Is the Hospital Smoke‐Free? Chemically Verified Abstinence among Hospitalized Smokers at Discharge and One Month after Discharge

1University of Chicago, Chicago, IL
2University of Chicago, Chicago, IL
3University of Chicago, Chicago, IL
4University of Chicago, Chicago, IL
5University of Chicago, Chicago, IL
6University of Chicago, Chicago, IL

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 91


The Joint Commission requires that U.S. hospitals be smoke free, creating a valuable opportunity for hospitalized smokers to quit. Smoking cessation counseling is also a quality measure for Medicare patients hospitalized with heart failure, myo‐cardiai infarction, or pneumonia. However, rates of chemically verified abstinence during and after hospitalization are currently unknown. The aim of this study was to assess chemically verified rates of abstinence at discharge and 4 weeks posfdischarge for a cohort of hospitalized smokers receiving usual care.


Smoking inpatients on the general medicine service were identified using National Health Interview Survey items to identify current smokers. Smokers were interviewed at admission about smoking behaviors and barriers to long‐term cessation. At discharge, they were asked to provide an expired‐air carbon monoxide (CO) test for chemical verification of abstinence. A cutoff of <5 ppm was used to verify smoking abstinence. Smokers were interviewed by telephone for a follow‐up 4 weeks postdischarge regarding the quality of care they received for their tobacco use during hospitalization (advised to quit, offered medications to assist with abstinence, or arranged to follow up with a tobacco cessation program at discharge). Self‐reported quitters were asked to return for CO testing as a verification of abstinence. Subjects were paid for their participation in follow‐up.


From September 2008 to December 2008, 128 smokers were identified and approached on the general medicine service, and 88% (113) agreed to participate. All subjects completed the admission interview, and 87% of them (98) completed the discharge interview. To date, 81% of subjects (92) have been eligible for follow‐up contact, and 85% (78) were successfully contacted by telephone. Of these 78 smokers, 59% (46) reported receiving advice to quit from a health care provider, only 31% (24) reported being offered nicotine replacement therapy, and only 4% (3) reported being offered oral medications (i.e., Wellbutrin) to assist with cessation during hospitalization. Additionally, only 32% (25) reported being offered a referral to the TCP at the time of discharge. Interestingly, 16% of smoking patients who completed the discharge interview (15) were found to have positive CO levels at discharge, indicating smoking during hospitalization. At the time of follow‐up, 26% of smokers (20) self‐reported quitting, but only 10% (8) provided objective CO confirmation.


The usual care for hospitalized smokers continues to show limitations in terms of compliance with U.S. Public Health guidelines. Therefore, it is not surprising that chemically verified rates of abstinence 4 weeks after discharge are extremely low. Additionally, despite the smoke‐free environment, some patients are likely to continue smoking in the hospital, raising the need for more intensive monitoring of smoking status in the hospital.

Author Disclosure:

L. Shah, none; A. King, none; J. Krishnan, none; K. Suresh, none; D. Meltzer, none; V. Arora, none.

To cite this abstract:

Shah L, Arora V, Suresh K, Meltzer D, Krishnan J, King A. Is the Hospital Smoke‐Free? Chemically Verified Abstinence among Hospitalized Smokers at Discharge and One Month after Discharge. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 91. Journal of Hospital Medicine. 2009; 4 (suppl 1). Accessed April 3, 2020.

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