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

Masuet Aumatell C, Ramon Torrell JM, Morchon Ramos S, Lopez Salguero GL

Health Promotion Hospitals Conference, Dublin 2005

PREDICTORS OF CONTINUED SMOKING ABSTINENCE AMONG HOSPITALIZED PATIENTS

Better health for the community

A more healthy organisation

Better health for the patients

Better health for the HCW

Empowerment strategy

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.

Predictors of continued abstinence (review)

Author Design Participants Continued Abstinence rate Predictor factors

Rigotti (1997) Clinical trial Medical & surgical (n=650)

28.9% (1M) 17.3% (6M; 1 single session verbal advice + self-help material + 3 weekly counseling by phone)

-Abstinence during hospital stay

Dale (1997) Retrospective analysis

Elderly people with Medical conditions (n=613)

24.8% (6M; medical consultation) -Hospitalization -Married to a non- smoking spouse -High motivation to quit -The longest time of previous abstinence <1 day or month

Hajek (2002) Clinical trial Cardiovascular (n=540)

40% (12M; 1 single session verbal advice)

-Low dependence on tobacco -High motivation to quit

MacKenzie (2004)

Survey Medical (n=154)

18% (6M ; phone survey +NRT) -High level of confidence to quit -Mutiple prior quit attempts

Ong (2005) Cohort study Cardiac & respiratory (n=248)

43.5% (2M; verbal advice in hospitalisation & every 2 weeks +booklets)

-Low dependence on tobacco -High motivation to quit -Initial hospitalization

MATERIAL AND METHODS

?%

Continued abstinence

-Cardiac, respiratory, surgical and medical patients-University-affiliated hospital from January to June 2004-Current smokers at admission

30-minute bedsidecounseling session

6 monthly counseling telephone calls

Objective: to determine predictors of continued smoking abstinence

220

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).

Results

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

53.84 (13.76) 51.71(15.20)

48 (88.9) 131 (78.4) 1.87 0.86 4.09

6 (11.1) 36 (21.6)

32 (59.3) 78 (46.7) 1.13 0.97 1.32

22 (40.7) 89 (53.3)

9 (17.3) 47 (26.8) 1.00

22 (42.3) 29 (18.5) 2.44 1.25 4.78

12 (23.1) 39 (24.8) 1.33 0.62 2.89

9 (17.3) 47 (29.9) 0.83 0.39 2.12

26 (49.1) 60 (37.1) 1.00

12 (22.6) 53 (32.7) 0.86 0.71 1.03

15 (28.3) 49 (30.2) 0.91 0.75 1.13

8 (17.0) 67 (44.4) 1.00

13 (27.7) 48 (31.8) 1.14 0.98 1.32

26 (55.3) 36 (23.8) 1.54 1.23 1.93

34 (75.6) 72 (59.0) 1.21 1.01 1.44

11 (24.4) 50 (41.0)

23 (46.0) 94 (66.2) 0.80 0.66 0.97

27 (54.0) 48 (33.8)

15.75 (5.88) 15.88 (6.11)

24.81 (5.05) 24.20 (6.78)

Age mean (SD)**

Male

Female

Sex

Yes

No

Comorbity

Medical service

Cardiac service

Respiratory service

Surgical service

Hospitalization service

Low

Intermediate

High

Tobacco dependence(Fagerström)

Low

Intermediate

High

Motivation

Yes

No

Some prior quit attempts

Yes

No

Smoker family members

Start smoking' age mean (SD)**

Number of cigarettes per day mean (SD)**

*

Yes n(%) No n(%)

Continued abstinence

CrudeOddsRatio(COR) LCI UCI

95% CI COR

No statistical differences ( p-value >0.05)**.

Categorical variables compared by Chi-squared test, and continuous variables compared by Student-T test. P-value two-tailed, and statistically significant p<0.05.*.

Logistic regression

0.99 0.96 1.02

1.26 0.41 3.86

1.00

2.30 0.82 7.56

2.47 1.21 5.06

0.52 0.23 1.20

1.82 0.72 4.60

1.00

2.21 0.64 7.70

0.87 0.24 3.18

0.64 0.16 2.46

Age

MaleSex

Precontemplative

Contemplative

Active

Motivation stage

Smoker family members

Some prior attempts to quit

Medical service

Cardiac service

Respiratory service

Surgical service

Hospitalization service

*

AdjustedOddsRatio(AOR) LCI UCI

95% CI AOR

Continued abstinence adjusted by age, sex, motivation, smoker family members, some prior attempts to quit,and hospitalization service.

*.

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.

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 aftermyocardial infarction and bypass surgery: randomised controlled trial. BMJ 2002; 324 (7329): 87-9.

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.