Table 1.

Trials of Smoking Cessation Counseling

Source	Setting -country/ -# of hospitals	Subjects n, diagnoses -smoking status -willingness to quit	Study design # of arms	Counseling Intervention Inpatient Post-discharge	Control condition	Pharmacotherapy?	Outcome -Abstinence type, -longest f/u, -validation method
Bolman 200240	Netherlands 11 hospitals	789 current smokers (smoked in past week) Admitted to cardiac ward. Willingness to quit not reported	Quasi-experimental, by hospital. 2 arms	MD advice, counseling by staff nurse (15-30 min), self-help material Post-discharge: none [Intensity 2]	Usual care	No	Sustained abstinence. at 12 months No validation
CASIS 199210	USA 3 hospitals	267 current smokers or recent quitters (smoke in past 2 mo). Inpatients with CAD enrolled post-catheterization. Not selected by willingness to quit.	RCT 2 arms	Counseling (40 min) by health educator, self-help material. Post-discharge: telephone calls (at 1, 3 wks and 3m) [Intensity 4]	Advice only	No	Sustained abstinence at 6 mo, 12 mo Validation: CO.
Chouinard 200525	Canada (# hospitals not reported)	168 current smokers (in past month) Inpatients with CVD (MI, angina, CHF) or PVD Not selected by motivation to quit	RCT 3 arms	Group 1: Stage-based counseling by research nurse (10-60 mins, average, 40 min). [Intensity 2] Group 2. Same as group 1 + 6 telephone calls over 2 mo post-discharge [Intensity 4]	Advice only	NRT in 23%, not allocated by study arm	Sustained abstinence at 2 & 6 months Validation: Urine cotinine or CO
Croghan 200536	USA 1 hospital	30 smokers Inpatients having surgery for newly diagnosed lung or esophageal cancer. Willingness to quit not reported.	RCT 2 arms	MD advice + stage-based counseling by trained counselor (45 min) + NRT Post-discharge: none [Intensity 2]	Physician advice only	NRT	7-day point-prevalence abstinence at 6m Validation: CO or saliva tobacco alkaloid
De Busk 199412	USA 5 hospitals	252 current smokers or recent quitters (smoked in past 6m) Inpatients with acute MI. Willing to make a quit attempt	RCT 2 arms	Physician advice + behavioral counseling by research nurse; + self-help material, relaxation tapes). Post-discharge: 8 telephone calls (at 48 hr, 1 wk, and monthly for 6m) [Intensity 4]	Advice only	NRT: Yes (partial) ('reserved for highly-addicted patients');	Sustained abstinence at 6m, 12m. Validation: CO and plasma cotinine.
Dornelas 200018	USA 1 hospital	100 current smokers (smoked in past month). Inpatients with acute MI. Not selected by willingness to quit.	RCT 2 arms	Behavioral counseling (total 20 min); 7 telephone calls post-discharge (at <1, 4, 8, 12, 16, 20, 26 wk) [Intensity 4]	Advice only	No	7-day point-prevalence abstinence at 12m. Validation by significant other (only in 70%).
Feeney 200137	Australia 1 hospital	198 current smokers (smoked in past week). Inpatients with acute MI admitted to CCU. Willingness to quit not reported.	RCT 2 arms	Physician advice to quit + behavioral counseling by nurse (time not specified)); 8 telephone calls post-discharge (at 1,2,3,4 wks and 2,3,6,12m) [Intensity 4] nurse.	Same as intervention in hospital but no follow up after discharge [Intensity 2]	No	Sustained abstinence at 1m,3m, 12m. Validation: Urinary cotinine
Froelicher 200423	USA 10 hospitals	277 female current smokers or recent quitters (smoked in past month), Inpatients with CVD or PVD. Willing to make quit attempt at discharge.	RCT 2 arms	Physician advice, cognitive/behavioural and relapse prevention counseling (30-45 min) by nurse; 5 telephone calls after discharge (at 2,7,21,28,90 days, 5-10 min/call) [Intensity 4]	Modified usual care (physician advice + booklet)	NRT offered after discharge to relapsers who wanted to quit (used by 20% of intervention, 23% of controls).	7-day point-prevalence abstinence at 12m. Validation: Saliva cotinine or family/friend verification
Hajek 200238	UK 17 hospitals	540 current smokers. Inpatients with acute MI who were. willing to stop smoking entirely.	RCT 2 arms	Nurse counseling (20-30 min) + self-help materials. [Intensity 2]	Brief advice + booklet	No	7-day point-prevalence abstinence at 12m. Validation: CO and salivary cotinine.
