Staying Free Smoking Cessation Program

Updated: Jan 25, 2018
Evidence Rating:
Top Tier


  • Program:

    A low-cost smoking cessation program for hospitalized smokers who are willing to make a quit attempt.

  • Evaluation Methods:

    Four well-conducted randomized controlled trials (RCTs).

  • Key Findings:

    30% increase in likelihood of confirmed abstinence from smoking approximately one year after patients’ discharge from the hospital.

Staying Free is a smoking cessation program for hospitalized smokers who (i) are willing to make a quit attempt during hospitalization; and (ii) do not have a medical history of substance abuse or psychiatric disorders, and are not pregnant, medically unstable, or cognitively disabled.

Participants first receive a one-minute scripted smoking cessation message from their physician, followed by:

  • An intensive counseling session provided at bedside by a nurse case-manager specially trained in smoking cessation (approximately 30-60 minutes); and
  • Four to seven telephone counseling sessions – each 5-10 minutes long – provided by the nurse at periodic intervals between 2 and 90 days after discharge.

The bedside session includes (i) education on hazards of smoking personalized to the patient’s condition, benefits of quitting, the withdrawal process, and importance of social support; (ii) take-home materials (video, workbook, relaxation tape); and (iii) counseling. The counseling focuses on relapse-prevention – specifically, identifying high-risk situations for smoking relapse and working with the nurse to develop behavioral, cognitive, and social support strategies to remain smoke-free in such situations. The post-discharge phone sessions also focus on relapse prevention. Pharmacotherapy (e.g., nicotine replacement therapy) is provided on an as-needed basis.

The program’s cost is $118-$236 per patient (2019 dollars). The program implementation manual is available here; a summary of effective strategies for program dissemination is available here.

To see our full evidence summary:
Download PDF


Study 1 – (Large Urban Canadian Hospital):

Smith, Patricia M. and Ellen Burgess. “Smoking Cessation Initiated During Hospital Stay for Patients with Coronary Artery Disease: A Randomized Controlled Trial.” Canadian Medical Association Journal, June 23, 2009, vol. 180, no. 13, pp. 1297-1303.

Study 2 – (San Francisco Area Hospitals, All-Female Sample):

Sivarajan Froelicher, Erika S., Nancy Houston Miller, Dianne J. Christopherson, Kirsten Martin, Kathleen M. Parker, Marcy Amonetti, Zhen Lin, Min Sohn, Neal Benowitz, C.B. Taylor, and Peter Bacchetti. “High Rates of Sustained Smoking Cessation in Women Hospitalized with Cardiovascular Disease: The Women’s Initiative for Nonsmoking (WINS).” Circulation, February 10, 2004, vol., 109, pp. 587-593.

Study 3 – (Kaiser Permanente Medical Centers in the San Francisco Bay Area):

Houston Miller, Nancy, Patricia M. Smith, Robert F. DeBusk, David S. Sobel, and C. Barr Taylor. “Smoking Cessation in Hospitalized Patients: Results of a Randomized Trial,” Archives of Internal Medicine, February 24, 1997, vol. 157, pp. 409-415.

Taylor, C. Barr, Nancy Houston Miller, Steven Herman, Patricia M. Smith, David Sobel, Lynda Fisher, and Robert F. DeBusk. “A Nurse-Managed Smoking Cessation Program for Hospitalized Smokers,” American Journal of Public Health, November 1996, vol. 86, no. 11, pp. 1557-1560.

Study 4 – (Community Hospitals in Ontario):

Smith, Patricia M., Linda Corso, K. Stephen Brown, and Roy Cameron. “Nurse Case-Managed Tobacco Cessation Interventions for General Hospital Patients: Results of a Randomized Clinical Trial.” Canadian Journal of Nursing Research, 2011, vol. 43, no. 1, pp. 98 – 117.

Other Studies:

Feeney, Gerald F. X., A. McPherson, J. P. Connor, A. McAlister, R. M.Young, and P. Garrahy. “Randomized Controlled Trial of Two Cigarette Quit Programmes in Coronary Care Patients after Acute Myocardial Infarction.” Internal Medicine Journal, 2001, vol. 31, pp.470 – 475.

DeBusk, Robert F., Nancy Houston Miller, H. Robert Superko, Charles A. Dennis, Randal J. Thomas, Henry T. Lew, Walter E. Berger III, Robert S. Heller, Jonathan Rompf, David Gee, Helena C. Kraemer, Albert Bandura, Ghassan Ghandour, Mia Clark, Raksha V. Shah, Lynda Fisher, and C. Barr Taylor. “Annals of Internal Medicine: A Case-Management System for Coronary Risk Factor Modification after Acute Myocardial Infarction.” Annals of Internal Medicine, May 1, 1994, vol. 120, no. 9, pp. 721-729.

Taylor, C. Barr, Nancy Houston-Miller, Joel D. Killen, and Robert F. DeBusk. “Smoking Cessation after Acute Myocardial Infarction: Effects of a Nurse-Managed Intervention.” Annals of Internal Medicine, 1990, vol. 113, pp. 118-123.

The LJAF Evidence-Based Policy Team is grateful to David Henry, Ph.D., Professor, Department of Psychiatry, University of Illinois at Chicago, for conducting the meta-analysis of the Staying Free program described in this summary.