Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial

Abstract

Background: Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.

Objective: We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.

Design: Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.

Participants: Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking.

Intervention: A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.

Main measures: The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.

Key results: Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001).

Conclusions: Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.

Trial registration: URL: http://www.

Clinicaltrials: gov . Unique identifier: NCT03521466.

Keywords: cessation; counseling; hospitalization; medical students; smoking; tobacco.

Figure 1

Structure of the Medical Student Counseling for Hospitalized patients Addicted to Tobacco (MS-CHAT) intervention.

Figure 2

Participant flow through the study.

Figure 3

Change in medical student knowledge between baseline, 6 weeks, and 12 months. Total score is 25 and is based on 15 questions. Mean knowledge scores at baseline, 6 weeks, and 12 months are reported. A comparison was made between scores at baseline and 12 months with an absolute mean difference of 3.3% between the two time points. p < 0.001 for change from baseline to 12 months.