Grant Number:	5R01CA141479-05 Interpret this number
Primary Investigator:	Bernstein, Steven
Organization:	Yale University
Project Title:	Treating Low-Income Smokers in the Hospital Emergency Department
Fiscal Year:	2014

DESCRIPTION (provided by applicant): Of the nation's 45 million adult smokers, nearly 20 million visit hospital emergency departments (EDs) each year. ED patients, particularly smokers, are disproportionately low-income, with limited access to traditional primary care settings. Patients presenting to the ED with a tobacco-related trigger event, like an asthma attack, may be experiencing a "teachable moment." Thus, the ED may be an ideal location in which to identify smokers and initiate treatment for tobacco dependence. Initial pilot research by our group has demonstrated the feasibility of ED-based brief interventions for smokers. Based on our feasibility studies, the Institute of Medicine 2006 report on tobacco and the 2008 US Public Health Service guidelines now list EDs as appropriate loci for tobacco control efforts. This study aims to test the efficacy of an ED-initiated tobacco intervention which includes counseling and medication. The intervention-Screening, Brief Intervention, and Referral to Treatment (SBIRT)-uses a form of motivational interviewing known as the Brief Negotiation Interview (BNI). Our proposed intervention combines a BNI with initiation of nicotine replacement therapy (NRT) and a fax referral to the state Smokers' Quitline during the ED visit. A 6-week starter kit of NRT (patch and/or gum, tailored to level of addiction and patient preference) will be provided with written materials. The initial dose of NRT will be given in the ED. A trained nurse will administer the booster intervention via telephone 3 days post-visit. The SBIRT+NRT arm will be compared to standard care (SC), which consists of written materials only, in a controlled trial of 778 smokers age 18 years or older randomized in a 1:1 fashion. The primary hypothesis is that SBIRT+NRT will be superior to SC in reducing self-reported and biochemically verified 7-day tobacco abstinence at 3 months. Secondary hypotheses include: (1) Patients with a tobacco- related diagnosis for the ED visit will have a higher cessation rate than patients without a tobacco-related diagnosis, and (2) Patients who believe their ED visit is smoking-related will have a higher quit rate than others. We will conduct a cost benefit analysis of the interventions. Follow-up assessments at 1, 3 and 12 months will combine self-report with in-person salivary cotinine testing at 3 months for smokers who assert abstinence via phone. Expansions of the proposed project as compared to earlier studies include: 1) initiation of NRT during the ED visit; 2) provision of multiple forms of NRT; 3) a proactive referral made to the Quitline; 4) a credible control condition with minimal baseline assessment, to avoid the assessment reactivity seen in similar ED studies; and 5) an economic analysis of the tested interventions.




Cost-Effectiveness of Smoking Cessation Approaches in Emergency Departments.
Authors: Miller T.R. , Johnson M.B. , Dziura J.D. , Weiss J. , Carpenter K.M. , Grau L.E. , Pantalon M.V. , Abroms L. , Collins L.M. , Toll B.A. , et al. .
Source: American journal of preventive medicine, 2023 Jul; 65(1), p. 39-44.
EPub date: 2023-01-28.
PMID: 36710199
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A Brief Negotiation Interview Adherence Scale for Smoking Cessation: A psychometric evaluation.
Authors: Pantalon M.V. , Dziura J. , Li F.Y. , D'Onofrio G. , Weiss J. , Bernstein S.L. .
Source: Journal of substance abuse treatment, 2021 Jul; 126, p. 108398.
EPub date: 2021-04-20.
PMID: 34116807
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Ask about smoking, not quitting: a chronic disease approach to assessing and treating tobacco use.
Authors: Bernstein S.L. , Toll B.A. .
Source: Addiction science & clinical practice, 2019-09-02; 14(1), p. 29.
EPub date: 2019-09-02.
PMID: 31474229
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Ability to Reach Low-Income Smokers Enrolled in a Randomised Controlled Trial Varies with Time of Month.
Authors: Hawk K. , Shi R. , Weiss J. , Makuch R. , Toll B. , Bernstein S.L. .
Source: Journal of smoking cessation, 2018 Dec; 13(4), p. 227-232.
EPub date: 2017-11-28.
PMID: 31452822
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Screening, treatment initiation, and referral for substance use disorders.
Authors: Bernstein S.L. , D'Onofrio G. .
Source: Addiction science & clinical practice, 2017-08-07; 12(1), p. 18.
EPub date: 2017-08-07.
PMID: 28780906
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Association Between Utilization of Quitline Services and Probability of Tobacco Abstinence in Low-Income Smokers.
Authors: Bernstein S.L. , Weiss J.M. , Toll B. , Zbikowski S.M. .
Source: Journal of substance abuse treatment, 2016 Dec; 71, p. 58-62.
EPub date: 2016-08-21.
PMID: 27776679
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Cell Phone Ownership and Service Plans Among Low-Income Smokers: The Hidden Cost of Quitlines.
Authors: Bernstein S.L. , Rosner J.M. , Toll B. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2016 Aug; 18(8), p. 1791-3.
EPub date: 2016-02-26.
PMID: 26920647
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A Multicomponent Intervention Including Texting to Promote Tobacco Abstinence in Emergency Department Smokers: A Pilot Study.
Authors: Bernstein S.L. , Rosner J. , Toll B. .
Source: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2016 Jul; 23(7), p. 803-8.
EPub date: 2016-07-01.
PMID: 27146116
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Concordance between timeline follow-back and single-question assessment of self-reported smoking in a clinical trial.
Authors: Bernstein S.L. , Rosner J. , Toll B. .
Source: Substance abuse, 2016 Jul-Sep; 37(3), p. 398-401.
PMID: 27007476
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Incentives to participate in clinical trials: practical and ethical considerations.
Authors: Bernstein S.L. , Feldman J. .
Source: The American journal of emergency medicine, 2015 Sep; 33(9), p. 1197-200.
EPub date: 2015-05-29.
PMID: 26095131
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Serum ubiquitin C-terminal hydrolase L1 as a biomarker for traumatic brain injury: a systematic review and meta-analysis.
Authors: Li J. , Yu C. , Sun Y. , Li Y. .
Source: The American journal of emergency medicine, 2015 Sep; 33(9), p. 1191-6.
EPub date: 2015-05-29.
PMID: 26087705
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Successful Tobacco Dependence Treatment in Low-Income Emergency Department Patients: A Randomized Trial.
Authors: Bernstein S.L. , D'Onofrio G. , Rosner J. , O'Malley S. , Makuch R. , Busch S. , Pantalon M.V. , Toll B. .
Source: Annals of emergency medicine, 2015 Aug; 66(2), p. 140-7.
EPub date: 2015-04-24.
PMID: 25920384
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A promising approach for emergency departments to care for patients with substance use and behavioral disorders.
Authors: Bernstein S.L. , D'Onofrio G. .
Source: Health affairs (Project Hope), 2013 Dec; 32(12), p. 2122-8.
PMID: 24301395
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