Background: Smoking is the leading cause of preventable death in the United States, and hospitalization is an excellent opportunity to promote smoking cessation. Motivation to quit has been shown to be associated with quit attempts, but studies have been predominantly limited to outpatient settings and selected inpatient groups. The aim of the current study is to assess the role of initial motivation as a predictor of successful abstinence from smoking among hospitalized patients.

Methods: During a 34-month period, we attempted to enroll every smoker hospitalized at two New York City “safety net” hospitals into a post-discharge cessation intervention. The 1,618 participants were randomized to multisession telephone counseling or referral to the state quitline at discharge. Research assistants conducted 2 and 6-month follow-up telephone surveys. At enrollment, patients were asked “how confident are you that you will be able to quit/ stay quit once you are discharged from the hospital?” on a scale from 1-5. We divided patients into three groups: mildly (1,2), moderately (3), and very (4,5) motivated and analysis was done to determine the effect of initial motivation on 2 and 6-month abstinence.

Results: At both 2 and 6 months after discharge, when controlling for covariates, patients in the intervention arm who had identified as very motivated were significantly more likely to be abstinent than patients in the quitline arm (odds 1.71 and 1.58, respectively, both p <0.05). Amongst the mildly and moderately motivated patients, there was no difference in abstinence at 2 or 6 months between patients randomized to the intervention or to the quitline.

Conclusions: We found that the intervention is more effective in patients who are very motivated. Among patients who are mildly or moderately motivated, there was no difference in abstinence from the intervention. Our study took place at two urban, public hospitals and may therefore be limited in its applicability to other settings. Furthermore, outcomes were only assessed up to 6 months after discharge and this limited timeframe affects the generalizability of our study. Further research is needed to determine the optimal interventions for patients of all motivation levels and in all settings in order to guide best practices and maximize resource allocation for smoking cessation.