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Introduction There is evidence that Yoga may be helpful as an aid for smoking cessation. Yoga has been shown to reduce stress and negative mood and may aid weight control, all of which have proven to be barriers to quitting smoking. This study is the first rigorous, randomized clinical trial of Yoga as a complementary therapy for smokers attempting to quit. Methods Adult smokers (N = 227; 55.5% women) were randomized to an 8-week program of cognitive-behavioral smoking cessation and either twice-weekly Iyengar Yoga or general Wellness classes (control). Assessments included cotinine-verified 7-day point prevalence abstinence at week 8, 3-month, and 6-month follow-ups. Results At baseline, participants’ mean age was 46.2 (SD = 12.0) years and smoking rate was 17.3 (SD = 7.6) cigarettes/day. Longitudinally adjusted models of abstinence outcomes demonstrated significant group effects favoring Yoga. Yoga participants had 37% greater odds of achieving abstinence than Wellness participants at the end of treatment (EOT). Lower baseline smoking rates (≤10 cigarettes/day) were also associated with higher likelihood of quitting if given Yoga versus Wellness (OR = 2.43, 95% CI = 1.09% to 6.30%) classes at EOT. A significant dose effect was observed for Yoga (OR = 1.12, 95% CI = 1.09% to 1.26%), but not Wellness, such that each Yoga class attended increased quitting odds at EOT by 12%. Latent Class Modeling revealed a 4-class model of distinct quitting patterns among participants. Conclusions Yoga appears to increase the odds of successful smoking abstinence, particularly among light smokers. Additional work is needed to identify predictors of quitting patterns and inform adjustments to therapy needed to achieve cessation and prevent relapse. Implications This study adds to our knowledge of the types of physical activity that aid smoking cessation. Yoga increases the odds of successful smoking abstinence, and does so in a dose-response manner. This study also revealed four distinct patterns of smoking behavior among participants relevant to quitting smoking. Additional work is needed to determine whether variables that are predictive of these quitting patterns can be identified, which might suggest modifications to therapy for those who are unable to quit.

Objective Our objective was to develop an instrument that can measure outcome expectations of yoga and to evaluate the instrument for internal consistency and initial construct validity. Methods A 20-item scale was developed to assess physical, mental, and spiritual health benefits related to yoga practice among adults. The scale was tested in a baseline survey with adults participating in a clinical trial. Principal component analysis was used to investigate the internal structure of the measure. Outcome expectations for yoga were examined for demographic differences. Results The sample (N = 185) was 54% women, 89% white and had a mean age of 46 years. The final 20-item scale had high item loadings that ranged from .57 to .88 with a Cronbach's alpha value of .96. Significant differences were found in outcome expectation score by sex. Conclusion This newly developed scale can be used to assess outcome expectations for yoga and tailor interventions to promote adherence to yoga practice.

Aims We tested two aims: (1) the teachable moment (TM): whether second-hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma versus parents of healthy children (HC); and (2) whether greater intervention intensity [enhanced-precaution adoption model (PAM)] produces greater cessation than a previously tested intervention (PAM). Design and interventions Aim 1: two home visits (asthma education or child wellness), and cessation induction using motivational interviewing and SHSe feedback. Aim 2: post-home-visits, parents with asthmatic children were randomized to PAM (n = 171; six asthma education calls) or enhanced-PAM (n = 170; six asthma education/smoking cessation calls + repeat SHSe feedback). Setting Rhode Island, USA. Participants Parents of asthmatic (n = 341) or healthy (n = 219) children who did not have to want to quit smoking to enroll. Measurements Measurements were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day point prevalence abstinence (ppa) and SHSe (primary) and asthma morbidity (secondary). Findings Aim 1: the TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.22–5.54] and 7-day ppa (OR = 2.26, 95% CI = 1.13–4.51) at 2 months (primary end-point) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR = 3.60; 95% CI = 1.72–7.55). Aim 2: enhanced-PAM was more likely to achieve 30-day ppa at the primary end-point, 4 months (OR = 2.12, 95% CI 1.09–4.12) and improved asthma outcomes versus PAM. Conclusions Smoking cessation intervention (Motivational Interviewing plus biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.

OBJECTIVES Yoga may improve stress, affect, and weight control, all of which are commonly cited barriers to quitting smoking. However, the importance of these concerns may vary by sex, race, ethnicity, and age. We examined smoking-relevant characteristics of individuals enrolling in an 8-week randomized controlled trial testing yoga as a complementary treatment to standard smoking cessation. METHODS Of 958 callers, 227 were eligible and enrolled. RESULTS The sample was 55% female, 86% non-Hispanic white, with a mean age of 46 years (SD = 12). Males smoked more cigarettes/ day than females and had lower motivation to quit smoking. Females were more likely to smoke for weight control, social and mood-related reasons, and had higher expectations for the efficacy of yoga. Age was negatively associated with the presence of other smokers in the household, and smoking in response to negative moods, and was positively associated with smoking rate, and confidence in quitting. CONCLUSIONS This study demonstrated that both males and females were interested in a program offering yoga as a complementary therapy for smoking cessation. However, there were both sex and age-related differences with respect to smoking-related variables that may suggest a need to adapt the intervention for sub-populations.

