Comparison of two smoking cessation interventions for inpatients

Antonio Carlos Ferreira Campos, Angela Santos Ferreira Nani, Vilma Aparecida da Silva Fonseca, Eduardo Nani Silva, Marcos César Santos de Castro, Wolney de Andrade Martins, Antonio Carlos Ferreira Campos, Angela Santos Ferreira Nani, Vilma Aparecida da Silva Fonseca, Eduardo Nani Silva, Marcos César Santos de Castro, Wolney de Andrade Martins

Abstract

Objective: This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge.

Methods: This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO).

Results: Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = -0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001).

Conclusions: The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

Figures

Figure 1. Comparison between the groups studied,…
Figure 1. Comparison between the groups studied, in terms of the rates of relapse and abstinence, at 6 months after discharge from the hospital.
Figure 2. ROC curves for event-free follow-up,…
Figure 2. ROC curves for event-free follow-up, by group.
Figure 3. Scores on the Brief Questionnaire…
Figure 3. Scores on the Brief Questionnaire of Smoking Urges, by outcome.
Figure 4. ROC curve for the Brief…
Figure 4. ROC curve for the Brief Questionnaire of Smoking Urges score, in relation to relapse.

References

    1. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation. 1997;96(9):3243–3247. doi: 10.1161/01.CIR.96.9.3243.
    1. Juster HR, Loomis BR, Hinman TM, Farrelly MC, Hyland A, Bauer UE. Declines in hospital admissions for acute myocardial infarction in New York state after implementation of a comprehensive smoking ban. Am J Public Health. 2007;97(11):2035–2039. doi: 10.2105/AJPH.2006.099994.
    1. Mohiuddin SM, Moos AN, Hunter CB, Grollmes TL, Cloutier DA, Hilleman DE. Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest. 2007;131(2):446–452. doi: 10.1378/chest.06-1587.
    1. Reichert J, Araújo AJ, Gonçalves CM, Godoy I, Chatkin JM, Sales MP. Smoking cessation guidelines--2008. J Bras Pneumol. 2008;34(10):845–880. doi: 10.1590/S1806-37132008001000014.
    1. Emmons KM, Goldstein MG. Smokers who are hospitalized a window of opportunity for cessation interventions. Prev Med. 1992;21(2):262–269. doi: 10.1016/0091-7435(92)90024-C.
    1. Molyneux A, Lewis S, Leivers U, Anderton A, Antoniak M, Brackenridge A. Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients. Thorax. 2003;58(6):484–488. doi: 10.1136/thorax.58.6.484.
    1. Simon JA, Carmody TP, Hudes ES, Snyder E, Murray J. Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement a randomized trial. Am J Med. 2003;114(7):555–562. doi: 10.1016/S0002-9343(03)00081-0.
    1. 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):255–259. doi: 10.1016/S0749-3797(99)00095-1.
    1. Le Foll B, George TP. Treatment of tobacco dependence integrating recent progress into practice. CMAJ. 2007;177(11):1373–1380. doi: 10.1503/cmaj.070627.
    1. Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalized patients. Cochrane Database Syst Rev. 2012;(5):CD001837–CD001837.
    1. Stramari LM, Kurtz M, Silva LC. Prevalence of and variables related to smoking among medical students at a university in the city of Passo Fundo, Brazil. J Bras Pneumol. 2009;35(5):442–448. doi: 10.1590/S1806-37132009000500009.
    1. Fagerstrom KO, Schneider NG. Measuring nicotine dependence a review of the Fagerstrom Tolerance Questionnaire. J Behav Med. 1989;12(2):159–182. doi: 10.1007/BF00846549.
    1. Araujo RB, Oliveira MS, Moraes JF, Pedroso RS, Port F, De Castro MG. Validation of the Brazilian version of Questionnaire of Smoking Urges-Brief. Rev Psiq Clin. 2007;34(4):166–175. doi: 10.1590/S0101-60832007000400002.
    1. Mayfield D, McLeod G, Hall P. The CAGE questionnaire validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131(10):1121–1123.
    1. Stelmach R, Fernandes FL, Carvalho-Pinto RM, Athanazio RA, Rached SZ, Prado GF. Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD are our patients telling us the truth? J Bras Pneumol. 2015;(2):124–132. doi: 10.1590/S1806-37132015000004526.
    1. Ferreira ÂS, Campos AC, dos Santos IP, Beserra MR, Silva EN, Fonseca VA. Smoking among inpatients at a university hospital. J Bras Pneumol. 2011;37(4):488–494. doi: 10.1590/S1806-37132011000400011.
