title: Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling.
abstract: Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e., nicotine patches and telephone counseling) in helping these patients stay quit after discharge from the hospital, and assesses a model of hospital-quitline partnership.
  
  
  
  This study had a 2×2 factorial design in which participants were stratified by recruitment site and smoking rate and randomly assigned to usual care, nicotine patches only, counseling only, or patches plus counseling. They were evaluated at 2 and 6 months post-randomization.
  
  
  
  A total of 1,270 hospitalized adult smokers were recruited from August 2011 to November 2013 from five hospitals within three healthcare systems.
  
  
  
  Participants in the patch condition were provided 8 weeks of nicotine patches at discharge (or were mailed them post-discharge). Quitline staff started proactively calling participants in the counseling condition 3 days post-discharge to provide standard quitline counseling.
  
  
  
  The primary outcome measure was self-reported 30-day abstinence at 6 months using an intention-to-treat analysis. Data were analyzed from September 2015 to May 2016.
  
  
  
  The 30-day abstinence rate at 6 months was 22.8% for the nicotine patch condition and 18.3% for the no-patch condition (p=0.051). Nearly all participants (99%) in the patch condition were provided nicotine patches, although 36% were sent post-discharge. The abstinence rates were 20.0% and 21.1% for counseling and no counseling conditions, respectively (p=0.651). Fewer than half of the participants in the counseling condition (47%) received counseling (mean follow-up sessions, 3.6).
  
  
  
  Provision of nicotine patches proved feasible, although their effectiveness in helping discharged patients stay quit was not significant. Telephone counseling was not effective, in large part because of low rates of engagement. Future interventions will need to be more immediate to be effective.
  
  
  
  This study is registered at www.clinicaltrials.gov NCT01289275.
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center at University of California, San Diego, La Jolla, California.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Cummins
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center at University of California, San Diego, La Jolla, California.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Gamst
authors.affiliation: Scripps Mercy Hospital Chula Vista, Chula Vista, California.
authors.forename: Kendra
authors.initials: K
authors.lastname: Brandstein
authors.affiliation: Department of Medicine, University of California, San Diego Health Sciences, La Jolla, California.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Seymann
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois.
authors.forename: Hillary
authors.initials: H
authors.lastname: Klonoff-Cohen
authors.affiliation: Moores Cancer Center at University of California, San Diego, La Jolla, California.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Kirby
authors.affiliation: Department of Internal Medicine, University of California, Davis, Sacramento, California.
authors.forename: Elisa K
authors.initials: EK
authors.lastname: Tong
authors.affiliation: Department of Quality Services and Improvement, Scripps Mercy Hospital, San Diego, California.
authors.forename: Edward
authors.initials: E
authors.lastname: Chaplin
authors.affiliation: Moores Cancer Center at University of California, San Diego, La Jolla, California.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Tedeschi
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center at University of California, San Diego, La Jolla, California. Electronic address: szhu@ucsd.edu.
authors.forename: Shu-Hong
authors.initials: SH
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D017216:Telemedicine; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*