Effectiveness of a Brief, Self-Determination Intervention for Smoking Cessation (Immediate or Progressive) among People Attending Emergency Departments: A Randomised Controlled Trial

Abstract

Background and Objectives: Smokers who are in physical discomfort attended to emergency departments present an excellent ‘teachable moment’ for smoking cessation interventions. Nevertheless, most cessation programmes generally take 20 to 30 minutes or more to implement and are thus not feasible in busy clinical settings. This study aimed to address the gap in existing literature by evaluating the effectiveness of using a brief, self-determination intervention on smoking cessation among people attending emergency departments. Methods: A multi-centre randomized controlled trial was conducted in emergency departments of four acute hospitals in Hong Kong. A total of 1571 patient were recruited, with 787 being randomized into the experimental group and 784 into the control group. Subjects in the experimental group were allowed to select their own schedules of quitting (immediate or progressive). They received a leaflet plus a brief intervention on smoking cessation. Subjects in the control group received a leaflet on smoking cessation. Four consecutive (1, 3, 6 and 12 months) follow-ups were conducted over the telephone. The primary outcome measure was biochemically validated abstinence at 6 months. Secondary outcomes included (i) biochemically validated abstinence at 12 months and (ii) self-reported 7-day point prevalence of abstinence at 6 and 12 months. Intention-to-treat analysis was adopted. Results: Subjects in the experimental group had a statistically significantly higher self-reported quit rate than those in the control group at 12 months (11.2% vs 6.8%, p=0.03). The biochemically validated abstinence was also statistically significantly higher in the experimental group than in the control group at 6 (6.6% vs 2.6%, p<.001) and 12 months (6.0% vs 3.0%, p=0.04). Conclusions: The brief, self-determination intervention was shown to be effective in promoting smoking cessation for people attending emergency departments. Such intervention should therefore be a more cost-effective and sustainable approach to helping smokers quit smoking, and consequently may save more lives.