INTRODUCTION: Cigarette smoking is associated with many adverse health effects and is an important public health concern. Increased understanding of smokers’ behavior is central to developing effective interventions. Cigarette scavenging, a behavior that involves smoking shared or previously used cigarettes has thus far only been shown to be prevalent among homeless or incarcerated populations. The current study examines whether cigarette scavenging is prevalent in a more general population of adult smokers enrolling in a smoking cessation clinical trial, and whether engagement in this behavior is associated with demographic or smoking-related psychosocial factors. METHODS: Baseline data was obtained from adult smokers (N=227) enrolling in a randomized clinical trial for smoking cessation. Cigarette scavenging was assessed using three items: a) sharing a cigarette with a stranger; b) smoking a “found” cigarette and c) smoking a previously used cigarette “butt”. Participants who endorsed engaging in at least one of these three behaviors were categorized as a scavenger. RESULTS: Approximately 32% of participants endorsed at least one cigarette scavenging behavior. A multiple logistic regression analysis found that scavengers were more likely to be: men (p

Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations.The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive-behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL). Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence.This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research.

Background. College students are vulnerable to a critical period in developmental maturation, facing rigorous academic work and learning how to function independently. Western aerobic exercise (WAE), such as running and bicycling, has been shown to improve mood and relieve stress. However, college students often have low levels of physical activity. Yoga is an ancient physical and mental practice that may affect mood and stress. However, rigorous studies examining the psychological effects of yoga are rare in peerreviewed Western journals. The aim of this research was to establish preliminary evidence for the acute effects of Vinyasa yoga on affect and stress in young-adult college students. Methods. Twenty healthy college students age 18 years and older were recruited to participate in this pilot study. Participants attended a Vinyasa yoga class at a local studio twice weekly for 8 weeks. Affect and stress were assessed before and after each yoga session. Measures included the Positive and Negative Affective Schedule (PANAS) and the Cohen Perceived Stress scale. Results. Positive affect scores increased significantly (p < 0.05) for 14 of the 16 yoga sessions (mean increase = 23.2%). Negative affect decreased significantly from pre- to postyoga (p < 0.05) for 15 of the 16 sessions (mean decrease = 22%). Repeated measures ANOVAs examining pre-post composite scores across all 8 weeks showed significant changes in PANAS, but not stress scores. Conclusions. Findings suggest that yoga practice is associated with acute improvements in affect in a young-adult college population. Future research is needed to examine the extent to which different types of yoga address the needs of different college sub-populations (e.g., eating disordered, overweight/obese, sedentary, and smokers).

This study compares the characteristics of men and women, respectively, participating in two randomized controlled pilot studies whose primary aims were to test the feasibility of yoga as a complementary therapy for smoking cessation. Participants were aged 18-65, generally healthy and were daily smokers. Analysis of variance (ANOVA) and chi-square tests examined gender differences in smoking rate, potential treatment mediators, and covariates (e.g., smoking history, health status, weight concerns, mood, and prior withdrawal symptoms). A total of 55 women and 38 men participated in the study. Differences between men and women at enrollment included: women reported significantly greater withdrawal (p

Tobacco smoking remains the leading preventable cause of death among American women. Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms. Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect.This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation. Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were randomized to a twice-weekly program of Vinyasa yoga or a general health and wellness program (contact control). The primary outcome measure was 7-day point prevalence abstinence at the end of treatment validated by saliva cotinine testing. Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up. We examined the effects of the intervention on potential mediating variables (e.g., confidence in quitting smoking, self-efficacy), as well as measures of depressive symptoms, anxiety, and perceived health (SF-36).At end of treatment, women in the yoga group had a greater 7-day point-prevalence abstinence rate than controls (odds ratio [OR], 4.56; 95% CI, 1.1-18.6). Abstinence remained higher among yoga participants through the six month assessment (OR, 1.54; 95% CI, 0.34-6.92), although differences were no longer statistically significant. Women participating in the yoga program also showed reduced anxiety and improvements in perceived health and well-being when compared with controls.Yoga may be an efficacious complementary therapy for smoking cessation among women.

ACADEMIC EMERGENCY MEDICINE 2011; 18:966–971 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Peripheral intravenous catheter (PIV) placement is a common, painful, and frequently difficult procedure in children. The VeinViewer is a device that delineates subcutaneous veins using near-infrared light and video technology. To the best of our knowledge, the benefit of this device for PIV placement in children in the emergency department (ED) has not been studied. Methods: The authors enrolled a prospective, randomized sample of children aged 0 to 17 years who required a nonemergent PIV in a tertiary care pediatric ED. Participants were randomized to standard PIV cannulation (SC) or PIV cannulation with the VeinViewer (VV). The primary outcome measure was time to PIV placement. Secondary outcome measures included number of PIV attempts and pain scores as reported by the child, parent or guardian, and nurse using a 100-mm visual analog scale (VAS). Results: A total of 323 patients completed the study: 174 boys and 149 girls. Age, sex, and body mass index (BMI) were not different between groups. There were no differences in time to PIV placement, number of PIV attempts, or pain scores for the overall study group. However, a planned subgroup analysis of children age 0 to 2 years (n = 107) did yield significant results for the geometric mean time to place the PIV (121 seconds [VV] vs. 167 seconds [SC], p = 0.047) and for nurses’ perception of pain (median VAS 34 [VV] vs. 46 [SC], p = 0.01). Conclusions: While no results were significant for the overall study group, subgroup analysis of children age 0 to 2 years suggests that the VeinViewer may decrease the time to PIV placement.

