A Successful Smoking Cessation Intervention

It is sometimes hard to believe how many Americans continue to smoke despite the overwhelming evidence of harm to health.  Cigarette smoking remains the single biggest cause of preventable death in the United States.  It leads to a lot of health spending.  It tends to afflict persons in lower socioeconomic classes disproportionately.  A number of smoking cessation interventions have been developed, with varying degrees of success.  Research reported in the Journal of the American Medical Association evaluates an intervention designed to bridge the transition from hospital to home for patients who wish to stop tobacco use.   (JAMA Article)   The Joint Commission on hospital accreditation has a quality measure requiring hospitals to identify smokers and offer smoking cessation programs to patients.  Hospital stays are usually short-term, however, and quitting tobacco use is a lengthy and difficult process.  The study tested an intervention designed to create continuity for patients identified as smokers and who wished to enter into a tobacco cessation program while in the hospital.  The study was conducted in a single, prominent Boston hospital and randomized patients to the intervention or usual care.  The intervention included a free smoking cessation medication, with regular automated telephone calls giving support messages and encouraging patients to call if they had questions or were having difficulty quitting.  The return calls were made by a trained counselor.  The primary outcome was tobacco cessation after 6 months, as validated by a biochemical test.  Patients in the intervention group were more like to use smoking cessation treatment during the first month following discharge from the hospital, by about 83% to 63%.  This difference continued throughout the 6 month followup period.  61% of the intervention patients completed 8 or more weeks of the 12 week treatment course compared to only 37% of the usual care patients.  At the primary outcome, 26% of intervention patients demonstrated no tobacco use compared to only 15% of usual care patients.  The incremental costs per patient for the intervention were $540 in the first year.  This particular intervention appears to be effective compared to usual care, but it is discouraging that even with the intervention the quit rate is low.  This demonstrates just how hard it is to change tobacco use behavior.  Given the health harms, and financial harms to often low-income users, it is worth spending a lot of time on how to get people off tobacco, but even better would be figuring out how to keep them from starting in the first place.