Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients: The Helping HAND 4 Randomized Clinical Trial.

Importance: Smoking cessation interventions for hospitalized patients must continue after discharge to improve long-term tobacco abstinence. How health systems can best deliver postdischarge tobacco treatment is uncertain. Objective: To determine if health system-based tobacco cessation treatment after hospital discharge produces more long-term tobacco abstinence than referral to a community-based quitline. Design, Setting, and Participants: This randomized clinical trial was conducted September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania, and Tennessee. Cigarette smokers admitted to a study hospital who received brief in-hospital tobacco treatment and wanted to quit smoking were recruited for participation and randomized for postdischarge treatment to health system-based Transitional Tobacco Care Management (TTCM) or electronic referral to a community-based quitline (QL). Both multicomponent interventions offered smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3 months. Data were analyzed from February 1, 2021, to April 25, 2022. Interventions: TTCM provided 8 weeks of NRT at discharge and 7 automated calls with a hospital-based counselor call-back option. The QL intervention sent referrals from the hospital electronic health record to the state quitline, which offered 5 counseling calls and an NRT sample. Main Outcomes and Measures: The main outcome was biochemically verified past 7-day tobacco abstinence at 6 months. Self-reported point-prevalence and continuous tobacco abstinence and tobacco treatment utilization were assessed 1, 3, and 6 months after discharge. Results: A total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706 randomized to TTCM and 703 randomized to QL. Participants were comparable at baseline, including 216 Black participants (15.3%), 82 Hispanic participants (5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge, more TTCM participants than QL participants used cessation counseling (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P < .001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001). More TTCM than QL participants reported continuous abstinence for 3 months (RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically verified point-prevalence abstinence at 6 months, was not statistically significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50). Conclusions and Relevance: In this randomized clinical trial, biochemically verified tobacco abstinence rates were not significantly different between groups at the 6-month follow-up. However, the health system-based model was superior to the community-based quitline model throughout the 3 months of active treatment. A longer duration of postdischarge treatment may sustain the superiority of the health system-based model. Trial Registration: ClinicalTrials.gov Identifier: NCT03603496.

COVID-19 Vaccine Hesitancy, Acceptance, and Promotion Among Healthcare Workers: A Mixed-Methods Analysis.

Even with vaccine mandates, COVID-19 vaccine hesitancy remains a concern among healthcare workers, in part due to their role in promoting vaccination among patients and communities. To examine COVID-19 vaccine hesitancy, acceptance, and promotion among healthcare workers, we conducted a mixed-methods analysis of (1) survey responses about COVID-19 vaccination and (2) Twitter messages (i.e., tweets) relevant to COVID-19 vaccination and healthcare. A total of 540 hospital employees completed the survey. Those that completed less than 80% of the survey or did not endorse employment at the hospital were excluded, resulting in a total of 511 valid responses; 93.2% reported receiving at least one dose of a COVID-19 vaccine. Approximately 1/3 of vaccinated individuals indicated they posted about receiving the vaccine on social media. Simultaneously, we analyzed a sample of 3845 tweets; 2299 (60%) were relevant to COVID-19 vaccination and 1863 (81%) were coded as authored by an individual. Of tweets authored by an individual, 6% (n = 106) were authored by a healthcare provider/health sciences student. Among relevant tweets, the most frequent code across all sentiment categories was related to the pharmaceutical industry (n = 529 tweets, 28%; n = 33, 31% of tweets authored by healthcare workers). Triangulation of results found themes including vaccine access, trust, and vaccine safety or negative health impacts. Results suggest that promoting the sharing of COVID-19 vaccine personal narratives on social media, combined with interventions targeting specific reasons for COVID-19 vaccine hesitancy and emphasizing freedom from fear once vaccinated could be effective at reducing COVID-19 vaccine hesitancy among this population.

Motivational Interviewing Strategies for Addressing COVID-19 Vaccine Hesitancy.

Severe acute respiratory syndrome coronavirus 2, or coronavirus disease 2019 (COVID-19), vaccine hesitancy, defined as a behavioral phenomenon whereby individuals neither fully accept nor fully reject the COVID-19 vaccine, presents a major health threat in the midst of the current pandemic. Traditional approaches for addressing vaccine hesitancy in health care lack empirical support and, in some instances, have actually increased vaccine hesitancy. Thus, there is an urgent need for approaches that effectively address COVID-19 vaccine hesitancy, especially in health care settings. The current article highlights the need for and importance of motivational interviewing (MI), which emphasizes collaborative communication between physicians and patients, in addressing vaccine hesitancy. We describe a 3-step process for addressing COVID-19 vaccine hesitancy that includes using a guiding style, using the MI toolbox, and responding mindfully and skillfully to the individual's degree of hesitancy. The discussion concludes with a consideration of possible challenges in implementing these steps when addressing and resolving COVID-19 vaccine hesitancy.