Objective: Secondhand smoke exposure is associated with asthma onset and exacerbation. Latino children have higher rates of asthma morbidity than other groups. The current study compared the effectiveness of a newly developed smoking cessation treatment with existing clinical guidelines for smoking cessation. Method: Latino caregivers who smoked (N = 133; 72.9% female; mean age = 36.8 years) and had a child with asthma were randomly assigned to receive 1 of 2 smoking cessation counseling interventions during a home-based asthma program: (a) behavioral action model (BAM; modeled on clinical guidelines for smoking cessation) or (b) precaution adoption model (PAM; feedback on the caregiver's carbon monoxide level and child's secondhand smoke exposure using Motivational Interviewing). Counseling was delivered by a bilingual Latina health educator, and the content was tailored to Latino values and culture. It was not necessary for smokers to want to quit smoking to participate. Smoking cessation was biochemically verified and secondhand smoke exposure was objectively measured through passive nicotine monitors. Results: Intent-to- treat analyses showed that 20.5% of participants in the PAM condition and 9.1 % of those in the BAM condition were continuously abstinent at 2 months posttreatment (OR = 2.54; 95% CI = 0.91-7.10), whereas 19.1% of participants in the PAM condition and 12.3% of those in BAM condition were continuously abstinent at 3 months posttreatment (OR = 1.68; 95% CI = 0.64-4.37). Secondhand smoke exposure decreased only in the BAM condition (p < .001), an effect due to less smoking around the child among nonquitters in this condition. Asthma morbidity showed significant decreases in the posttreatment period for the PAM group only (p < .001). Conclusions: Results provide support for targeting specific populations with theory-based interventions.

Objectives The primary objective of this study was to determine the feasibility of ultrasound-guided femoral nerve blocks in elderly patients with hip fractures in the emergency department (ED). The secondary objective was to examine the effectiveness of this technique as an adjunct for pain control in the ED. Methods This prospective observational study enrolled a convenience sample of 13 patients with hip fractures. Ultrasound-guided femoral nerve block was performed on all participants. To determine feasibility, time to perform the procedure, number of attempts, and complications were measured. To determine effectiveness of pain control, numerical rating scores were assessed at baseline and at 15 minutes, 30 minutes, and hourly after the procedure for 4 hours. Summary statistics were calculated for feasibility measures. Wilcoxon matched-pairs signed-rank tests and Friedman analysis of variance test were used to compare differences in pain scores. Results The median age of the participants was 82 years (range, 67-94 years); 9 were female. The median time to perform the procedure was 8 minutes (range, 7-11 minutes). All procedures required only one attempt; there were no complications. After the procedure, there were 44% and 67% relative decreases in pain scores at 15 minutes (P ≤ .002) and at 30 minutes (P ≤ .001), respectively. Pain scores were unchanged from 30 minutes to 4 hours after the procedure (P ≤ .77). Conclusions Ultrasound-guided femoral nerve blocks are feasible to perform in the ED. Significant and sustained decreases in pain scores were achieved with this technique.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.

Objective To determine the proportion of emergency department (ED) patients who have been tested for human immunodeficiency virus (HIV) infection and assess if patient history of HIV testing varies according to patient demographic characteristics. Design From July 2005–July 2006, a random sample of 18–55-year-old English-speaking patients being treated for sub-critical injury or illness at a northeastern US ED were interviewed on their history of HIV testing. Logistic regression models were created to compare patients by their history of being tested for HIV according to their demography. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Results Of 2107 patients surveyed who were not known to be HIV-infected, the median age was 32 years; 54% were male, 71% were white, and 45% were single/never married; 49% had private health-care insurance and 45% had never been tested for HIV. Of the 946 never previously tested for HIV, 56.1% did not consider themselves at risk for HIV In multivariable logistic regression analyses, those less likely to have been HIV tested were male (OR: 1.32 [1.37–2.73]), white (OR: 1.93 [1.37–2.73]), married (OR: 1.53 [1.12–2.08]), and had private health-care insurance (OR: 2.10 [1.69–2.61]). There was a U-shaped relationship between age and history of being tested for HIV; younger and older patients were less likely to have been tested. History of HIV testing and years of formal education were not related. Conclusion Almost half of ED patients surveyed had never been tested for HIV. Certain demographic groups are being missed though HIV diagnostic testing and screening programmes in other settings. These groups could potentially be reached through universal screening.

