Introduction

Managed care organisations provide a key channel for delivering smoking cessation interventions to populations. This effort has largely focused on outpatient settings, usually primary care practices. Far less attention has been paid to settings that deliver more acute medical care, despite the opportunities that these present for changing behaviour. Illness, especially a tobacco related illness, boosts a smoker's motivation to quit smoking, presumably by increasing a smoker's perceived vulnerability to the health hazards of tobacco use. Illness also brings smokers to the health care setting, where providers have an opportunity to encourage cessation. A hospital stay provides a special incentive for initiating cessation now that the Joint Commission on Accreditation of Healthcare Organizations requires US hospitals to have policies which prohibit smoking. A hospitalised smoker must abstain temporarily from tobacco use and is accessible to multiple caretakers who could provide smoking cessation assistance. Smoking interventions delivered in hospitals and other sites treating patients with chronic medical illness might be particularly effective.

The value of this idea has been demonstrated over the past decade. Observational studies have shown that a hospital stay can trigger smoking cessation even in the absence of intervention, especially in patients with cardiovascular and pulmonary disease or in patients having surgery.1-5 Subsequent work has attempted to enhance this effect with smoking interventions that begin in the hospital and continue after discharge. The three papers in this section are examples of these efforts.6-8

Programs designed for patients recovering from myocardial infarction have produced the best results. These programs have doubled the smoking cessation rate of post-myocardial infarction patients. Cessation rates as high as 60–70% at one year have been reported in carefully controlled randomised clinical trials.9 10 The impressive findings from research studies can be maintained when the model program is implemented in new, “real …