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Feliu A, Ravara S, Papadakis S, Enriquez M, Antón L, Saura J, Company A, Romero O, Ripoll R, Ruz A, Precioso J, Pascoal I, Videira L, Correia C, Ferreira S, Fernández E, Martínez C. Factors associated with changes in inpatients' smoking pattern during hospitalization and one month after discharge: A cohort study. J Nurs Scholarsh 2021; 54:332-344. [PMID: 34755457 DOI: 10.1111/jnu.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Smokers are frequent users of healthcare services. Admissions to hospital can serve as a "teachable moment" for quitting smoking. Clinical guidelines recommend initiating smoking cessation services during hospitalization; however, in Southern European countries less than 5% of inpatients receive a brief intervention for smoking cessation. OBJECTIVES The aims of this study were (i) to examine rates of smoking abstinence during and after hospitalization; (ii) to measure changes in smoking patterns among persons who continued smoking after discharge; and (iii) to identify predictors of abstinence during hospitalization and after discharge. METHODS A cohort study of a representative sample of current adult smokers hospitalized in two Spanish and two Portuguese hospitals. We surveyed smokers during hospitalization and recontacted them one month after discharge. We used a 25-item ad hoc questionnaire regarding their smoking pattern, the smoking cessation intervention they have received during hospitalization, and hospital and sociodemographic characteristics. We performed a descriptive analysis using the chi-square test and a multivariate logistic regression to characterize the participant, hospital, and smoking cessation intervention (5As model) characteristics associated with smoking abstinence. RESULTS Smoking patients from both countries presented high abstinence rates during hospitalization (Spain: 76.4%; Portugal: 70.2%); however, after discharge, their abstinence rates decreased to 55.3% and 46.8%, respectively. In Spain, smokers who tried to quit before hospital admission showed higher abstinence rates, and those who continued smoking reduced a mean of five cigarettes the number of cigarettes per day (p ≤ 0.001). In Portugal, abstinence rates were higher among women (p = 0.030), those not living with a smoker (p = 0.008), those admitted to medical-surgical wards (p = 0.035), who consumed their first cigarette within 60 min after waking (p = 0.006), and those who were trying to quit before hospitalization (p = 0.043). CONCLUSIONS Half of the smokers admitted into the Spanish hospitals are abstinent one month after discharge or have reduced their cigarettes per day. Nevertheless, success rates could be increased by implementing evidence-based tobacco cessation programs at the organizational-level, including post-discharge active quitting smoking support. CLINICAL RELEVANCE Three-quarters of the inpatients who smoke remain abstinent during hospitalization and over half achieve to maintain their abstinence or at least reduce their consumption one month after discharge, proving that admission to hospitals is an excellent teachable moment to quit smoking.
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Affiliation(s)
- Ariadna Feliu
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Sofia Ravara
- CICS-UBI, Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Marta Enriquez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Antón
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Catalan Network for Smoke-free Hospitals, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Assumpta Company
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Romero
- E-oncologia, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruth Ripoll
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Angels Ruz
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Precioso
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Ivone Pascoal
- Serviço de Pneumologia. Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Lídia Videira
- Centro Hospitalar Universitário da Cova da Beira, EPE, Covilhã, Portugal
| | - Claudia Correia
- Centro de Investigação em Estudos da Criança, Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Soraia Ferreira
- CISP-ENSP, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Cristina Martínez
- Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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