Studies of Tobacco Use and Treatment Featured in Current Mayo Clinic Proceedings

Tuesday, February 13, 2001

J. Taylor Hays, M.D., associate director of the Mayo Clinic Nicotine Dependence Center, discusses findings of the studies:

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ROCHESTER, MINN. — The February issue of Mayo Clinic Proceedings features four studies related to tobacco use. Each article shows that people have an overall interest to either quit smoking or have a smoke-free environment. Highlights of these four studies include: - Inpatient more effective than outpatient therapy - Smokers and non-smokers prefer smoke-free restaurants and bars - Smoking cessation advice enhances patient satisfaction - Mayo Medical students report success of free smoking intervention clinic

Each of the four articles that appear in Mayo Clinic Proceedings is summarized below:

Study Finds Intensive Residential Treatment Program Helps Severely Addicted Smokers Stop A Mayo Clinic study comparing results between smokers who were treated in an inpatient setting versus an outpatient setting showed that inpatient treatment was more effective in some smokers who are moderately to severely nicotine dependent.

The results of this study provide the first published evidence that a residential nicotine-dependence treatment program is more effective than outpatient treatment for selected smokers.

In an accompanying editorial, Nancy Rigotti, M.D., and Anne Thorndike, M.D., of Massachusetts General Hospital, Harvard Medical School say the inpatient treatment outlined in the article is a good model for a population that is otherwise likely to fail at quitting smoking.

Residential treatment for nicotine dependence at Mayo Clinic comprises several components: a confined, smoke-free environment, individual counseling, group counseling, medical supervision and medication administration to treat nicotine withdrawal.

At both the six-month and 12-month follow-ups, the abstinence rate among patients who were in the residential or inpatient setting was nearly double that of patients who had undergone outpatient therapy. At six months, abstinence rates for inpatient versus outpatient treatment were 45 percent and 26 percent, and the 12-month abstinence rates were 45 percent and 23 percent.

This degree of success in the residential group is particularly impressive because these patients were severely nicotine dependent,¨ says J. Taylor Hays, M.D associate director the Mayo Clinic Nicotine Dependence Center.

Researchers also found that the year in which a residential patient was treated influenced outcomes; patients treated more recently had better outcomes than those treated earlier. Researchers said this is likely to be due to maturing of the residential treatment program and more effective delivery of services later in the learning curve.¨

More intense treatment for nicotine dependence in a residential setting results in significantly better outcomes for smokers who are severely nicotine dependent, for those who have relapsed after other interventions and for those who have significant medical or psychiatric comorbidity,¨ says Dr. Hays. "This is hopeful news for smokers who have not been able to stop and for their doctors and other care providers." Olmsted County Residents Prefer Smoke-Free Environments A telephone survey of Olmsted County ,Minn. found that 70 percent of adults would choose a smoke-free restaurant or bar over one where smoking is permitted.

The survey was conducted by CardioVision 2020, a community partnership to reduce the burden of cardiovascular disease in Olmsted County.

The responses of 1,224 Olmsted County residents indicated they prefer smoke-free restaurants, bars and nightclubs. The researchers report that the data are consistent with national preferences.

Although the results reflect only the attitudes of Olmsted County in Minnesota, the issue is topical as communities not only in Minnesota but elsewhere debate and enact laws to ban smoking in restaurants, bars and nightclubs.

Researchers also found that only 31 percent of those who said they were smokers indicated they prefer a restaurant where smoking was allowed. Nearly 50 percent were indifferent. Regarding the question about preference of smoking in bars or nightclubs, 54 percent of the smokers said they preferred a setting where smoking was permitted. The indifferent were 35 percent.

However, 90 percent of the survey's respondents said their dining habits would be the same if all restaurants were smoke-free.

The survey was done to help plan implementation of one of CardioVision's goals: eliminating tobacco smoke in public places in Olmsted County.

We've known for a long time that smoke-free bars and smoke-free restaurants are good for the health of the customers and the employees," says Thomas Kottke, M.D., a Mayo Clinic cardiologist and the principal author of the study. Now we know that they are also good for business."

Patient Satisfaction Higher With Discussion Of Smoking Cessation Greater patient satisfaction is associated with physicians and nurses who discuss smoking cessation advice during a patient's visit, reports a survey of 2,714 cigarette smokers.

The authors, affiliated with HealthPartners/HealthPartners Research Foundation, the Minnesota Department of Human Services and Blue Cross and Blue Shield of Minnesota, said that the study presents evidence that physicians and nurses should not fear that they will antagonize smokers if they bring up tobacco use, assess interest, provide encouragement, and help in quitting. In fact, the authors said, this study suggests that not doing these things may jeopardize the very satisfaction that healthcare professionals seek.

In our experience, smokers these days expect to be asked about tobacco use when they visit the doctor,¨ editorialists Drs. Rigotti and Thorndike write. "If they are not, they may wonder if other important health issues are being neglected."

The 1,898 smokers who reported that they had been asked about tobacco use or advised to quit during the latest visit had a 10 percentage point greater satisfaction rating and 5 percentage point less dissatisfaction than those not reporting such discussions. Those differences were two-to-three times as great for other actions, such as asking about interest in quitting or offering help or cessation medications. Smokers reporting no interest in quitting at the time of the latest visit also demonstrated similarly greater satisfaction in association with these actions.

This study should encourage doctors and nurses to be much more active in following the smoking cessation recommendations that have been proven to be effective in treating this serious medical problem,¨ said Leif Solberg, M.D., director for Care Improvement Research at HealthPartners Research Foundation and the principal author of the study.

Free Smoking Cessation Clinic Initiated By Medical Students Helps Patients Mayo Medical School students who staffed a free smoking intervention clinic reported abstinence rates comparable to other treatment programs and they believed they improved their smoking cessation counseling skills.

The clinic was set-up in conjunction with the Salvation Army Free Acute Care Clinic in Rochester, Minn. This report describes the smoking intervention clinic's first 13 months of operation during which 88 patients were seen. The study involved 30 medical school student volunteer counselors. The six-month self-reported smoking abstinence rate was 18 percent.

The authors note that a free smoking intervention clinic operated by medical students under the guidance of licensed physicians is feasible, if it has proper funding. It provides a treatment resource to people who might be unable to afford such support. And it helps medical students who participate in such clinics by giving them confidence to deal with future patients in stopping smoking by using both counseling techniques and pharmacological therapy.

This proved to be an excellent example of how medical schools can provide a unique educational opportunity to future physicians and still provide a quality service to a population in need,¨ says Lowell Dale, M.D., associate director, Mayo Clinic Nicotine Dependence Center, and one of the report's authors. We hope this report will encourage other schools to consider similar programs.¨

Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.

John Murphy (Mayo Clinic) 507-538-1385 (days) 507-284-2511 (evenings) e-mail:newsbureau@mayo.edu

Shelly Plutowski (Mayo Clinic) 507-284-2417 (days) 507-284-2511 (evenings) e-mail: newsbureau@mayo.edu

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