1. Smoking Intervention in the Emergency Department Colleen Connor York College Biology Department Is smoking intervention in the emergency department achievable? Introduction: Smoking causes over 400,000 deaths per year and is the number one avoidable cause of death in the United States. The U.S. Public Health Service (PHS) had smoking cessation as one of the eight critical focus areas for health promotion. The rate of smoking in an urban-based emergency department (ED) has been estimated as high as 40%, compared to the national average of approximately 23% (Boudreaux et al. 2005). Of all adult ED visits, 4.2% can be attributed to smoking, which amounts over 3 million visits per year (Bernstein 2000). It has been reported that in the ED 77% of smokers had some desire to quit smoking. In addition, close to 50% were willing to stay an extra 15 minutes for smoking cessation counseling (Boudreaux et al. 2005). The prevalence of smokers and their desire to quit smoking makes the emergency department an appropriate place for smoking cessation counseling. In previous studies patients have not been inclined to enroll in smoking cessation services offered to them during an ED visit. However, these patients were required to pay a fee of $200 to enroll in the program and it is believed that this may have deterred them from enrolling. Close to seventy percent of the patients surveyed expressed a desire to quit smoking (Richman et al. 2000). In this study it is believed that patients will be more likely to enroll in a program that is free of charge. Effectiveness of a Smoking Intervention Program in the Emergency Department of York Hospital Colleen Connor Department of Biology, York College Results The patients’ readiness to quit for all patients was 6.16 (table 1). Patients were asked if they believed they would be able to quit smoking within in one month of the survey. An average of 35.6% believed they could quit in one month. Group A had 37% that believed they could quit within one month, but when contacted only 11.1% had successfully quit. None of the patients that were referred to the smoking cessation programs enrolled. Table 2 shows the data collected for smoking history. Group A had the most prior quit attempts and also the only group known to have patients that successfully quit. Methods: This study was developed to determine the success of offering smoking cessation programs in the ED. A survey was used to establish if the patients wanted to quit smoking, the level of readiness to quit, if they believed they could quit, amount they smoke, and if they had any prior attempts at quitting. The survey was administered to patients in the ED of York Hospital who (1) were identified as smokers, (2) fit the inclusion criteria, and (3) agreed to participate. The patients that agreed to a follow- up survey were contacted by phone one to two months after their first survey and placed in group A. Patients were called several different times a day on several different days of the week. If not reached by the fifth phone call they were categorized as unavailable, and the data from their survey were placed in group B. Patients with disconnected phone numbers were also placed in group B. The patients that declined a follow-up survey were placed in Group C. Inclusion Criteria: Exclusion Criteria: Smoker aged >18 Age <18 Discharged from ED Admitted to Hospital Patient too ill Objectives: The first objective of this study is to determine if the emergency department is an effective place to offer smoking cessation programs. The second objective is to determine if patients would be more likely to enroll to a program provided to them free of charge. Group AGroup B Group C Average of all Groups Wanted to quit88.9%80.9%54.5%79.7% Readiness to quit A 6.835.745.36.16 Ability to quit in 1 month 37%42.9%18.2%35.6% Ability to quit in 6 months 70.3%66.7%27.2%61.0% Referred to Wellspan 48.1%23.8%----- 37.5% B Referred to Quitline14.8%19%----- 16.7% B Quit11.1%----- Table 1. Averages of Smoking Data from Survey Conclusions In conclusion, although many of the patients surveyed did have a desire to quit smoking (79.7%), they did not use the smoking cessation resources made available to them. Also the 11.1% of patients that were successful in quitting did not use the services provided. Therefore, even though the emergency department has a high number of patients that smoke it may not be an effective place for smoking intervention. Future Studies This study did not find any conclusive results with the success of smoking cessation programs in the emergency department. However, it only included a limited number of patients and with more patients enrolled it could be more successful. Future studies may also include further investigation into why patients are not inclined to participate into the smoking cessation programs even though they express a desire to quit smoking. Literature Cited Bernstein, S. 2000. Emergency Medicine Smoking-associated Illness and Resource Utilization in U.S. Emergency Departments. Academic Emergency Medicine. 7:5435 Boudreaux, E.D., Baumann, B.M., Friedman, K., and Ziedonis, D.M. 2005. Smoking Stage of Change and Interest in an Emergency Department-based Intervention. Academic Emergency Medicine. 12: 211-218. Richman, P.B., Dinowitz, S., Nashed, A.F., Eskin, B., Sylvan, E., Allegra, C., Allegra, J., and Mandell, M. 2000. The Emergency Department as a Potential Site for Smoking Cessation Intervention: A Randomized, Controlled, Study. Smoking. 7: 348-353. A Readiness to quit determined on scale 1-10 with 10 being the most ready B This average only includes group A and group B Group A Group BGroup C Average of all Groups Time smoking (in years) 2117.720.119.6 Amount consumed (cig/day) 13.81412.413.4 Prior Quit attempts (per person) 21.9511.65 Average Quit time (in days) 85437.75365419 Table 2. Patient Smoking History Data Results: Fifty nine patients were surveyed and 48 patients agreed to be contacted for a follow-up survey. The results are presented in the three groups. There were 27 patients in Group A, 21 in group B and 11 in group C. For each of the questions pertaining to wanting to quit, able to quit, and referred to program the percentages of patients answering were was calculated. For the other data gathered the averages were calculated for each group, as well as all groups together. In table 1, close to 80% of all patients wanted to quit smoking, while only 37.5% wanted to be referred to Wellspan Smoking Cessation Program and 16.7% to Pennsylvania Quitline program. Acknowledgements: I would like to thank Dr. Benenson, The York Hospital, Dr. Kaltreider, and Dr. Rehnberg. No data collected Do you smoke? Yes No Asked to participate Yes No Survey Completed Asked to enroll in smoking cessation program No Yes Asked for a follow up Information referred to program No Yes Called for follow-up survey Available No Yes Asked follow-up questions Data in Group C Data in Group B Data in Group A Flow Chart for Interviewing Patients