A randomized trial of a multicomponent cessation strategy for emergency department smokers

Steven L. Bernstein, Polly E. Bijur, Nina Cooperman, Saba Jearld, Julia H. Arnsten, Alyson B. Moadel-Robblee, E. John Gallagher

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives: The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention. Methods: This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months. Results: A total of 338 subjects were enrolled, mean (±SD) age was 40.2 (±12.0) years, 51.8% were female, and 56.5% were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7% vs. 13.2%, respectively). The proportion of subjects making a quit attempt (69.2% vs. 66.5%) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 1.61 to 7.26) or subject belief that the ED visit was tobacco-related (OR = 2.47, 95% CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95% CI = 0.10 to 0.50). Conclusions: The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.

Original languageEnglish (US)
Pages (from-to)575-583
Number of pages9
JournalAcademic Emergency Medicine
Volume18
Issue number6
DOIs
StatePublished - Jun 2011

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Hospital Emergency Service
Tobacco
International Classification of Diseases
Pamphlets
Odds Ratio
Smoking Cessation
Confidence Intervals
Tobacco Products
Tobacco Use Cessation Products
Medicaid
Referral and Consultation
Demography
Interviews
Physicians
Control Groups
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

A randomized trial of a multicomponent cessation strategy for emergency department smokers. / Bernstein, Steven L.; Bijur, Polly E.; Cooperman, Nina; Jearld, Saba; Arnsten, Julia H.; Moadel-Robblee, Alyson B.; Gallagher, E. John.

In: Academic Emergency Medicine, Vol. 18, No. 6, 06.2011, p. 575-583.

Research output: Contribution to journalArticle

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abstract = "Objectives: The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention. Methods: This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months. Results: A total of 338 subjects were enrolled, mean ({\^A}±SD) age was 40.2 ({\^A}±12.0) years, 51.8{\%} were female, and 56.5{\%} were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7{\%} vs. 13.2{\%}, respectively). The proportion of subjects making a quit attempt (69.2{\%} vs. 66.5{\%}) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR] = 3.42, 95{\%} confidence interval [CI] = 1.61 to 7.26) or subject belief that the ED visit was tobacco-related (OR = 2.47, 95{\%} CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95{\%} CI = 0.10 to 0.50). Conclusions: The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.",
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AU - Cooperman, Nina

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AU - Arnsten, Julia H.

AU - Moadel-Robblee, Alyson B.

AU - Gallagher, E. John

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N2 - Objectives: The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention. Methods: This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months. Results: A total of 338 subjects were enrolled, mean (±SD) age was 40.2 (±12.0) years, 51.8% were female, and 56.5% were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7% vs. 13.2%, respectively). The proportion of subjects making a quit attempt (69.2% vs. 66.5%) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 1.61 to 7.26) or subject belief that the ED visit was tobacco-related (OR = 2.47, 95% CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95% CI = 0.10 to 0.50). Conclusions: The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.

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