Please select the eligibility criteria that correspond to the clinical trial below.
Title: Smoking Interventions for Hospital Patients: A Comparative Effectiveness Trial
Brief Summary: Cigarette smoking is the leading preventable cause of death in the U.S. Nearly 4 million U.S. smokers are hospitalized each year, many of them at high risk for tobacco-related disease or death. A hospital admission provides an opportunity for a smoker to quit. Smoking cessation counseling provided in the hospital is effective, but only if it continues for \>1 month after discharge. Smoking cessation medications add benefit to counseling but are not often used. The challenge is to translate this efficacy research into routine clinical practice. The major barrier is to make the transition from inpatient to outpatient care. An evidence-based, cost-effective intervention model that can be adopted by U.S. hospitals is needed to realize the potential impact of hospital smoking interventions.

The Specific Aim of this project is to conduct a randomized controlled comparative effectiveness trial of two strategies to promote smoking cessation in hospitalized patients: (1) a hospital-only intervention that meets the current standard of the National Hospital Quality Measures("Standard Care"), and (2) an "Extended Care Management" model with 2 components that aims to encourage and facilitate the sustained use of smoking cessation treatment (counseling and medication use) after discharge in order to achieve long-term abstinence. It adds to Standard Care 3 months of telephone-based contact after discharge and feature 2 innovations: (1) to increase medication use, smokers willing to make a quit attempt receive a free, refillable 30-day sample of their choice of FDA-approved smoking cessation medication at hospital discharge; (2) to increase counseling cost-effectiveness, interactive voice recognition (IVR) technology is used to make automated telephone calls to identify the smokers interested in or most likely to benefit from continued counseling after discharge. The trial will enroll 330 adult smokers admitted to Massachusetts General Hospital, a 900-bed teaching hospital. Outcomes will be measured 1,3 and 6 months after hospital discharge. Study hypotheses are that the enhanced care arm, compared to usual care, is feasible and will increase (1) the use of smoking cessation treatment after discharge, (2) the duration of post-discharge tobacco abstinence, and (3) validated tobacco abstinence 6 months after hospital discharge (primary outcome). The principal secondary outcome measure is self-reported 7-day point prevalence tobacco abstinence after hospital discharge. Other secondary endpoints include self-reported point prevalence abstinence at 1 and 3 months, prolonged abstinence (self-reported tobacco abstinence at 1, 3, and 6 months). The cost-effectiveness (cost per quit) of the interventions will be also be compared.


Options:
A: Inclusion Criteria:

* Smoke 5+ cigarettes/day
* \< 3 months abstinence in the past year
* Have a smartphone
* Score greater than or equal to 8 of 10 on the Contemplation Ladder (Biener \& Abrams, 1991)

Exclusion Criteria:

* None
B: Inclusion Criteria:

* Cigarette smoker (daily smoker when smoking in usual way during the month before hospital admission)
* Counseled by hospital smoking counselor during hospital stay
* Plans to stop smoking tobacco products after hospital discharge
* Appropriate for use of smoking cessation medication after discharge

Exclusion Criteria:

* Expected hospital length of stay \<24 hours
* Not expected to be discharged to home
* No access to a telephone
* Unable to communicate by telephone
* Severe psychiatric or neurologic disease precluding ability to be counseled
* Pregnant, nursing, or planning to become pregnant in next 3 months
* Active substance abuse other than tobacco
* Unable to speak English
C: Inclusion Criteria:

* Diagnostic and Statistical Manual of Mental Disorders IV criteria (DSM-IV) for diagnosis code 309.81 PTSD
* Willingness to participate
* Currently smoking 1 or more cigarettes per day

Exclusion Criteria:

* Use smokeless tobacco, pipes or cigars instead of cigarettes
* Have imminent risk of suicide or violence
* Have severe psychiatric symptoms or psychosocial instability likely to prevent participation in protocol (provider will assess appropriateness)
* Have clinically apparent gross cognitive impairment
* Unable to connect Health Buddy in home
D: Inclusion Criteria:

* Community based primary care practices who have:

  * Internet access in office
  * Sees 4 - 5 smokers per week

Exclusion Criteria:

* Practices with more than five providers

Answer: B