Evidence-based brief cessation advice plus active referral for emergency department patients who smoke: a single-arm, real-world clinical trial
Abstract
Background: 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.
Methods: 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.
Results: 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…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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