Hasuo 200424	Japan 1 hospital	120 current smokers or recent quitters (smoked in past month) Inpatients (all diagnoses) Intend to quit at discharge	RCT 2 arms	Nurse counseling (3 × 20 min sessions) + 3 telephone calls after discharge (at 7, 21, 42 days, 5 min/call) [intensity 4]	Same as intervention in hospital but no post-discharge contact [Intensity 2]	No	Abstinence (type not stated) at 12m Validation: urinary cotinine at 12m
Hennrikus 200526	USA 4 hospitals	2095 current smokers (smoked in past week) Inpatients with all diagnoses, not selected by willingness to quit.	RCT 3 arms	Group 1. Physician advice + nurse counseling (motivational interviewing and relapse prevention) for 20 min. (43% of counseling done after discharge, not at bedside). Follow up: 3-6 phone calls over 6m (10 min/call median). [Intensity 4] Group 2: Physician advice + smoking cessation booklet + additional mailed booklet after discharge. [Intensity 1]	Modified usual care (smoking cessation booklet)	No	7-day point-prevalence abstinence at 12m. Validation: Saliva cotinine
Miller 199714	USA 4 hospitals	1942 current smokers. All inpatients (32% cardiovascular, 12% pulmonary diagnoses) Prepared to make quit attempt and willing to get help	RCT 3 arms	Group 1. Physician advice + behavioural counseling (30 min) + self-help material, relaxation tapes, video. Post-discharge: 4 telephone calls (at 48hr, 1, 3 wks, 3m [Intensity 4] Group 2. Physician advice + behavioural counseling (30 min) + self-help material, relaxation tapes, video. Post-discharge: 1 telephone call (at 48 hr) [Intensity 3]	Advice only	No	Sustained abstinence at 3, 6 & 12 months. Validation: Plasma cotinine or family member corroboration.
Mohiuddin 20076	USA 1 hospital	209 current smokers CCU inpatients with MI or acute coronary syndrome or decompensated CHF. Not selected by willingness to quit.	RCT 2 arms	Intervention: Counseling (30 mins) + self-help booklet + free NRT and/or bupropion. Follow up: weekly group meetings (60 min each for up to 3m) with trained tobacco counselor [Intensity 4]	Inpatient: same as intervention group, but no post-discharge contact [Intensity 2]	NRT or bupropion offered on individual basis to both groups	Sustained abstinence at 3m, 6m, 12m. (note: sustained abstinence to 24m reported but not used in pooling) Validation: CO
Nagle 200534	Australia 1 hospital	1422 current smokers or quitters (smoked in past 12m). Inpatients (all diagnoses) excluding intensive care units. Not selected by willingness to quit	RCT 2 arms	Nurse counseling (20 min, withdrawal symptom management, coping skills) + booklet + offer of NRT Follow up: none. [Intensity 2]	Modified usual care (Physician advice + booklet)	NRT in hospital (3% received) and for 5 days after discharge	7-day point-prevalence abstinence at 12m. Validation: Saliva cotinine
Ortigosa 200019	Spain 2 hospitals	90 current smokers. Inpatients with acute MI. Not selected by willingness to quit	RCT 2 arms	Physician advice. Follow up: 3 telephone calls (at 2,3,4 wks). [Intensity 3]	Usual care	No	7-day point-prevalence abstinence at 12m.. Validation: CO
Pedersen 200530	Denmark 1 hospital	105 current smokers Inpatients with cardiac disease, not selected by willingness to quit.	RCT 2 arms	Usual hospital care (advice to quit + information about NRT + NRT available) Follow up: 5 visits after discharge (30 min/meeting); [Intensity 4]	Usual care (advice to quit + NRT available)	NRT (partial)	Abstinence (probably point-prevalence) at 12m. Validation: no.
Pederson 199135	USA 1 hospital	74 current smokers. Inpatients with COPD, not selected by willingness to quit.	RCT 2 arms	Counseling (total 45-160 mins), self-help materials. Post-discharge: none [Intensity 2]	Advice only	No	7-day point-prevalence abstinence at 6m. Validation: Serum COHb (in a sample).
Pelletier 199839	Canada 3 hospitals	504 current smokers. Inpatients with acute MI who were willing to quit	Quasi-experimental, allocation by hospital	Physician advice. Self-help materials. [Intensity 2]	Usual care	No	Abstinence: self-reported PP at 12m Validation: None.
