The emergency department as a potential site for smoking cessation intervention: A randomized, controlled trial

Objective: To assess the effect of physician counseling and referral on smo king cessation rates and attendance at a smoking cessation program. Methods : This was a prospective, randomized clinical trial set in a suburban, comm unity teaching hospital emergency department (ED). During study hours, dedi cated research associates enrolled consecutive, stable, oriented patients w ho were smokers. Eligible, consenting patients were randomized to one of tw o intervention groups. The control group received a two-page "Stop Smoking" pamphlet from the American Heart Association (AHA). Patients in the interv ention group were given the AHA pamphlet along with pharmacologic informati on and standardized counseling by the attending emergency physician, includ ing written and oral referral to a smoking cessation program. The primary o utcome measures were telephone contact/attendance at the smoking cessation program by the intervention group and the rate of smoking cessation in both study groups at three months post-ED visit. Categorical data were analyzed by chi-square and Fisher's exact tests. Rank data were analyzed by Mann-Wh itney tests and continuous data by t-tests, All tests were two-tailed with alpha set at 0.05. Results: One hundred fifty-two patients were enrolled; 7 8 were randomized to the intervention group. Nearly 70% of patients (103) w ere available for telephone follow-up, The study groups were statistically similar with regard to baseline demographic characteristics and the prevale nce of moderate or severe nicotine addiction. None of the patients (0%) in the intervention group cone-acted or attended the smoking cessation program during the study period (95% CI = 0-4%). The percentages of patients who s topped smoking after three months were similar in the two groups [10.4% (5/ 48) control vs 10.9% (6/55) intervention; p = 1]. Conclusion: The authors f ound no difference in the smoking cessation rates between ED patients who r eceived written material and those who were counseled by emergency physicia ns. Referral of patients who smoked to a cessation program was unsuccessful .