Smoking Cessation after Hospital Discharge: Factors Associated with Abstinence
Hospitalization offers tobacco smokers an opportunity to quit smoking, but factors associated with abstinence from tobacco after hospital discharge are poorly understood. We analyzed data from a multisite, randomized controlled trial testing a smoking cessation intervention for 1,357 hospitalized cigarette smokers who planned to quit. Using multiple logistic regression, we assessed factors identifiable in the hospital that were independently associated with biochemically confirmed tobacco abstinence 6 months after discharge. Biochemically confirmed abstinence at 6 months (n = 218, 16%) was associated with a smoking-related primary discharge diagnosis (Adjusted Odds Ratio[AOR] = 1.98, 95% CI: 1.41–2.77), greater confidence in the ability to quit smoking (AOR = 1.31, 95% CI: 1.07–1.60), and stronger intention to quit (plan to quit after discharge vs. try to quit; AOR=1.68, 95% CI: 1.19-2.38). In conclusion, smokers hospitalized with a tobacco-related illness and those with greater confidence and intention to quit after discharge are more likely to sustain abstinence in the long term. Hospital clinicians’ efforts to promote smoking cessation should target smokers’ confidence and motivation to quit.
© 2018 Society of Hospital Medicine
Cigarette smoking is the leading cause of preventable deaths in the United States.1 Smoking contributes to several health problems that require hospitalization. Hospitalization also offers smokers an opportunity to quit because hospital policies prohibit smoking indoors while a health threat increases the motivation to quit.2 Brief bedside smoking cessation counseling with follow-up contact after discharge increases postdischarge tobacco abstinence rates by 37%.2 Identifying the characteristics of patients who are most likely to stop smoking after hospital discharge could identify strategies for interventions to help more smokers to succeed. It could also guide hospital clinicians’ efforts to provide effective brief messages to promote cessation by inpatients under their care during this teachable moment.
Sociodemographic factors, tobacco use, and psychological and medical factors have been associated with successful quit attempts by smokers in the general population.3,4 Far less is known about the predictors of success in quitting smoking and maintaining abstinence after hospitalization. The characteristics associated with abstinence at postdischarge follow-up in prior studies of hospitalized smokers were male gender, greater confidence in quitting, greater readiness to quit, less nicotine dependence, and having a smoking-related illness.5-8 However, most of the prior studies were limited to 1 geographic region,5,6 focused only on a specific subgroup (eg, coronary patients9), or did not biochemically verify tobacco abstinence.8 In fact, to our knowledge, only one prior study has examined the predictors of quitting among a broad sample of hospital patients enrolled across multiple hospitals and biochemically verified abstinence.6 That study was conducted nearly two decades ago in one Midwestern state.
Thus, the present study aimed to identify factors independently associated with sustained postdischarge tobacco abstinence among hospitalized smokers who planned to quit smoking.10 Building on previous work, this study includes a large number of smokers with varied diagnoses admitted to one of three hospitals in two states, uses biochemically verified abstinence as the outcome measure, and examines multiple variables that were identified during the inpatient stay. We hypothesize that consistent with prior literature on this topic, factors independently associated with cessation in the present study will include confidence and intention to quit, degree of nicotine dependence, and a discharge diagnosis of a smoking-related disease.
