Hospitalization is a unique opportunity to help tobacco users quit. Smokers have more chronic disease than non-smokers, and thus are hospitalized more frequently. Inpatient smoking cessation programs are effective at helping smokers quit. In fact, the cessation rates are often higher than for outpatient programs, perhaps from a heightened sense of vulnerability due to the hospitalization.

If inpatient smoking cessation programs are so great, then why don't all hospitals have a program? In my opinion, it is because it is not easy. While hospitals have gotten very good at changing in some areas (particularly those targeted by the Joint Commission on Accreditation of Healthcare Organizations), they can be notoriously resistant to change at times. This is true not only for hospitals, but also for any large complex system.

Implementing an inpatient smoking cessation program requires changing the system of care at the hospital, and system change requires consistent and coordinated effort. This book represents an outstanding resource for someone contemplating such a change. It provides a detailed, organized step-by-step approach. The eight chapters in Part I cover the background, including topics such as the evidence supporting this approach, program administration, and management, defining the target population, and financing. Part II (Program Development) includes seven chapters to help with all the details, including roles, systematic identification, training, and evaluation. Particularly welcome is the chapter on promoting the program, an often-overlooked topic. The third and final part includes two chapters focusing on "Ramp Up and Delivery."

This book is very clear and well written. Someone considering starting an inpatient program could not ask for a better resource. The authors draw from their extensive experience. They give a thorough description of the program (Staying Free) developed by one of the authors and disseminated by the other author. The rest of the text is appropriately general, drawing on the author's experience but not locking the reader into one specific program.

My two suggestions are minor ones. The first is in relation to the impact and economic rationale for these programs. The authors discuss the cost-effectiveness of smoking cessation and of inpatient programs. While there is a section outlining the reach of these programs, it would be nice to have more detail, as this is crucial in determining whether to spend money here rather than in other places. This is an issue we have been examining in detail in the Veterans Health Administration. We have considered mandating that each facility have a program for inpatient smoking cessation, but our decision depends in part upon what percentage of smokers are admitted in a typical year. It is more essential to have these programs if 30% of smokers are admitted each year than if only 3% are admitted. While the frequency will vary from population to population, it would be nice to know the range and how this affects the impact of inpatient programs.

Second, it would have been nice to have a section or table on "making the case" for an inpatient program at your facility. All of the necessary material is in the book, but it is spread across different chapters. There is a comprehensive set of checklists in Chapter 4, but it is not quite as useable as it might be, due to its thoroughness. Since making the case is so crucial, it would have been nice to have a table of the key steps, along with several actual examples of how people have done it.

In summary, this book is an excellent, easy to-read compendium of information. Anyone who is considering starting an inpatient smoking cessation program should read this, as should anyone currently involved with such a program.

About the Author: Scott E. Sherman, M.D., M.P.H., is affiliated with the VA New York Harbor HealthCare System and the New York University School of Medicine.