Learning Objectives: Describe changes in the stages of smoking cessation after respiratory failure, during and after hospitalization. Explain the high relapse rates after initial advancements in smoking cessation stages. List effective measures to be employed by clinicians, counsellors and program managers in maintaining and improving smoking cessation processes after hospitalization for severe tobacco related disorders.
Abstract: Objective: To determine the impact of life threatening tobacco related respiratory complications on the stages of smoking cessation. Target audience includes clinicians caring for patients with tobacco related diseases; counsellors and program managers involved in tobacco prevention and control programs.
METHODS: Fourty-eight patients with history of tobacco use (mean=25.4 pack years) and chronic obstructive lung disease (COPD) admitted to the medical intensive care unit with first episode of respiratory failure from underlying COPD with or without superimposed acute bronchitis or pneumonia were identified. These patients were administered a structured questionnaire to determine their stage on the "stages of change theory" with regards smoking cessation prior to hospitalization, during hospital stay and thrity days after discharge.
RESULTS: During the pre-admission period, 26 (54%) of patients were in the pre-contemplative stage. 14 (29%) were in the contemplative stage, while 8 (17%) were in readiness for action stage. During hospitalization, 4 (8%) were in the pre-contemplative stage, 21 (44%) in the contemplative stage, 17 (35%)readiness for action and 6 (13%)in the stage of action. At thirty days and greater after discharge, 4 (8%) remained in the pre-contemplative stage, 28 (58%) contemplative, 11 (23%)readiness for action and 2 (4%) in the maintanance stage.
Discussion: Life threatening respiratory complications are important stimuli for begining smoking cessation process. A large proportion of individuals advance to contemplative, readiness for action and action stages during hospitalization. Regrettably, these initial gains are lost at graeter than thirty days from discharge implying the need for sustained efforts.
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