University of Vermont

UVM Undergrads and Community Benefit from Freeman’s ER-based Smoking Intervention Study

Kalev Freeman and student
Assistant Professor of Surgery Kalev Freeman, M.D., Ph.D., and former undergraduate research associate Heidi Considine, B.S.'14, in the UVM Medical Center emergency department. (Photo: COM Design & Photography)

If there’s a right time for a smoker to consider quitting, it’s arguably when he or she lands in the emergency room.

Even if the patient shows up with a broken arm or a gashed knee that has nothing to do with the tobacco habit, the hospital ER setting heightens awareness. It’s going to make that person open to suggestions for better health.

That’s where the National Alliance of Research Associates Programs (NARAP) comes in. The organization advocates the use of pre-med college students as researchers who can cost-effectively communicate with emergency room patients and visitors on a variety of public health issues. The location is a smart choice: More than 115 million people are seen annually at emergency departments in the U.S. each year.

The University of Vermont Medical Center, which has an estimated 60,000 patient encounters annually, is one of 10 participating institutions in NARAP, which recently conducted and published a smoking-cessation intervention study. Kalev Freeman, M.D., Ph.D., UVM assistant professor of surgery and director of Emergency Medicine Research, leads the UVM program that has worked with NARAP and is a coauthor of the online study, which will appear in the January 2015 issue of Addictive Behaviors.

According to Freeman and the study’s authors, the Centers for Disease Control and Prevention estimates that more than 45 million adults nationwide currently smoke cigarettes. In Vermont, the number of smokers is estimated to be 75,000.

The NARAP students – referred to as research associates (RAs) – enrolled 19,149 patients or their visitors, age 18 and older, 10,303 of whom had used tobacco for at least one month over their lifetimes. Of those smokers, 2,151 requested a faxed referral to their state’s Quitline smoking cessation program.

The UVM RAs enrolled 518 patients or their visitors in the study, which is believed to be the fourth-largest interventional effort ever undertaken in the United States, says Keith Bradley, M.D., NARAP’s founder, an emergency medicine physician based at St. Vincent’s Medical Center in Bridgeport, Conn., and a coauthor on the study.

Freeman’s and UVM’s involvement in such studies helps expand NARAP’s national reach and furthers its mission to use the ER “to facilitate primary healthcare for large segments of the population,” Bradley says. He would like UVM to get involved in NARAP’s current study of cervical and breast cancer screening and next study focusing on colorectal cancer screening in 2015.

Freeman developed his own research assistant program at UVM to focus on studies in his area of expertise: brain injury and trauma.

A primary goal of a research assistant program is to give future health professionals early, hands-on experience with patients in a real medical setting. With the quit-smoking study, Freeman says, he saw an opportunity to engage UVM students in an important area of public health and let them interact with more emergency department patients, not only those involved with trauma.

“That’s what we want to encourage when they’re going into medical school,” he notes. “It demonstrates a commitment to patient care.”

Alex Thomas ’17, a second-year student in the UVM College of Medicine, worked as a research assistant with Freeman while a pre-med UVM undergraduate and helped with the stop-smoking study. He said he enjoyed the chance not only to encourage smokers to quit but also to contribute to valuable public health research.

“It was great talking with patients and their families about the study, their smoking habits and then being able to offer them information about smoking cessation and a referral to the Quitline,” Thomas says. Many patients told him they “appreciated that it took advantage of the extra time they had while waiting to be seen.”

The average emergency room wait time in the United States is four hours, according to Bradley.

“Patients received a benefit,” Freeman says, "because we successfully connected hundreds of Vermonters to the State’s tobacco Quitline. Many patients are looking to quit but unaware of the State’s program and appreciate the personal referral.”

While the study provided no funding to follow the results of the Quitline referrals and any related success with kicking the habit, Freeman has a scientifically immeasurable optimism about the outcome: “The fact that people even take the referrals means they want to quit.”