Quist-Paulsen 200321	Norway 1 hospital	240 current smokers Cardiac ward inpatients with MI, unstable angina, post-CABG care. Not selected by willingness to quit.	RCT 2 arms	Nurse counseling (1-2 times, time not specified), advice on using NRT). Post-discharge: 5 telephone calls (2,7,21, days, 3m, 5m) , clinic visit to cardiac nurse at 6 wk); NRT encouraged for subjects with strong urges to smoke in hospital. [Intensity 4]	Usual care (advice + booklet)	NRT	7-day point-prevalence abstinence at 12m. Validation: Urine cotinine.
Reid 200332	Canada 1 hospital	254 current smokers (smoked in past month) Inpatients with MI, CABG, PTCA, coronary angiography Motivated to quit	RCT 2 arms	Nurse counseling (5-10 mins) + booklet . Follow up: nurse call at 4 wks; if smoking, offered 3 × 20 min in-person counseling sessions (wks 4,8,12) and NRT patch recommended for 8 wks. [Intensity 4]	Same as intervention group but no contact after discharge	NRT if relapse after discharge	Abstinence: 7-day PP at 12m. Validation: CO requested in random 25 self-reported non-smokers
Rigotti 199413	USA 1 hospital	87 current smokers or recent quitters (past 6 mo) Inpatients scheduled for CABG surgery. Not selected by willingness to quit.	RCT 2 arms	Behavioral counseling (60 min) by nurse, self-help materials, video. Post-discharge: 1 telephone call (at 1 wk) [Intensity 3]	Advice only	No	Sustained abstinence at 4m, 8m, 12m. Validation: Salivary cotinine.
Rigotti 199715	USA 1 hospital	650 current smokers or recent quitters (smoked in past month) Inpatients with all diagnoses. Not selected by willingness to quit.	RCT 2 arms	MD advice, behavioral counseling (total 15 min) by trained counselor; booklet. Post-discharge: 3 telephone calls (1,2,3 wks) [Intensity 3]	Usual care	NRT in 4%	Abstinence: PP at 6m. Validation: Salivary cotinine.
Simon 199716	USA 1 hospital	299 current smokers. Inpatients undergoing non-cardiac surgery. Prepared to make quit attempt.	RCT 2 arms	Behavioral counseling (30-60 min) by health educator; self-help materials, video. NRT gum for 3 m. if no contraindications. Post-discharge: 5 telephone calls (1-3 wks, 2m, 3m). [Intensity 4]	Advice only	NRT in 65% of intervention, 17% of control	Abstinence: PP at 12m Validation: Serum or saliva cotinine or corroboration by significant other.
Simon 200322	USA 1 hospital	223 current smokers (smoked in past week), in contemplation or action stage, able to use NRT. Inpatients (all diagnoses)	RCT 2 arms (NRT in both arms)	Cognitive/behavioural counseling (30-60 min) by nurse or health educator + booklet Post-discharge: 5 telephone calls at 1,3 wks and 1m, 2m, 3m (<30 min/call); [Intensity 4]	Brief counseling (10 min)	NRT patches × 8 wks to all patients in both groups	Abstinence: 7-day PP at 12m. Validation: Saliva cotinine <15 ng/ml OR spousal corroboration.
Stevens 199311	USA 2 hospitals	1119 current smokers or recent quitters (smoked in past 3 months) Inpatients with all diagnoses. Not selected by willingness to quit.	Not random (allocation alternated between hospitals monthly).	Behavioral counseling (20 min) by masters level counsellor, self-help materials, video. Postdischarge: 1-2 telephone calls (at 1-3 wks) [Intensity 3]	Usual care	No	Sustained abstinence at 3m, 12m. Validation: None
Stevens 200020	USA 2 hospitals	1173 current smokers or recent quitters (smoked in past 3 months) Inpatients with all diagnoses. Not selected by willingness to quit.	Not random (alternated between hospitals monthly).	Behavioral counseling (20 min) by respiratory therapist, self-help materials, video. Post-discharge: 1 telephone call at 1 wk [Intensity 3]	Usual care	No	Sustained abstinence at 6m, 12m Validation: None.
Taylor 19909	USA 4 hospitals	173 current smokers or recent quitters (smoked in past 6 mo) Inpatients with acute MI. Prepared to make a quit attempt.	RCT 2 arms	Behavioral counseling (time not stated) by nurse, self-help materials, relaxation tapes. Post-discharge: 6-7 telephone calls at 1-3 wks + very month for 4m) [Intensity 4]	Usual care	NRT gum given to 5 patients.	Sustained abstinence at 3m, 12m. Validation: Serum thiocyanate, expired air CO.