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  1. P Aveyard,
  2. M Munafo
  1. 1
    Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK
  1. Dr P Aveyard, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, UK; p.n.aveyard{at}

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Kastelik et al describe an excellent example of a smoking cessation intervention for “hospitalised” patients. The recent Cochrane review of interventions for hospitalised patients reports that intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least 1 month after discharge increased smoking cessation rates after discharge.1 The odds ratio (OR) was 1.65, 95% confidence interval (CI) 1.44 to 1.90. It is therefore likely that the continued behavioural support given by Kastelik et al was an important contributor to the cessation seen. However, the review reports evidence that brief or even intensive interventions that began in hospital and provided less than 1-month follow-up behavioural support were ineffective. The clear message for others wishing to follow this excellent example is that it is important to provide behavioural support following discharge. In the UK this could easily be accomplished by booking the patient an appointment with the NHS Stop Smoking Service clinic after discharge while the patient is still an inpatient.

We would like to make two other suggestions for those emulating Kastelik and colleagues. First, it might be preferable to provide more frequent contacts in the first month after cessation. Relapse is much more likely in the first week or two than later on. This is based on intuitive reasoning rather than trials comparing a weekly visiting schedule with a more spaced visiting schedule. Second, research shows that many interventions are effective at increasing the cessation, meaning more people remain abstinent to the end of treatment, typically 2–3 months after quitting. However, a Cochrane review of trials to prevent relapse shows almost without exception that relapse prevention interventions in those who have been abstinent for a few weeks are ineffective.2 This is another factor that might suggest that behavioural support should be concentrated in the first 2–3 months.



  • Competing interests: None.

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