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Nicotine & Tobacco Research Advance Access published online on May 7, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp056
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Increasing smoking cessation care provision in hospitals: A meta-analysis of intervention effect

Megan Freund, Elizabeth Campbell, Christine Paul, Rebecca Sakrouge, Patrick McElduff, Raoul A. Walsh, John Wiggers, Jenny Knight and Afaf Girgis

Megan Freund, Grad. Dip. (HP), Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia, School of Medicine and Public Health University of Newcastle, Newcastle, New South Wales, Australia, and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Elizabeth Campbell, Ph.D., Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia, University of Newcastle, Newcastle, New South Wales, Australia, and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Christine Paul, Ph.D., Centre for Health Research and Psycho-oncology, New South Wales Cancer Council and the University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Rebecca Sakrouge, B.A., Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Patrick McElduff, Ph.D., Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Raoul A. Walsh, Ph.D., Centre for Health Research and Psycho-oncology, NSW Cancer Council and the University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
John Wiggers, Ph.D., Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia, University of Newcastle, Newcastle, New South Wales, Australia, and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Jenny Knight, M.Med. Sci., Hunter New England Population Health, Hunter New England Area Health Service, New South Wales, Australia, University of Newcastle, Newcastle, New South Wales, Australia, and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
Afaf Girgis, Ph.D., Centre for Health Research and Psycho-oncology, NSW Cancer Council and the University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia, Hunter Medical Research Institute, Newcastle, New South Wales, Australia

Corresponding Author:Megan Freund, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. Telephone: +61-2-4924-6374; Fax: +61-2-4924-6212; E-mail: megan.freund{at}hnehealth.nsw.gov.au


  Abstract

Introduction: Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals.

Methods: A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral.

Results: Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9–28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance.

Discussion: Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.

Received: August 12, 2008; Accepted: February 2, 2009
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