PREDICTORS OF CONTINUED SMOKING ABSTINENCE AMONG HOSPITALIZED PATIENTS

1. PREDICTORS OF CONTINUED SMOKING ABSTINENCE AMONG HOSPITALIZED PATIENTS Masuet Aumatell C, Ramon Torrell JM, Morchon Ramos S, Lopez Salguero GL Health Promotion Hospitals Conference, Dublin 2005

2. Empowerment strategy Better health for the patients Better health for the HCW A more healthy organisation Better health for the community

3. Background • No-smoking policies are mandatory in all Spanish hospitals. • The smoker patients require to abstain temporarily from tobacco. • Nevertheless 25% of hospitalised smokers report smoking during hospital stay, although 4% of smokers do it indoors (Rigotti, 2000). In our hospital we made a survey in 2003 and we found 35%, and 5% respectively. Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Pasternak RC, Singer DE. Smoking by patients in a smoke-free hospital: prevalence, predictors and implications. Prev Med 2000; 31 (2): 159-66.

4. Predictors of continued abstinence (review)

5. MATERIAL AND METHODS Objective: to determine predictors of continued smoking abstinence 30-minute bedside counseling session Continued abstinence 6 monthly counseling telephone calls ?% 220 • -Cardiac, respiratory, surgical and medical patients • University-affiliated hospital from January to June 2004 • Current smokers at admission

6. MATERIAL AND METHODS • Outcome measurements: Continuous abstinence at six months by self-report (not validated). • Statistical analysis:categorical variables were studied by chi-squared test, continuous variables by Student T test, and the statistically significant associated were included in a logistic regression model (step-forward).

7. Results • At 6 months post-discharge, 73 (33%) patients remained abstinent, being 43% in cardiology ward, and 24.9% in respiratory ward.

9. Logistic regression

10. Conclusion • Among this cohort of inpatients receiving smoking cessation intervention the motivation stage was the only independent predictor of smoking abstinence at 6 months after hospital discharge being over twice as likely to maintain the abstinence. • On the other hand sex, the tobacco dependence, the family smoker member, type of ward, prior attempts to quit were not obtained as predictors.

11. Discussion • Multiple session verbal advice delivered by phone might have insufficient power to influence highly dependent smokers, even if single one has been demostrated to have less power (Hajek, 2002). • Low continued abstinence rate (33%) but comparable to other series if we considered the cardiac (43%) and respiratory (24.9%) patients. Hajek P, Taylor TZ, Mills P. Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial. BMJ 2002; 324 (7329): 87-9.

12. Discussion • Low intensity hospital-based smoking cessation program increase smoking cessation rates for 6 month after discharge but not lead to long-term tobacco abstinence (Rigotti, 1997). Maybe more than increase monthly counseling sessions by phone might build on this initial success to produce permanent smoking cessation. • Reconsider the validation of abstinence by self-report through CO, even if some organizational problems have to be solve. Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Singer DE, Pasternak RC. The use of nicotine-replacement therapy by hospitalized smokers. Am J Prev Med 1999; 17 (4): 255-9.