Objectives: Video-based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video “Do you know about rapid HIV testing?” is an acceptable alternative to an in-person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information. Methods: This was a noninferiority trial of 574 participants in an ED opt-in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live-action 9.5-minute video or an in-person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in-person information session if the 95% confidence interval (CI) of the difference (Δ) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in-person information session arm’s mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. Results: The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in-person information session arm. The difference in mean scores compared to the mean score for the in-person information session met the noninferiority criterion for this investigation (Δ = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks/African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner/marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. Conclusions: In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in-person information session were less effective in providing pretest information for patients with fewer years of formal education.

To estimate the incidence of first-responder visits to emergency departments (EDs) for blood or body fluid exposures, elucidate any temporal patterns of these visits, and quantify human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) utilization for these exposures.This was a retrospective study of first responders presenting to Rhode Island EDs for blood or body fluid exposures from 1995 to 2001. Incidence rates for exposures with 95% confidence intervals (CIs) were estimated. Temporal trends for visits were modeled. Factors associated with HIV PEP utilization were identified using logistic regression. Odds ratios (ORs) with 95% CIs were estimated.The average incidence rate of ED visits for blood or body fluid exposures was 23.29 (20.07-26.52) ED visits per 100,000 ambulance runs. The incidence rose between 1995 and 1999 and then decreased. First-responder ED visits were lowest in October and highest in April and were lowest at 7 am and highest at 7 pm. First responders presenting with a percutaneous or blood-to-mucous membrane exposure had a 4.13 (1.82-8.89) greater odds and those exposed to a known HIV-infected source had a 9.03 (1.59-51.26) greater odds of being offered HIV PEP. First responders presenting to a teaching hospital had a 2.21 (1.02-4.77) greater odds of being offered prophylaxis and a 4.20 (1.08-16.32) greater odds of accepting prophylaxis when it was offered.First responders face a risk of blood or body fluid exposure that varies over the course of the day and the year. HIV PEP is more likely to be used if the exposures are percutaneous, or blood-to-mucous membrane, or if the source is known to be HIV-infected. Standardization of protocols across EDs for administering HIV prophylaxis appears to be needed.

OBJECTIVES. We assessed the offering of American Academy of Pediatrics–recommended tests and prophylaxes after sexual assault to adolescents who presented to Rhode Island emergency departments for 3 categories of sexual exposures: sexual assault, consensual sex, and suspected sexual abuse. PATIENTS AND METHODS. This study entailed a retrospective review of visits for adolescent sexual exposures across 11 Rhode Island emergency departments between January 1995 and June 2001. Cases were identified through billing codes. Offering of each test and prophylaxis was compared by gender, category of sexual exposure, and type of sexual assault. Multivariable linear regression models were used to identify factors associated with the offering of a greater number of tests and prophylaxes after sexual assault. RESULTS. The vast majority of emergency department visits for adolescent sexual exposures were by sexually assaulted girls (82.5%). Across the 3 sexual exposure categories, girls were offered tests and prophylaxes more often than boys (eg, chlamydia or gonorrhea testing and prophylaxis). Among sexually assaulted adolescents, 32.8% of girls and no boys were offered all recommended tests and prophylaxes. The multivariable linear regression found that vaginally and/or anally assaulted girls were offered, on average, 2.5 more tests and prophylaxes than patients with other types of sexual assaults. Girls presenting for care at the state's women's health care specialty hospital emergency departments were offered 1.7 more tests and prophylaxes than those evaluated in general hospital emergency departments. CONCLUSIONS. Many adolescents did not receive American Academy of Pediatrics–recommended tests and prophylaxes after sexual assault. Boys received fewer tests than girls. Testing and prophylaxis varied by type of emergency department. Efforts are needed to improve and standardize emergency department medical management of adolescent sexual exposures.

Background: Depression is the most common psychiatric disorder among adolescents and is more prevalent among those seeking care in the emergency department (ED). However, adolescents are rarely screened for depressive symptoms in the pediatric emergency department (PED). Objectives: To evaluate the sensitivity and specificity of one- and two-item screens for depressive symptoms compared to the 20-question Center for Epidemiologic Studies Depression Scale (CESD) among adolescents seeking care in a PED. Methods: This was a cross-sectional study of a convenience sample of adolescents 12–17 years old presenting to an urban PED with subcritical illness or injury. Participants completed three screening instruments: the two-question screen, the single-question screen, and the CESD. Results: A total of 321 patients were approached to enter the study, of whom 212 (66%) agreed to participate. Seventy-eight (37%) of the study participants screened positive for depression on the CESD using a cutoff score of ≥16. The two-question screen had a sensitivity of 78% (95% confidence interval [CI] = 73% to 84%) and specificity of 82% (95% CI = 77% to 87%) for depressive symptoms compared with the CESD. The single-question screen had a sensitivity of 56% (95% CI = 50% to 63%) and specificity of 93% (95% CI = 90% to 96%) compared with the CESD. Conclusions: The two-question screen is a sensitive and specific initial screen for depressive symptoms in adolescents being seen in the PED. This quick, simple instrument would be ideal for use in the busy PED setting and would allow clinicians to identify adolescents who require more extensive psychiatric evaluation.

