Mixed Results for Hospital-Based Smoking Cessation Program

Hospital-based transitional tobacco care management was no better than referral to a community-based quitline for getting smokers to abstain from tobacco, a randomized trial found.

For 1,409 cigarette smokers who received brief in-hospital tobacco treatment and wanted to quit smoking, the two postdischarge strategies produced similar rates of biochemically validated past 7-day abstinence at the 6-month mark (19.9% vs 16.9%, respectively; RR 1.18, 95% CI 0.92-1.50), reported Nancy A. Rigotti, MD, of Massachusetts General Hospital in Boston, and colleagues.

Nevertheless, their report, published in JAMA Internal Medicine, highlighted several findings at 3 months favoring the health system model over the quitline:

• More use of cessation counseling (35.1% vs 17.5%, P<0.001)
• Greater pharmacotherapy use (52.0% vs 37.6%, P<0.001)
• More participant-reported tobacco abstinence (RR 1.30, 95% CI 1.06-1.58)

The authors suggest this may be due to the short duration of the tested strategies and that longer post-discharge treatment may be necessary for transitional tobacco care management to maintain a higher level of effectiveness.

“Health system-based care can leverage patients’ familiarity and trust in existing caregivers and permits tobacco counselors to manage cessation medications and coordinate care with a patient’s clinical team,” study authors said.

The health-system based program tested in the study lasted just 12 weeks and consisted of 8 weeks of free nicotine replacement treatment (NRT) and regular automated calls for postdischarge counseling, monitoring, and offers of 5-10 minutes of behavioral counseling with a tobacco counselor.

In contrast, the trial’s quitline intervention sent referrals from the hospital’s electronic health record to state quitlines offering on average 5 counseling calls and a week-long NRT sample.

Cigarette smoking continues to be the leading cause of preventable death in the U.S., claiming 480,000 lives a year, according to the CDC.

Investigational strategies to get people to quit smoking are proliferating as well. For example, a study recently reported some success with a gamified smoking cessation program among people not ready to quit. On the other hand, a popular herbal product failed to meet noninferiority against varenicline (Chantix) among those who did want to quit.

Further research should be conducted on extended post-discharge treatment to leverage hospital admission as an opportunity to promote smoking cessation, Rigotti’s group suggested.

The present randomized trial was conducted from September 2018 to November 2020 at three hospitals in Pennsylvania, Tennessee, and Massachusetts.

Participants had a mean age of 51.7 years, 55.6% were women, and they reported smoking a mean of 16.4 cigarettes a day. For racial demographics, 16.4% of the participants were Black, 5.8% Hispanic, and 77.3% white.

A major limitation of the study was that 26% of people were lost to follow-up by 6 months. However, Rigotti and colleagues noted that this figure was similar to that of other hospital-based studies and that the missing data were not biased toward either group.

The authors also acknowledged that they were not able to verify 28% of self-reported tobacco abstinence nor check that mailed saliva and breath samples belonged to a given participant.

Furthermore, the results may not be generalizable to the non-hospital patient population, they cautioned.