Evidence-based brief cessation advice plus active referral for emergency department patients who smoke: a single-arm,...

Emergency department (ED) visits present opportunities to promote smoking cessation, as patients seeking urgent care may be more receptive to adopting healthier behaviors. This study evaluated the efficacy of brief cessation advice plus active referral to smoking cessation services among smokers attending EDs.

A single-arm, real-world, multicenter clinical trial was conducted in the EDs of four public hospitals in Hong Kong from August 2019 to November 2021. Current smokers aged ≥ 18 years, triaged as semi- or non-urgent, were enrolled. Participants received the AWARD (Ask, Warn, Advise, Refer, and Do-it-again) model-based brief counseling and were offered active referral by trained healthcare professionals (HCPs) to local cessation services. Booster calls at 1 week and 1 month reinforced referrals for those who accepted. All participants were followed up at 6 and 12 months. The primary outcome was biochemically validated 7-day point prevalence abstinence (PPA) at 6 months; secondary outcomes included validated PPA at 12 months, self-reported PPA, and cigarette reduction rates. Implementation outcomes were evaluated using the RE-AIM framework. Propensity score matching (PSM) and multivariable logistic regression were applied to compare referred and unreferred groups.

Among the 1601 enrolled smokers, most were male (1443, 90%), with a mean age of 48 years; 77.6% and 72.1% completed 6-month and 12-month follow-ups, respectively. Following the brief advice intervention at baseline, 455 (28.4%) participants opted to receive a referral to smoking cessation services. Their overall biochemically validated 7-day PPA was 4.4% and 5.1% at 6 and 12 months, respectively. After PSM, the active referral group had significantly higher biochemically validated 7-day PPA at 6 months (6.1% vs. 3.2%; adjusted OR 2.35, p = .009) and 12-month follow-up (9.3% vs. 3.0%; adjusted OR 3.54, p < .001), higher self-reported 7-day PPA, and significant reduction rates at 6 and 12 months compared with the unreferred group. Implementation outcomes revealed strong institutional adoption, with 93 trained HCPs and a high reach among eligible smokers. This trial was limited by a non-randomized design.

Brief cessation advice combined with active referral is feasible in ED settings and may yield clinically meaningful improvements in smoking abstinence.

ClinicalTrials.gov: NCT03818360, 25 January 2019.