The goal of this study was to explore the prevalence of smoking and attitudes and behaviors relevant to smoking cessation among parents of babies treated in a neonatal intensive care unit (NICU). Participants were 235 mothers and 83 fathers of infants admitted to the NICU of a large, university-based hospital. The 38-item survey included questions that assessed smoking status (current, former, never-smoker), motivation to quit, perceived health risks from smoking, and whether or not they received smoking cessation advice or counseling from a health care provider. A total of 26% of all participants were current smokers. Compared with mothers, fathers were more likely to be current smokers (22% vs. 31%) and smoked more cigarettes per day (11.3% vs. 17.2%). Among participants, 57% reported that smoking affected their own health "a little" or "not at all," and 70% believed that others' smoking would affect the baby's health "a little" or "somewhat." Mothers were more likely than fathers to report health care provider intervention for smoking cessation. Indeed, none of the fathers in this study reported being offered assistance with quitting smoking. More than half of smokers were willing to receive counseling for smoking cessation, and health care provider intervention was positively associated with both motivation to quit and perceived health risk to their infant (p

Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, "Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake," convened a public health focus group. The question this group addressed was "What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?" Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population.

The pediatric emergency department is an important source of treatment for children with complaints related to environmental tobacco smoke (ETS) and may provide a teachable moment to address parent smoking. Parents who smoke were recruited from a pediatric emergency department waiting room and completed an interview assessment used to develop intervention messages. Of the 715 parents in the final sample, 77% were women, 60% White, and 60% low income (

Objectives For female emergency department (ED) patients, we sought to assess the prevalence of contraceptive usage as well as the extent of contraceptive knowledge and to determine if demographic and sexual health history factors, comprehension of contraceptive methods and moral/religious opinions on contraception were associated with current usage of birth control pills (BCPs), prior usage of emergency contraception (EC) and frequency of condom usage. Methods English-speaking female ED patients aged between 18 and 55 years at a northeastern United States urban ED were surveyed on their usage, comprehension and opinions regarding BCPs, EC and condoms. Results Of the 539 respondents (64.6% were aged ≤35 years), most were White (63.1%), single (42.5%), Catholic (48.4%) and privately insured (55.3%). Among the 223 women at pregnancy risk [not currently pregnant, not using any form of nonsurgical birth control (except condoms) and with no prior tubal ligation or hysterectomy], about 25% were using BCPs, fewer than 10% had used EC and almost 40% never used condoms. Most women displayed good knowledge about BCPs and condoms but poor understanding about EC. In multivariate logistic regression analyses, current BCP usage among women at risk of pregnancy was associated with younger age [odds ratio (OR)=0.54; 95% confidence interval (CI)=0.37–0.79], private insurance (OR=2.52; 95% CI=1.30–4.86) and recent intercourse (OR=1.61; 95% CI=1.19–2.18). Among women at risk of pregnancy, those who had an abortion (OR=2.56; 95% CI=1.17–5.61) and those who displayed greater EC knowledge (OR=3.23; 95% CI=1.50–6.95) had greater odds of having used EC. Among all women, more frequent condom usage was associated with being younger (OR=0.57; 95% CI=0.46–0.70), having never been married (OR=0.44; 95% CI=0.28–0.68) and not having intercourse recently (OR=0.79; 95% CI=0.64–0.98). Conclusions A high percentage of female ED patients (41.4%) were at risk of pregnancy. Demographic and sexual history factors can help identify women who might benefit from receiving referrals or education on contraceptive measures.

To determine whether brief, focal pretreatment of children's skin with low-frequency ultrasound followed by a 5-minute application of a 4% lidocaine topical anesthetic decreases the pain of intravenous (IV) catheter placement.A randomized, double-blind, placebo-controlled trial enrolling children 8 to 18 years of age undergoing IV placement as part of their care in a pediatric emergency department. Thirty-eight children received pretreatment followed by 5-minute application of a topical anesthetic. Thirty-nine children received pretreatment followed by 5-minute application of a placebo cream. Children and parents rated the pain associated with IV placement using the visual analog scale (VAS).There were no significant differences in demographics between the 2 groups. Children in the treatment group had significantly lower VAS scores (mean, 2.29) than children in the control group (mean, 3.23) (P = 0.023; 95% confidence interval of the mean difference, -1.87 to -0.02). The parents' VAS scores of the child's pain were also lower for the treatment group (mean, 2.47 vs 3.39; P = 0.038; confidence interval, -1.97 to 0.11).Visual analog scale scores measuring children's pain and parents' perception of the child's pain were lower in those who were pretreated with brief focal ultrasound and 5 minutes of 4% lidocaine cream when compared with those pretreated with ultrasound and placebo.

