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:

* willing to remain abstinent post discharge
* 1 cpd past 30 days
* active phone
* has a usual source of care
* willing to participate
* willing to provide contact information for follow up
* provide informed consent

Exclusion Criteria:

* critical care or labor/delivery units
* pregnant or breastfeeding
* physically unable to participate
* cognitively impaired
* no phone
B: Inclusion Criteria:

* Must be 18 years of age or older.
* Must be a current smoker.
* Must receive primary care at one of the participating clinics.
* Must have had a PCP visit within the last month at a participating clinic.
* Must have a working phone number listed in Partner's database.
* Must report race /ethnicity as African American or Hispanic or live in a low-SES block group (a census block group with a median income of \< $65,000).
* Must speak English or Spanish.

Exclusion Criteria:

* Hearing impaired patients who cannot use the telephone.
C: 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
D: Inclusion Criteria:

* VA patients followed by the Durham VA Primary Care, Women's Health, and Geriatric clinics
* Must have had more than one visit to the VA in preceding 12 months
* Age 60 and over
* Impaired glucose intolerance documented by recent fasting blood glucose between 100 and 125 mg/dL
* Body mass index between 25-40 kg/m2
* Able to walk 10 meters without human assistance (assistive device acceptable)
* All participants must be assigned a primary care provider and have had more than one visit to the VA in the preceding 12 months

Exclusion Criteria:

* Free of frank diabetes
* Fasting blood sugar above 125 mg/dL
* HbA1c \> 7%
* Unstable angina
* Recent history of ventricular tachycardia
* Unstable chronic obstructive pulmonary disease (two hospitalizations within the previous 12 months and/or on oxygen)
* Uncontrolled hypertension (diastolic blood pressure \>110 mm/Hg or systolic \> 200mm/Hg)
* Stroke with moderate to severe aphasia
* Diagnosis of chronic pain which may interfere with their ability to be physically active
* Diagnosis of unstable mental or behavioral disorder
* Diagnosis of memory loss or dementia
* Visual or hearing loss severe enough to interfere with ability to receive telephone counseling and review written materials
* Active substance abuse
* A terminal diagnosis
* Followed by VA for medications only
* Regularly, vigorously physically active for six months or longer.

Answer: C