Effect of clinician advice and patient preparedness to quit on subsequent quit attempts in hospitalized smokers

BACKGROUND: Although smoking cessation counseling for cardiac inpatients is a quality measure, little data exist regarding postdischarge quit attempts in a primarily urban, African American, underserved population. This study aimed to assess preparedness to quit smoking and quit behaviors. METHODS: Smokers on the cardiology service were asked to rate preparedness using the 10-step Contemplation Ladder. During phone surveys given 30-days postdischarge, patients reported whether they made quit attempts, method and success of attempts, and recall of receiving advice to quit. RESULTS: From February 2006 through July 2007, 2906 of 3364 of inpatients were interviewed. Fifteen percent (436/2906) were current smokers and 415/436 completed the inpatient assessment. Of these, 75% (310/415) indicated they were prepared to quit. At the 1-month follow-up, 67% (276/415) were interviewed and 71% of those patients (195/276) reported making a quit attempt, with most (76%) reporting quitting "cold turkey" (without aid). Compared with less prepared patients, prepared patients were more likely to report making a quit attempt after discharge (77% [163/212] vs. 50% [32/64], P < 0.001) and were successful in that attempt (43% [90/212] vs. 25% [16/64], P = 0.010). CONCLUSIONS: The majority of smokers hospitalized with cardiac disease reported being prepared to quit smoking. Those prepared, and who received advice to quit, were more likely to make a quit attempt and report abstinence than those less prepared. However, most quit attempts were made using the least effective methods. Future studies in a population of primarily African American patients should assess preparedness to quit and target prepared patients with more effective interventions.