(1) Using clearly defined methods, provide a current assessment of the epidemiology of human bites sustained by pediatric patients evaluated at a pediatric ED; (2) Compare the frequency, demography, locations, and management of these injuries from the results of the current study to the 2 prior ED studies on pediatric human bites; and (3) Determine if the frequency of these injuries varies by year, gender, or body location.The current study involved a retrospective analysis of all visits to an urban, northeastern, United States pediatric ED from 1995 to 2001. Visits for human bites were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes using 2 separate computerized billing databases. Data were extracted from 2 prior published studies for the comparative portion of the study. Frequency estimates and 95% confidence intervals were created using STATA7.For the current study, there were 115 visits for human bites, which comprised 0.04% [0.03-0.05] of total visits to this pediatric ED. Bite visits as a percentage of pediatric ED visits remained the same during the 7 years of the current study. For all 3 pediatric EDs, human bites consisted of much less than 1% of the overall patient volume. The majority (65% [55.8-73.9]) of the patients in the current study were male. When adjusted for the frequency of all patient visits by gender, there was no statistically significant difference in percentage of visits for human bites between males and females (0.05% [0.039-0.063] vs. 0.03% [0.023-0.044]) in the current study. Prior studies did not reveal a statistically significant predominance of males presenting for human bites. As a percentage of visits by age group, human bites were more frequent among adolescents in the current study. Altercations and child play were reported approximately equally as the circumstances contributing to the bites in the current study, although altercations were reported more often in older age groups. In all 3 studies, fewer than 14% of patients were admitted and over 80% presented within 12 or 24 hours after the bite.Pediatric ED visits for human bites are infrequent and from the current study data, the frequency of visits for these injuries appears to be currently stable. Altercations may not be the main circumstances surrounding all pediatric human bites, yet altercations and human bites might be jointly associated with adolescence. The current study results suggest that most pediatric ED human bite patients are male, although males may not necessarily sustain human bites more frequently than females. Visits for human bite injuries may increase in frequency with age, in comparison to visits for other medical conditions.

This study examined the extent to which alcohol-related expectancies were associated with assaults among 278 injured drinkers in the emergency department setting. Results of logistic regression analyses indicated that patients who were male, had high blood alcohol levels and who expected alcohol to make them more careless were more likely to report being assaulted. Conversely, among males, patients who expected to become more powerful and aggressive when drinking were less likely to be assaulted. These findings suggest that helping patients understand how expectancies surrounding alcohol use shape drinking and its behavioral concomitants may circumvent their risk for future assaults.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

Objectives: To determine the frequency and type of patient visits for blood or body fluid exposures to a large, urban emergency department (ED); to ascertain the frequency that human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was prescribed for these exposures; and to compare HIV PEP usage by patient group, occupation, and exposure type. Methods: Retrospective medical record review of ED patient visits (January 1, 1995, through June 30, 2001) extracted from two separate billing record computerized databases using 14 ICD-9 codes that defined blood or body fluid exposures. Results: Of the 1,436 visits, 22% were by health care workers (HCWs) and 78% by non-HCW adults, adolescents, or children. Sixty percent of the HCWs sustained needlestick or sharp injuries, 73% of non-HCW adults had human bites, and 81% of adolescents and children had sexual exposures. Nurses were the largest group of HCWs, whereas police, correction officers, and security guards were the largest group of non-HCWs exposed at work. HCWs and non-HCW adults who sustained nonsexual exposures were much more likely to present for an evaluation within 24 hours than adolescents or children who suffered sexual assault (p < 0.001). HIV PEP was prescribed 143 times: 92 to HCWs and 51 to all other patients. HIV PEP was most often prescribed to HCWs sustaining needlestick injuries. Conclusions: The majority of patients were not HCWs, which attests to the need for national, nonoccupational blood or body fluid management guidelines. There may be particular groups who would benefit from educational campaigns informing them of the need for early-intervention, postexposure measures to prevent an HIV infection.

Objectives: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. Methods: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of $8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. Results: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcoholrelated (OR = 2.26, 95% CI = 1.45 to 3.53) and motorvehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. Conclusions: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use. Key words: alcohol use; marijuana use; substance abuse; injury prevention; emergency medicine; brief intervention. ACADEMIC EMERGENCY MEDICINE 2003; 10:43‐51.

Innovative treatments like yoga for men’s smoking cessation (SC) are lacking. To examine the feasibility and acceptability of yoga for men’s SC. We randomly assigned eligible men (smoker, ≥5 cigarettes/day, age 18–65) to receive cognitive behavioral therapy for SC, plus a yoga or wellness program. Measures included feasibility (recruitment, class attendance) and acceptability (customer satisfaction). We enrolled 38 of 49 eligible men of 167 screened in response to ads (mean age 39.9 years, ±13.7) who smoked on average 18.6 cigarettes/day (±8.3). Wellness (75.8 %) versus yoga (56 %) men attended more SC classes, p

Background. Acute Respiratory Illness accounts for over 12 million visits to emergency departments in the United States each year. Between one-fourth and one-half of these patients are smokers. We examined the frequency of physician intervention for smoking cessation among acute respiratory illness patients in the emergency department, and examined the influence of physician intervention on patients' perceived risk from smoking and motivation to quit. Methods. This study was conducted in the emergency department of a large inner-city hospital. Adult smokers (n = 63) presenting with symptoms of acute respiratory illness were surveyed by exit interview while in the emergency department. The frequency and extent of physician interventions for smoking were examined using the Agency for Health Care Policy and Research guidelines as a model. We also assessed patients' perceptions of risk from smoking, the presence of other household smokers, and the patients' motivation to quit. Results. Emergency department physicians provided incomplete and inconsistent intervention for smoking. While most patients reported being asked if they smoked, only half of smokers were advised to quit. Only 9% were offered any assistance with quitting. Risk perception was generally low, however, the majority of smokers were willing to receive on-site smoking cessation counseling while in the emergency department. Conclusions. The small sample size in this study requires that results be interpreted with caution. However, the findings of this study suggest that the emergency department setting may provide a unique “teachable moment” in which to initiate smoking cessation counseling for this high-risk population.

