RESEARCH PAPERS

Emergency department-initiated tobacco control: a randomised controlled trial in an inner-city university hospital

Bruno Neuner MD MSE¹, Edith Weiss-Gerlach¹, Peter Miller PhD², Peter Martus PhD³, Doreen Hesse MD¹, Claudia Spies MD¹

¹ Charité-Universitaetsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Germany;
² Center for Drug and Alcohol Programs, Medical University of South Carolina, Germany;
³ Charité-Universitaetsmedizin Berlin, Institute of Biostatistics and Clinical Epidemiology, United States

E-mail: bruno.neuner{at}charite.de

Objectives: Emergency department (ED) patients show high smoking rates. We investigated the effects of ED-initiated tobacco control (ETC) on the 7-days abstinence at 12 months.

Methods: Randomized-controlled intention-to-treat trial (Trials Registry no.: ISRCTN41527831 [controlled-trials.com] ) in 1,044 patients in an urban ED. ETC consisted of on-site counselling plus up to 4 telephone booster sessions. Controls received usual care. Analysis was by logistic regression.

Results: Overall 630 (60.7%) were males, the median age was 30 years, (range 18 – 81), and the median smoking intensity was 15 (range 1 – 60) cigarettes per day. Five hundred eighty study participants (55.6%) were unmotivated, 331 (31.7%) were ambivalent, and 133 (12.7%) were motivated smokers. ETC (median time 30 (range 1 – 99) minutes) was administered to 472 (91.7% out of 515) randomized study participants. At follow-up, 685 study participants (65.6% of 1,044) could be contacted. Overall, 73 out of 515 (14.2%) in the ETC group were abstinent, whereas 60 out of 529 (11.3%) controls were abstinent (Odds ratio adjusted for age and gender: 1.31 (95%-confidence interval (0.91 – 1.89), p=0.15). Stratified for motivation to change behavior, the adjusted Odds ratios for ETC versus usual care were 1.00 (95%-confidence interval (0.57 – 1.76)) in unmotivated smokers, respectively 1.37 (95%-confidence interval (0.73 – 2.58)) in ambivalent smokers and 2.19 (95%-confidence interval (0.98 – 4.89)) in motivated smokers, p for trend = 0.29.

Conclusions: ETC, in the form of on-site counselling with up to 4 telephone booster sessions, showed no overall effect on tobacco abstinence after 12 month. A non-significant trend for a better performance of ETC in more motivated smokers was observed.

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