Stage-Tailored Tobacco Cessation Treatment in Inpatient Psychiatry

Abstract Introduction Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed. Methods Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge. Results Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not. Conclusions An “opt-out” tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services. Implications This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.

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Phone and Web-Based Tobacco Cessation Treatment: Real-World Utilization Patterns and Outcomes for 11,000 Tobacco Users

Journal of Medical Internet Research ◽

10.2196/jmir.999 ◽

2008 ◽

Vol 10 (5) ◽

pp. e41 ◽

Cited By ~ 65

Author(s):

Susan M Zbikowski ◽

Jenny Hapgood ◽

Sara Smucker Barnwell ◽

Tim McAfee

Keyword(s):

Real World ◽

Tobacco Cessation ◽

Web Based ◽

Cessation Treatment ◽

Utilization Patterns

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Climate for innovation, 12-step orientation, and tobacco cessation treatment

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2013.10.016 ◽

2014 ◽

Vol 46 (4) ◽

pp. 447-455 ◽

Cited By ~ 10

Author(s):

Jessica L. Muilenburg ◽

Tanja C. Laschober ◽

Lillian T. Eby

Keyword(s):

Tobacco Cessation ◽

Cessation Treatment

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Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis

Addiction ◽

10.1111/add.14863 ◽

2019 ◽

Vol 115 (3) ◽

pp. 527-533 ◽

Cited By ~ 1

Author(s):

Donna R. Shelley ◽

Christina Kyriakos ◽

Ann McNeill ◽

Rachael Murray ◽

Kapka Nilan ◽

...

Keyword(s):

Qualitative Analysis ◽

Tobacco Control ◽

Tobacco Cessation ◽

Cessation Treatment

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Intersectionality and Smoking Cessation: Exploring Various Approaches for Understanding Health Inequities

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa052 ◽

2020 ◽

Cited By ~ 1

Author(s):

Lindsey N Potter ◽

Cho Y Lam ◽

Paul M Cinciripini ◽

David W Wetter

Keyword(s):

Smoking Cessation ◽

High Risk ◽

Tobacco Cessation ◽

Health Inequities ◽

Marginalized Groups ◽

Cessation Treatment ◽

Increase Risk ◽

Race Ethnicity ◽

Cox Proportional Hazard Regression ◽

Target Intervention

Abstract Objective Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes. Methods A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes. Results Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse. Conclusions Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes. Implications Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.

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Leveraging Patient Reported Outcomes Measurement via the Electronic Health Record to Connect Patients with Cancer to Smoking Cessation Treatment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145034 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5034 ◽

Cited By ~ 1

Author(s):

Julia R. May ◽

Elizabeth Klass ◽

Kristina Davis ◽

Timothy Pearman ◽

Steven Rittmeyer ◽

...

Keyword(s):

Tobacco Use ◽

Patient Reported Outcomes ◽

Tobacco Cessation ◽

Treatment Engagement ◽

Cancer Center ◽

Health Record ◽

Patient Portal ◽

Smoking Cessation Treatment ◽

Cessation Treatment ◽

Patient Reported

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the “cold call” following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.

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