Disasters frequently demand exceptional skills from medical responders. Providers work most efficiently and effectively, however, within the roles and hierarchical structures with which they are familiar. The goal of disaster medical response planners is to assign personnel to roles that are as familiar as possible and to simultaneously enhance flexibility of response to extraordinary circumstances. We have outlined the most common disaster medical response roles and the personnel types that fit most directly as a primary provider within each role. Medics excel in field operations and field care of patients, whereas the training of nurses and physicians makes them the most flexible all-around providers, if specially trained in field emergency care, and the sole providers of definitive care. None of the providers, by virtue of their basic training, is well equipped to manage the public health consequences of disasters, but nurses and physicians should be able to easily move into the role, given appropriate special training. Some of the special courses needed to make medics, nurses, and physicians capable of serving flexible roles already exist; others need to be developed or enhanced.

Objectives: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT-positive, subcritically injured population. Methods: A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results. Results: During the study. 791 subcritically injured patients had SATs performed. Twenty-one percent of these patients were found to be alcohol-positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT-positive patients. There were higher SAT-positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%). Conclusions: While the SAT identified 21% of the subcritically injured patient population as alcohol-positive, ED nurse and EP documentation did not identify half of these alcohol-positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.

Study objective Brief interventions (BI) for alcohol misuse and recently for marijuana use for emergency department patients have demonstrated effectiveness. We report a 12-month outcome data of a randomized controlled trial of emergency department (ED) patients using a novel model of BI that addresses both alcohol and marijuana use. Methods ED research assistants recruited adult patients who admitted alcohol use in the last month, and marijuana use in the last year. In the ED, patients received an assessment of alcohol and marijuana use and were randomized to treatment (n = 249) or standard care (n = 266). Treatment consisted of two sessions of BI. At 3 and 12 months, both groups had an assessment of alcohol and marijuana use and negative consequences of use. Results 515 patients were randomized. We completed a 12-month follow-up assessments on 83% of those randomized. Measures of binge drinking and conjoint marijuana and alcohol use significantly decreased for the treatment group compared to the standard care group. At 12-month binge alcohol use days per month in the treatment group were (M = 0.72:95% CI = 0.36–1.12) compared to standard care group (M = 1.77:95% CI = 1.19–1.57) Conjoint use days in the treatment group (M = 1.25.1:95% CI = 0.81–1.54) compared to standard care group (M = 2.16:95% CI = 1.56–2.86). No differences in negative consequences or injuries were seen between the treatment and standard care groups. Conclusions BI for alcohol and marijuana decreased binge drinking and conjoint use in our treatment group. BI appears to offer a mechanism to reduce risky alcohol and marijuana use among ED patients but expected reductions in consequences of use such as injury were not found 12 months after the ED visit.

Emergency departments and hospitals are being urged to implement onsite interventions to promote smoking cessation, yet little is known about the theoretical underpinnings of behavior change after a healthcare visit. This observational pilot study evaluated three factors that may predict smoking cessation after an acute health emergency: perceived illness severity, event-related emotions, and causal attribution. Fifty smokers who presented to a hospital because of suspected cardiac symptoms were interviewed, either in the emergency department (ED) or, for those who were admitted, on the cardiac inpatient units. Their data were analyzed using both qualitative and quantitative methodologies to capture the individual, first-hand experience and to evaluate trends over the illness chronology. Reported perceptions of the event during semistructured interview varied widely and related to the individual’s intentions regarding smoking cessation. No significant differences were found between those interviewed in the ED versus the inpatient unit. Although the typical profile was characterized by a peak in perceived illness severity and negative emotions at the time the patient presented in the ED, considerable pattern variation occurred. Our results suggest that future studies of event-related perceptions and emotional reactions should consider using multi-item and multidimensional assessment methods rated serially over the event chronology.

