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Stanford Report, October 10, 2001

Research-based program at Stanford Hospital helps compel smokers to quit

By CHARLES CLAWSON

A model program at Stanford Hospital capitalizes on the unique motivations associated with hospitalization to compel patients to stop smoking. The in-patient program is based on more than a decade of research and combines the proven elements of behavioral counseling, pharmacological therapy and follow-up support.

"When people are in the hospital, they're focused on their health," said Emily Wien Fagans, MA, research coordinator for the program. "The enforced abstinence of being in the hospital can get them through the worst of withdrawal. Also, they're removed from their daily cues to smoke, such as smoking after a meal."

The program at Stanford is unique. Under the direction of Jeanne Kennedy, director of Community and Patient Relations, the program enlists professionals known as Smoking Cessation Advisors who volunteer to provide information and counseling to patients. The SCAs receive intensive training, and most hold impressive credentials; three of the seven current volunteers are foreign physicians waiting to enter residency programs while others are Stanford pre-med or science students, or health care professionals interested in volunteering.

An important component of the program is cognitive behavioral counseling, which helps patients identify and overcome behavior patterns that trigger them to smoke. "Instead of picking up that cigarette, we want to give them a new skill," said Wien Fagans. "For some people it might be simply telling themselves, ‘I want to live to see my grandchildren grow up.' A behavioral strategy might be to take a 10-minute walk during that time."

Another program component is telephone follow-up after patients are discharged. Counselors call at 48 hours, seven days, 21 days and 90 days after discharge to offer support and assistance. "If people relapse it's usually in the first three weeks, so those 48-hour and seven-day phone calls can really make a difference," said Wien Fagans.

Pharmacological therapy, comprised of nicotine patches or gum and Zyban, is also offered. Other features of the program include a patient workbook, videotape and a relaxation CD or cassette tape.

The program dates back to 1985 when it began as a research protocol for Stanford patients who had suffered heart attacks. Biochemical measures performed a year later indicated that the patients who underwent the intervention had a smoking cessation rate of 71 percent "That's the highest smoking cessation outcome that I'm aware of in the literature," said Nancy Houston Miller, RN, co-creator of the program and associate director of the Stanford Cardiac Rehabilitation Program.

Further studies also revealed that systemizing an in-hospital protocol for all smokers -- identifying smokers, asking them to make an attempt to quit and providing strong medical advice with handout materials -- increased cessation rates at one year from roughly 10 percent (when no intervention was provided) to 18 percent. When the counseling and follow-up phone calls were added, the rates rose to 30-40 percent. "When you systemize things in a hospital, it's a very powerful place to intervene," said Houston Miller.

During the mid-1990s the program was implemented at Stanford with a nurse who provided bedside counseling, but it was later eliminated as budgets tightened. The program was reinstated last November with the support of hospital administration.