Nicotine dependence, motivation to quit, and diagnosis in emergency department patients who smoke

ObjectivesTo assess the effect of diagnosis on motivation to quit in adult smokers in an emergency department (ED).MethodsA survey of patients visiting two EDs from September to November, 2003. Patients screening positive for smoking completed a Fagerstrom Test for Nicotine Dependence and Ladder of Contemplation. ICD9 codes and disposition status were recorded. Smoking-related diagnoses were drawn from standard sources. Data were analyzed with parametric and non-parametric statistics.ResultsFive hundred and eighty-five were interviewed, median age 40 (interquartile range 29–50); 323 (55%) were female. Ninety percent of all patients were non-White; 69% were uninsured or had Medicaid. Of 152 patients with smoking-related diagnoses, the median Fagerstrom score was 4.7 vs. 4.1 for patients with a non-smoking-related diagnosis (p = 0.02, 95% CI for the difference 0.2, 0.9). Patients with smoking-related and non-smoking-related diagnoses had similar levels of motivation to quit (Ladder score, respectively, 5.5 vs. 5.1, p = 0.03, 95% CI for difference 0.03, 0.8).ConclusionsAdult ED smokers exhibit mild–moderate levels of nicotine addiction and interest in quitting. ED-based tobacco control should target all smokers.