Background Tobacco smoking remains the leading preventable cause of death among American women. Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns, improves affect, and reduces nicotine withdrawal symptoms and cigarette craving. Studies have shown that the practice of yoga improves weight control, and reduces perceived stress and negative affect. Yoga practice also includes regulation of breathing and focused attention, both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes. Methods/Design This pilot efficacy study is designed to examine the rates of cessation among women randomized to either a novel, 8-week Yoga plus Cognitive Behavioral Therapy (CBT) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention. Outcome measures include 7-day point prevalence abstinence at end of treatment, 3 and 6 months follow up and potential mediating variables (e.g., confidence in quitting smoking, self-efficacy). Other assessments include measures of mindfulness, spirituality, depressive symptoms, anxiety and perceived health (SF-36). Discussion Innovative treatments are needed that address barriers to successful smoking cessation among men and women. The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better understand the mechanism(s) by which yoga may act as an effective complementary treatment for smoking cessation. If shown to be effective, yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters. Trial Registration ClinicalTrials NCT00492310

Public health research requires sound design and thoughtful consideration of potential biases that may influence the validity of results. It also requires careful implementation of protocols and procedures that are likely to translate from the research environment to actual clinical practice. This article is the product of a breakout session from the 2009 Academic Emergency Medicine consensus conference entitled "Public Health in the ED: Screening, Surveillance, and Intervention" and serves to describe in detail aspects of performing emergency department (ED)-based public health research, while serving as a resource for current and future researchers. In doing so, the authors describe methodologic features of study design, participant selection and retention, and measurements and analyses pertinent to public health research. In addition, a number of recommendations related to research methods and future investigations related to public health work in the ED are provided. Public health investigators are poised to make substantial contributions to this important area of research, but this will only be accomplished by employing sound research methodology in the context of rigorous program evaluation.

The aim of this investigation was to assess emergency department (ED) patients' perceptions and preferences about an opt-in, universal, rapid HIV screening program and identify patient groups who expressed stronger beliefs about components of the testing program. From July 2005 to July 2006, ED patients in the opt-in, universal, rapid HIV screening program were interviewed in person. Multivariable regression models were used to compare participants on their beliefs about the program components. Of the 561 participants, 62.0% had previously been tested for HIV. The majority of participants (58.8%) believed the rapid and standard/conventional HIV tests to be equally accurate, 27.7% believed the rapid test to be less or much less accurate, and 8.7% believed the rapid test to be more or much more accurate. Almost two-thirds (65.1%) favored having a rapid instead of a standard/conventional HIV test, 94.6% wanted the test results within one hour, and 61.3% would be likely or very likely to undergo testing in the ED if it prolonged their ED visit. Almost all (92.5%) believed that their medical care was "not at all" delayed because of being tested, 94.1% believed that testing did "not at all" divert attention from the reason for their ED visit, and 80.9% thought that testing in the ED was "not at all" stressful. In multivariable logistic regression models, males and those with more than 12 years of formal education showed greater concerns about the rapid HIV test's accuracy. Hispanic/Latinos, participants with governmental insurance, and those previously HIV tested were more apt to be screened for HIV even if testing delayed their ED departure. Overall, participants were highly accepting of the components of this opt-in rapid HIV screening program. However, concerns regarding the accuracy of the rapid HIV test might limit test acceptance and should be addressed during pre-test information procedures.

Objectives. We assessed emergency department (ED) patient acceptance of opt-in, rapid human immunodeficiency virus (HIV) screening and identified demographic characteristics and HIV testing-history factors associated with acceptance of screening. Methods. A random sample of 18- to 55-year-old ED patients was offered rapid HIV screening. Patient acceptance or decline of screening and the reasons for acceptance or decline were analyzed with multivariable regression models. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for the logistic regression models. Results. Of the 2,099 participants, 39.3% accepted HIV screening. In a multinomial regression model, participants who were never married/not partnered, did not have private health insurance, and had 12 or fewer years of education were more likely to be screened due to concern about a possible HIV exposure. In a multivariable logistic regression model, the odds of accepting screening were greater among those who were younger than 40 years old (OR=1.61, 95% CI 1.32, 2.00), nonwhite (OR=1.28, 95% CI 1.04, 1.58), not married (OR=1.82, 95% CI 1.44, 2.28), lacking private health insurance (OR=1.40, 95% CI 1.13, 1.74), and who had 12 or fewer years of education (OR=1.43, 95% CI 1.16, 1.75). Despite use of a standardized protocol, patient acceptance of screening varied by which research assistant asked them to be screened. Patients not previously tested for HIV who were white, married, and 45 years or older and who had private health insurance were more likely to decline HIV screening. Conclusions. In an opt-in, universal, ED HIV screening program, patient acceptance of screening varied by demography, which indicates that the impact of such screening programs will not be universal. Future research will need to determine methods of increasing uptake of ED HIV screening that transcend patient demographic characteristics, HIV testing history, and motivation for testing.

We sought to determine the extent to which adult female emergency department participants viewed two women’s cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors’ Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women’s receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.

This study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking. Participants were adult smokers (N = 543) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infarction. Participants were randomly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up. All individuals choosing to quit were offered nicotine patch therapy. Follow-up assessments were conducted at 1, 3 and 6 months. Abstinence (7-day point prevalence) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care (OR = 1.62, 95% CI [1.05-2.50]). The largest difference occurred at 1 month: 16.8% of usual care and 27.3% of the tailored intervention group were abstinent, with differences decreasing over time. One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up. In addition to treatment assignment, psychosocial variables including motivation to quit, confidence, reduced temptation to smoke in response to negative affect, and the perception that their chest pain was related to their smoking, were significant predictors of cessation. Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit. Additional intervention may be needed to assist late quitters and to prevent relapse.