Original research
Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial Ian Pope , 1 Lucy V Clark , 1 Allan Clark , 1 Emma Ward , 1 Pippa Belderson , 1 Susan Stirling, 1 Steve Parrott , 2 Jinshuo Li , 2 Tim Coats , 3 Linda Bauld , 4 Richard Holland , 5 Sarah Gentry , 1 Sanjay Agrawal , 6 Benjamin Michael Bloom , 7 Adrian A Boyle , 8 Alasdair J Gray, 9 M Geraint Morris, 10 Jonathan Livingstone-Banks , 11 Caitlin Notley 1
ABSTRACT Background Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED- based smoking cessation intervention can help people to quit smoking. Methods In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at 6 months. Results An intention-to-treat analysis included 972 of 1443 people screened for inclusion (484 in the intervention group, 488 in the control group). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The 6-month biochemically-verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk 1.76; 95% CI 1.03 to 3.01; p=0.038). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk 1.80; 95% CI 1.36 to 2.38; p<0.001). No serious adverse events related to taking part in the trial were reported. Conclusions An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events. Trial registration number NCT04854616. INTRODUCTION Tobacco kills more than 8 million people each year worldwide. 1 In the UK 6.4 million people continue to smoke, with those in ‘routine and manual’ occu- pations having a smoking rate of 22.8% compared with 8.3% for those in ‘managerial and profes- sional’ occupations. 2 Treating tobacco addiction is a
Handling editor Jason E Smith ► Additional supplemental material is published online only. To view, please visit the journal online (https://doi. org/1 0.1136/e mermed-2023- 213824). For numbered affiliations see end of article. Correspondence to Dr Ian Pope, Norwich Medical School, University of East Anglia, Norwich, UK; i.pope@u ea.ac.u k Received 4 December 2023 Accepted 17 January 2024 Published Online First 26 March 2024
powerful tool to combat premature death, address health inequalities and to reduce healthcare utili- sation. 3 4 Emergency Departments (EDs) see large numbers of people, and those who attend the ED are more likely to smoke 5 and suffer complex health inequalities. 6 Smoking cessation interventions embedded in EDs have shown promise; however, there is uncer- tainty about the long-term impact and optimal intervention components. 7 Previous studies in ED settings have evaluated behavioural support Findings were limited by relatively low biochemical validation rates and slightly differential rates of follow-up. ⇒ This trial contributes to the existing evidence that ED-based interventions are effective and is the first trial to test e-cigarettes in the ED setting. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ Policy makers should consider the ED as a location to deliver smoking cessation interventions as long as appropriate funding is available for dedicated staff. ⇒ This study shows that it is possible to recruit efficiently and to deliver a brief opportunistic intervention to support sustained tobacco smoking abstinence in the ED setting. WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Emergency Department (ED)-based smoking cessation interventions have shown promise but there is uncertainty about the best intervention components and longer term outcomes. ⇒ E-cigarettes have been shown to be one of the most effective smoking cessation tools but have never been tested in the ED environment. WHAT THIS STUDY ADDS ⇒ In this trial significantly more people receiving a smoking cessation intervention in the ED achieved long-term smoking abstinence compared with those receiving usual care.
► http://d x.d oi.o rg/1 0.1 136/ emermed-2 024-213940 ► http://d x.d oi.o rg/1 0.1 136/ emermed-2 024-214073
To cite: Pope I, Clark LV, Clark A, et al . Emerg Med J 2024; 41 :276–282. © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
Pope I, et al . Emerg Med J 2024; 41 :276–282. doi:10.1136/emermed-2023-213824
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