• Marna Rayl Greenberg, Michael Weinstock, Deborah Gaston Fenimore, and Gina M Sierzega.
• Lehigh Valley Hospital, Allentown, PA 18103-6980, USA. mrgdo@ptd.net
• J Am Osteopath Assoc. 2008 Aug 1;108(8):391-6.

ContextThe emergency department (ED) is often the primary source of healthcare for uninsured and underinsured patients.ObjectivesTo evaluate ED staff attitudes toward and participation in referring patients to a tobacco cessation program, and to assess the program's effectiveness.MethodsA nonvalidated survey on smoking cessation and preventative services for ED patients was mailed to ED staff at a suburban hospital. After survey completion, ED staff was encouraged to refer smokers with diagnoses substantially worsened by tobacco use to a brief intervention delivered in the ED. An incentive was provided to staff beginning in the second month of the 3-month period. Referred patients were briefly counseled by a hospital social worker or an ED physician or nurse. Follow-up telephone interviews with patients occurred 1 to 3 months postintervention.ResultsOf the 70 ED staff contacted, 63 (90%) responded to the survey. Most staff members (81%) agreed that they should facilitate clinical prevention. Fewer staff (60%) were comfortable advising patients to quit tobacco use (P<.03), and fewer still (51%) agreed that ED staff should assist patients in tobacco cessation (P<.001). Tobacco users were more likely to favor implementing patient education in the ED (P=.01) and were less comfortable advising patients to quit (P=.06). Staff referrals increased with program incentives (P=.008), with a total of 150 interventions occurring in the 3-month span. Of the 36 patients (24%) reached for follow-up, 13 (36%) attempted to quit and 6 (17%) succeeded. Overall, 45% of the patients reached for follow-up either cut down or quit tobacco use.ConclusionsStaff members' attitudes toward tobacco cessation are not a firm barrier to the successful implementation of an ED tobacco cessation program. In addition, the ED provides an important opportunity to encourage patients to quit or cut down tobacco use.

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