Smoking cessation interventions for hospitalized smokers: a systematic review

Abstract

Background: A hospital admission provides an opportunity to help people stop smoking. Providing smoking cessation advice, counseling, or medication is now a quality-of-care measure for US hospitals. We assessed the effectiveness of smoking cessation interventions initiated during a hospital stay.

Methods: We searched the Cochrane Tobacco Addiction Review Group's register for randomized and quasirandomized controlled trials of smoking cessation interventions (behavioral counseling and/or pharmacotherapy) that began during hospitalization and had a minimum of 6 months of follow-up. Two authors independently extracted data from each article, with disagreements resolved by consensus.

Results: Thirty-three trials met inclusion criteria. Smoking counseling that began during hospitalization and included supportive contacts for more than 1 month after discharge increased smoking cessation rates at 6 to 12 months (pooled odds ratio [OR], 1.65; 95% confidence interval [CI], 1.44-1.90). No benefit was found for interventions with less postdischarge contact. Counseling was effective when offered to all hospitalized smokers and to the subset admitted for cardiovascular disease. Adding nicotine replacement therapy to counseling produced a trend toward efficacy over counseling alone (OR, 1.47; 95% CI, 0.92-2.35). One study added bupropion hydrochloride to counseling, which had a nonsignificant result (OR, 1.56; 95% CI, 0.79-3.06).

Conclusions: Offering smoking cessation counseling to all hospitalized smokers is effective as long as supportive contacts continue for more than 1 month after discharge. Adding nicotine replacement therapy to counseling may further increase smoking cessation rates and should be offered when clinically indicated, especially to hospitalized smokers with nicotine withdrawal symptoms.

Figure 1

Efficacy of smoking cessation counselling, by intensity of counselling intervention. Outcome is number quit at longest follow-up (≥6 months) Intensity 1= contact in hospital of ≤ 15 minutes and no post-discharge support. Intensity 2= contact in hospital of >15 minutes and no post-discharge support; Intensity 3= any hospital contact plus post-discharge support lasting ≤1 month. Intensity 4=any hospital contact plus post-discharge support lasting >1 month. I² measures statistical heterogeneity among studies.

Figure 2A

Efficacy of smoking cessation counselling, by intensity of counselling, in studies that enrolled hospitalized smokers with all admission diagnoses Outcome: number quit at longest follow-up (≥6 months). See Figure 1 legend for definition of levels of counselling intensity. I² measures statistical heterogeneity among studies.

Figure 2B

Efficacy of smoking cessation counselling, by intensity of counselling, in studies that enrolled patients who were admitted for cardiovascular disease. Outcome: number quit at longest follow-up (≥6 months). See Figure 1 legend for definition of levels of counselling intensity. I² measures statistical heterogeneity among studies.

Figure 3

Efficacy of adding smoking cessation pharmacotherapy to counselling. Outcome: number quit at longest follow-up (≥6 months). NRT=nicotine replacement therapy. I² measures statistical heterogeneity among studies.