Smoking Cessation Interventions for Hospitalized Smokers: A Systematic Review
Open accessAbstract
BACKGROUND: A hospital admission provides an opportunity to help people stop smoking. Providing smoking cessation advice, counseling, or medication is now a quality-of-care measure for US hospitals. We assessed the effectiveness of smoking cessation interventions initiated during a hospital stay. METHODS: We searched the Cochrane Tobacco Addiction Review Group's register for randomized and quasirandomized controlled trials of smoking cessation interventions (behavioral counseling and/or pharmacotherapy) that began during hospitalization and had a minimum of 6 months of follow-up. Two authors independently extracted data from each article, with disagreements resolved by consensus. RESULTS: Thirty-three trials met inclusion criteria. Smoking counseling that began during hospitalization and included supportive contacts for more than 1 month after discharge increased smoking cessation rates at 6 to 12 months (pooled odds ratio [OR], 1.65; 95% confidence interval [CI], 1.44-1.90). No benefit was found for interventions with less postdischarge contact. Counseling was effective when offered to all hospitalized smokers and to the subset admitted for cardiovascular disease. Adding nicotine replacement therapy to counseling produced a trend toward efficacy over counseling alone (OR, 1.47; 95% CI, 0.92-2.35). One study added bupropion hydrochloride to counseling, which had a nonsignificant result (OR, 1.56; 95% CI, 0.79-3.06). CONCLUSIONS: Offering smoking cessation counseling to all hospitalized smokers is effective as long as supportive contacts continue for more than 1 month after discharge. Adding nicotine replacement therapy to counseling may further increase smoking cessation rates and should be offered when clinically indicated, especially to hospitalized smokers with nicotine withdrawal symptoms.
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Continuing smoking cessation after hospital discharge increases success.
“Smoking cessation initiated during hospital admission should continue for a prolonged period after discharge to increase success.255”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [255]
In hospitalized patients, sudden nicotine abstinence has been reported to cause manifestations including bradycardia, irritability, anxiety, agitation, confusion, or hallucinations.
“In hospitalized patients, studies have reported several manifestations related to sudden nicotine abstinence, such as bradycardia, irritability, anxiety and agitation, confusion, or hallucinations, but intensive care unit (ICU) patients are usually excluded from published studies [6].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [6]
ICU patients are usually excluded from published studies of manifestations of sudden nicotine abstinence.
“In hospitalized patients, studies have reported several manifestations related to sudden nicotine abstinence, such as bradycardia, irritability, anxiety and agitation, confusion, or hallucinations, but intensive care unit (ICU) patients are usually excluded from published studies [6].”
From Nicotine withdrawal and agitation in ventilated critically ill patients (2010) · cites this paper as [6]
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Self-citation
- Authors
- Rigotti, N. A., Munafo, M. R., & Stead, L. F.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2008-10-13
- Volume
- 168
- Issue
- 18
- Pages
- 1950
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC4500120
- OpenAlex
- W2057773936
- Cited by
- 273
- References
- 52
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 11 · 2021: 3 · 2020: 9 · 2019: 11 · 2018: 11 · 2017: 13 · 2016: 22 · 2015: 18 · 2014: 13 · 2013: 19 · 2012: 39
- FWCI
- 2.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Explore Bristol Research (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (2 K24 HL04440, K24HL004440)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- smoking cessation, hospitalized smokers, smoking cessation counseling, nicotine replacement therapy, bupropion, post-discharge follow-up, cardiovascular disease, nicotine withdrawal symptoms, quality of care
- MeSH terms
- Smoking Prevention, Hospitalization, Humans, Inpatients, Smoking, Smoking Cessation, Treatment Outcome
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