Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling

Area of Science:

• Public Health
• Addiction Medicine
• Behavioral Science

Background:

• Hospitalized smokers often relapse after discharge despite temporary abstinence.
• Effective interventions are needed to support sustained smoking cessation post-hospitalization.

Purpose of the Study:

• To test the effectiveness of nicotine patches and telephone counseling for smoking cessation in hospitalized smokers post-discharge.
• To assess a hospital-quitline partnership model for smoking cessation.

Main Methods:

• A 2x2 factorial design randomized 1,270 hospitalized smokers to usual care, nicotine patches, telephone counseling, or both.
• Assessments of self-reported 30-day abstinence occurred at 2 and 6 months post-randomization.

Main Results:

• Nicotine patch use showed a non-significant trend towards higher abstinence rates (22.8% vs. 18.3%, p=0.051).
• Telephone counseling did not improve abstinence rates (20.0% vs. 21.1%, p=0.651), with only 47% receiving counseling.
• Nicotine patch provision was feasible, but engagement with counseling was low.

Conclusions:

• Nicotine patches and telephone counseling, as implemented, were not significantly effective for sustained smoking cessation post-hospitalization.
• Low engagement with telephone counseling limits its effectiveness.
• Future interventions should focus on immediate support and higher engagement strategies for better outcomes.