addiction and smoking continues to play an important role in public health. However, referrals to outpatient tobacco cessation programs by emergency physicians are rarely pursued by patients following discharge. This study explored cost as a barrier to follow-up.
  
  
  METHODS
  The study was performed at a large urban hospital emergency department (ED) in Camden, New Jersey. Enrollment included adults who reported tobacco use in the past 30 days. Study participants were informed about a "Stop Smoking Clinic" affiliated with the hospital and, depending on enrollment date, cost of treatment was advertised as $150 (standard fee), $20 (reduced fee), or $0 (no fee). Monitoring of patient inquiries and visits to the clinic was performed for 6 months following enrollment of the last study subject.
  
  
  RESULTS
  The analyzed sample consisted of 577 tobacco users. There were no statistically significant demographic differences between treatment groups (p > 0.05). Two-hundred forty-seven (43%) participants reported "very much" interest in smoking cessation. However, there was no significant difference in initiating treatment with the Stop Smoking Clinic across experimental condition. Only a single subject, enrolled in the no-fee phase, initiated treatment with the clinic.
  
  
  CONCLUSIONS
  Cost is unlikely to be the only barrier to pursing outpatient tobacco treatment after an ED visit. Further research is needed to determine the critical components of counseling and referral that maximize postdischarge treatment initiation.
authors.affiliation: University of Massachusetts Medical School, Worcester, USA.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Ozhathil
authors.forename: Beau
authors.initials: B
authors.lastname: Abar
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Baumann
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Douglas
authors.initials: D
authors.lastname: Ziedonis
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Boudreaux
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016540:Smoking Cessation / Q000191:economics* / Q000706:statistics & numerical data*