title: Smoking-Cessation Interventions for Urban Hospital Patients: A Randomized Comparative Effectiveness Trial.
abstract: Hospitalization is a unique opportunity for smoking cessation, but prior interventions have measured efficacy with narrowly defined populations. The objective of this study was to enroll smokers admitted to two "safety net" hospitals and compare the effectiveness of two post-discharge cessation interventions.
  
  
  
  A randomized comparative effectiveness trial was conducted.
  
  
  
  At two New York City public hospitals, every hospitalized patient identified as a smoker (based on admission records) was approached. Inclusion criteria were: smoked cigarettes in the past 30 days; spoke English, Spanish, or Mandarin; had a U.S. phone number; not discharged to an institution where follow-up or smoking was limited; and not pregnant/breastfeeding. Of 18,797 patients identified as current smokers between July 2011 and April 2014, a total of 3,047 (16%) were discharged before being approached, 3,273 (17%) were not current smokers, 4,026 (21%) had no U.S. phone number, 2,831 (15%) were ineligible for other reasons, and 3,983 (21%) refused participation. In total, 1,618 (9%) participants enrolled in the study. During follow-up, 69% of participants were reached at 2 months and 68% at 6 months.
  
  
  
  At discharge, participants were randomized to multisession telephone counseling from study staff (n=804) or referral to the state quitline for proactive outreach and counseling (n=814).
  
  
  
  Self-reported abstinence at 6 months was measured. Analyses were conducted in late 2015.
  
  
  
  One quarter of participants were homeless or in unstable housing, 60% had a history of substance abuse, 43% reported current hazardous drinking, and half had a psychiatric diagnosis other than substance abuse. At follow-up, the rate of abstinence (30-day point prevalence) was higher in the intensive counseling arm than the quitline arm at 2 months (29.0% vs 20.7%; relative risk=1.40; 95% CI=1.13, 1.73) and 6 months (37.4% vs 31.5%; relative risk=1.19; 95% CI=1.01, 1.40).
  
  
  
  Intensive counseling was more effective than referral to the state quitline. Long-term abstinence was excellent in both groups. Many patients were not eligible for enrollment despite minimal exclusion criteria.
  
  
  
  This study is registered at www.clinicaltrials.gov NCT01363245.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, VA New York Harbor Healthcare System, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: scott.sherman@med.nyu.edu.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Alissa R
authors.initials: AR
authors.lastname: Link
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Research Service, VA New York Harbor Healthcare System, New York, New York.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Rogers
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Research Service, VA New York Harbor Healthcare System, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Krebs
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ladapo
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Shelley
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Binhuan
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Ellie
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064876:Safety-net Providers / Q000706:statistics & numerical data; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data