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Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic

Educational Objective To determine factors associated with smoking quitline engagement and cessation programs for patients who were undergoing thoracic surgery.
1 Credit CME
Key Points

Question  What factors are associated with a higher level of engagement and smoking cessation outcomes among patients in a thoracic surgery clinic who agreed to participate in a smoking quitline intervention?

Findings  Although the level of quitline engagement in this cohort study was similar between patients who underwent surgery (55%) and those who did not undergo surgery (45%), those undergoing surgery were nearly twice as likely (64% vs 36%) to quit smoking regardless of quitline participation. Patients undergoing surgery who engaged in the quitline had a 1.8-fold higher odds of point prevalence abstinence at 6 months than those who did not.

Meaning  Patients undergoing a thoracic operation are motivated to quit smoking, and quitline engagement amplifies long-term abstinence.


Importance  Smoking quitline programs effectively promote smoking cessation in outpatient primary care settings.

Objective  To examine the factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral.

Design, Setting, and Participants  A retrospective cohort study was conducted from January 1, 2014, to December 31, 2018, among 111 active smoking patients referred to the quitline from a thoracic surgery outpatient clinic visit. Patients were divided into operative and nonoperative cohorts.

Main Outcomes and Measures  Primary outcomes were engagement rates in the quitline program and successful smoking cessation. Secondary outcomes were self-reported point prevalence abstinence at 1 month and 6 months after the smoking quit date.

Results  Of 111 patients (62 men; mean [SD] age, 61.8 [11.2] years) who had a quitline referral, 58 (52%) underwent surgery, and 32 of these 58 patients (55%) participated in the program. Of the 53 nonoperative patients (48%), 24 (45%) participated in the program. In the operative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (21 of 32 [66%] vs 16 of 6 [62%]; P = .79) or in point prevalence abstinence at 1 month (23 of 32 [72%] vs 14 of 25 [56%]; P = .27) or 6 months (14 of 28 [50%] vs 6 of 18 [33%]; P = .36). Similarly, in the nonoperative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (8 of 24 [33%] vs 11 of 29 [38%]; P = .78) or in point prevalence abstinence at 1 month (7 of 24 [29%] vs 8 of 27 [30%]; P = .99) or 6 months (6 of 23 [26%] vs 6 of 25 [24%]; P = .99). Regardless of quitline participation, operative patients had a 1.8-fold higher proportion of successful smoking cessation compared with nonoperative patients (37 of 58 [64%] vs 19 of 53 [36%]; P = .004) as well as a 2.2-fold higher proportion of 1-month point prevalence abstinence (37 of 57 [65%] vs 15 of 51 [29%]; P < .001) and a 1.8-fold higher proportion of 6-month point prevalence abstinence (20 of 45 [44%] vs 12 of 48 [25%]; P = .05). Having surgery doubled the odds of smoking cessation (odds ratio, 2.44; 95% CI, 1.06-5.64; P = .04) and quitline engagement tripled the odds of remaining smoke free at 6 months (odds ratio, 3.57; 95% CI, 1.03-12.38; P = .04).

Conclusions and Relevance  Patients undergoing thoracic surgery were nearly twice as likely to quit smoking as those who did not have an operation, and smoking quitline participation further augmented point prevalence abstinence. Improved smoking cessation rates, even among nonoperative patients, were associated with appropriate outpatient counseling and intervention.

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Article Information

Accepted for Publication: March 15, 2020.

Corresponding Author: David T. Cooke, MD, Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, 2335 Stockton Blvd, North Addition Office Building, Ste 6121, Sacramento, CA 95817 (dtcooke@ucdavis.edu).

Published Online: July 1, 2020. doi:10.1001/jamasurg.2020.1915

Author Contributions: Dr Cooke had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Clark, Huynh, Brown, Cooke.

Acquisition, analysis, or interpretation of data: Mustoe, Clark, Huynh, Tong, Wolf, Cooke.

Drafting of the manuscript: Mustoe, Clark, Cooke.

Critical revision of the manuscript for important intellectual content: Clark, Huynh, Tong, Wolf, Brown, Cooke.

Statistical analysis: Clark, Huynh, Cooke.

Administrative, technical, or material support: Tong, Wolf, Cooke.

Supervision: Clark, Tong, Brown, Cooke.

Conflict of Interest Disclosures: Ms Mustoe reported receiving personal fees from a Medical Student Research Fellowship, UC Davis School of Medicine, and an American Association for Thoracic Surgery Summer Intern Scholarship in Cardiothoracic Surgery during the conduct of the study. Dr Tong and Ms Wolf reported receiving grants from National Cancer Institute during the conduct of the study. Dr Brown reported receiving grants from National Center for Advancing Translational Sciences, National Institutes of Health during the conduct of the study. No other disclosures were reported.

Funding/Support: Dr Tong and Ms Wolf were supported by award P30CA093373-15S from the National Cancer Institute of the National Institutes of Health.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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