    1. Munafò M, Rigotti N, Lancaster T, Stead L, Murphy M. Interventions for smoking cessation in hospitalized patients a systematic review. Thorax. 2001;56(8):656–663. doi: 10.1136/thorax.56.8.656.
    1. Warner DO, Patten CA, Ames SC, Offord K, Schroeder D. Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery. Anesthesiology. 2004;100(5):1125–1137. doi: 10.1097/00000542-200405000-00014.
    1. 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. Pt 1Prev Med. 2000;31(2):159–166. doi: 10.1006/pmed.2000.0695.
    1. Prochaska JJ, Gill P, Hall SM. Treatment of tobacco use in an inpatient psychiatric setting. Psychiatr Serv. 2004;55(11):1265–1270. doi: 10.1176/appi.ps.55.11.1265.
    1. Oliveira MV, Oliveira TR, Pereira CA, Bonfim AV, Leitão FS, Filho, Voss LR. Smoking among hospitalized patients in a general hospital. J Bras Pneumol. 2008;34(11):936–941. doi: 10.1590/S1806-37132008001100008.
    1. Tanni SE, Iritsu NI, Tani M, Camargo PA, Sampaio MG, Godoy I. Evaluation of hospitalized patients in terms of their knowledge related to smoking. J Bras Pneumol. 2010;36(2):218–223. doi: 10.1590/S1806-37132010000200010.
    1. Bösch D. Smoking habits and teachable moment among hospitalized patients admitted to the internal medicine department. Chest Dis Rep. 2012;2(1):e6. doi: 10.4081/cdr.2012.e6.
    1. Bolliger CT, van Biljon X, Humair JP, El Fehri V, Cornuz J. Promoting hospital-based smoking cessation services at major Swiss hospitals a before and after study. Swiss Med Wkly. 2008;138(29-30):427–431.
    1. Borglykke A, Pisinger C, Jørgensen T, Ibsen H. The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD) Clin Respir J. 2008;2(3):158–165. doi: 10.1111/j.1752-699X.2008.00055.x.
    1. Hjalmarson A, Boëthius G. The effectiveness of brief advice and extended smoking cessation counseling programs when implemented routinely in hospitals. Prev Med. 2007;45(2-3):202–207. doi: 10.1016/j.ypmed.2007.06.014.
    1. Hajek P, Taylor TZ, Mills P. Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery randomized controlled trial. BMJ. 2002;324(7329):87–89. doi: 10.1136/bmj.324.7329.87.
    1. Wolfenden L, Campbell E, Walsh R, Wiggers J. Smoking cessation interventions for in-patients a selective review with recommendations for hospital-based health professionals. Drug Alcohol Rev. 2003;22(4):437–452. doi: 10.1080/09595230310001613967.
    1. Rigotti NA, Munafo MR, Murphy MF, Stead LF. Interventions for smoking cessation in hospitalized patients. Cochrane Database Syst Rev. 2003;(1):CD001837–CD001837.
    1. Rigotti NA, Munafo MR, Stead LF. Interventions for smoking cessation in hospitalized patients. Cochrane Database Syst Rev. 2007;(3):CD001837–CD001837. doi: 10.1002/14651858.CD001837.pub2.
    1. Agboola S, McNeill A, Coleman T, Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction. 2010;105(8):1362–1380. doi: 10.1111/j.1360-0443.2010.02996.x.
    1. Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services one-year outcomes. Addiction. 2005;100(2):59–69. doi: 10.1111/j.1360-0443.2005.01028.x.
    1. Hawkins J, Hollingworth W, Campbell R. Long-term smoking relapse a study using the British house hold panel survey. Nicotine Tob Res. 2010;12(12):1228–1235. doi: 10.1093/ntr/ntq175.
    1. Hughes JR, Peters EN, Naud S. Relapse to smoking after 1 year of abstinence a meta-analysis. Addict Behav. 2008;33(12):1516–1520. doi: 10.1016/j.addbeh.2008.05.012.
    1. Goodman MJ, Nadkarni M, Schorling JB. The Natural History of Smoking Cessation Among Medical Patients in a Smoke-Free Hospital. Subst Abus. 1998;19(2):71–79. doi: 10.1080/08897079809511376.
    1. Wetter DW, Cofta-Gun L, Fouladi RT, Cinciprini PM, Sui D, Gritz ER. Late relapse/sustained abstinence among former smokers a longitudinal study. Prev Med. 2004;39(6):1156–1163. doi: 10.1016/j.ypmed.2004.04.028.
    1. Gilpin EA, Pierce JP, Farkas AJ. Duration of smoking abstinence and success in quitting. J Natl Cancer Inst. 1997;89(8):572–576. doi: 10.1093/jnci/89.8.572.
    1. Fernández E, Schiaffino A, Borrell C, Benach J, Ariza C, Ramon JM. Social class, education, and smoking cessation Long-term follow-up of patients treated at a smoking cessation unit. Nicotine Tob Res. 2006;8(1):29–36. doi: 10.1080/14622200500264432.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj