Hospital Initiatives in Promoting Smoking Cessation: A Survey of Internet and Hospital-Based Programs Targeted at Consumers

John T. Denny, MD, FCCP, Steven Ginsberg, MD, Denes Papp, MD, George Browne, MS-3, Sharon Morgan, CRNA, MS, Lawrence Kushins, MD, Alann Solina, MD


CHEST. 2002;122(2) 

In This Article

Abstract and Introduction

Study objectives: This study assesses how often local US hospitals provide smoking cessation information in the following two ways: via hospital Web sites; and via routing incoming phone calls to their hospital switchboards to an in-house smoking cessation clinic.
Design: Random survey of US hospitals.
Setting: US hospital Web pages and telephone switchboards.
Patients or participants: One hundred two randomly selected US hospitals.
Interventions: One hundred two hospital Web sites were randomly selected across the United States. The site was searched for the topic of smoking cessation. In the second phase of the survey, the main switchboard number of the same 102 hospitals was anonymously called and the "stop smoking clinic" was asked for.
Measurements and results: The overall results indicate that among the hospital Web sites surveyed, only 30% contained information relating to smoking cessation programs. The phone survey of hospital switchboards showed that 47% had a smoking cessation program available via phone inquiry, while 53% did not.
Conclusions: Of the US hospital Web sites visited, only 30% contained information on smoking cessation. The yield of finding the desired information was increased by the presence of an intrasite search option, which is a low-cost enhancement to any complex Web site. The relatively low cost of promoting healthy behaviors such as smoking cessation on a hospital Web site should be used more widely. Surprisingly, the phone survey of hospitals showed that the lower technology route of providing smoking cessation information to patients via a patient-initiated phone call is only available in 47% of hospitals. Both the Internet and phone-based switchboard referrals could be more widely and effectively used. Joint Commission on Accreditation of Healthcare Organizations guidelines would be one avenue of increasing the availability of smoking cessation information at hospital switchboards and Web sites.

Of the 50 million smokers in the United States, each year approximately 20 million try to stop. In the long term, only about 6% of smokers succeed in quitting.[1] Eighty-five percent of these smokers try to stop on their own.[2] Patients who are simply advised to stop smoking in a physician's office have a quit rate of approximately 3 to 9% without any other pharmacologic or psychological support.[3] If a patient is approached at a time of health crisis (eg, myocardial infarction), the short-term quit rates are 20 to 60%, although most patients relapse without further intervention.[4] Although physicians' and dentists' offices are important sites for promoting smoking cessation, they harbor important limitations.[5,6,7] Although 70% of smokers report that they want to quit and have made at least one attempt to do so,[8] only about half of current smokers report ever having been asked about their smoking status or urged to quit.[9,10,11] Even fewer have been given specific advice on how to successfully quit.[10,11,12]

Hospitals have several potential roles in smoking cessation.[13,14,15,16] They serve as portals of entry into the healthcare system for many patients without traditional insurance coverage or regular physicians. Hospitals also serve in the continuity of patient care for patients with ongoing medical needs or conditions. Hospitals serve as acute interveners for patients with insurance coverage who pass through their doors for the diagnosis or treatment of an acute condition. Thus, hospitals fulfill many potential roles for different sets of patients. Common to all of these roles is the potential to intervene in freeing patients from their tobacco habits.[17,18,19] The fact that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires hospitals to be smoke free creates a window of opportunity for smokers to quit.[20]

In addition, access to smoking cessation programs via hospitals is important because a significant number of smokers come from lower socioeconomic groups and, thus, are less likely to have their own personal physician, let alone easy access to that physician. It is well-known that in lower socioeconomic groups, disproportionately more medical care is obtained in hospital emergency departments than in a less rushed office consultation. Evidence exists that some subgroups of smokers are not reached by, or are not impacted by, conventional means (ie, a doctors office). Yet, some subgroups would potentially benefit the most in terms of risk reduction and improved quality of life, for example, the occult early COPD patient who may not seek medical attention because of a lack of symptoms.

Many hospitals traditionally have offered health promotion classes with aims such as smoking cessation through community education departments. These classes are accessible to the public via traditional means such as telephoning the hospital and asking for a smoking cessation program. In this study, we determined which hospitals had smoking cessation programs that were available via this traditional approach by anonymously phoning the hospital main switchboard and asking for the smoking cessation clinic.

The Internet is participating in a transformation of business, education, and money management in different forms varying from online stock trading to bill paying. The impact of the Internet on medicine is still in the early stages, but it offers many possibilities, including diagnostics, record keeping, information dissemination, and patient education.

One feature of the World Wide Web is the ubiquitous access to information from around the globe without having to see a physician. Many hospitals are embracing the new medium of the Internet to promote the use of Web pages, which are easily accessible from the next county as well as from around the world, by their institutions. The second portion of this survey examined the same set of hospitals to determine the degree to which traditional smoking cessation programs are featured on hospital Web sites and the accessibility of this information to Web site visitors.