Smokers listen when emergency department doctors tell them to kick the habit, according to a new study published in the Annals of Emergency Medicine. The results of this study suggest that ED physicians have a great opportunity to reduce overall smoking rates for the approximately 20 million smokers across the United States.
Tobacco use is common among ED patients. One 2011 study showed the age-stratified tobacco rates were almost double those of the general population. ED patients also tend to have low incomes, as individuals with low socioeconomic status prefer acute care settings to ambulatory care.
Quitting smoking, which is an increasingly expensive habit, would help these low-income patients both financially and medically.
"Because approximately 20 million smokers visit emergency departments annually, this intervention has the potential to greatly reduce tobacco use among our patients," said lead study author Steven L. Bernstein, M.D., of the Yale School of Medicine in New Haven, Connecticut. "Given that cigarette smoking is the leading cause of preventable death and illness in the United States, anything we can do to discourage smoking has value. The need is particularly acute in low-income populations like those we studied."
The researchers' objective was to study the efficacy of an intervention model that focuses on motivational interviewing, nicotine replacement and a referral to a telephone-based smoking cessation program, known as a quitline.
The scientists performed a two-arm randomized clinical trial from October 2010 to December 2012. They gathered data from an urban emergency department in the United States that saw an average of 90,000 patient visits each year. Participants were over the age of 18, smokers and were either self-pay or covered by Medicaid.
The 386 participants in the intervention group received a motivational interview conducted by a trained research assistant, a six-week supply of nicotine patches and gum, a faxed referral to the smoker quitline in that state, a brochure and a booster call. The 388 subjects in the control group received only the brochure, which contained the information to the state's quitline.
The researchers confirmed tobacco abstinence in three months using biochemical testing. The scientists also confirmed quitline use.
Of the 778 participants enrolled in the study, 774 were still alive after three months. Biochemical analysis confirmed abstinence in 12.2 percent of the intervention group versus 4.9 percent in the control group. This means participants who received intensive intervention from ED doctors were 2.5 times more likely to remain tobacco-free after three months than are those who received only a brochure.
"While a busy emergency department may not welcome the additional responsibility of tobacco-cessation counseling, sometimes we have to meet our patients where they are," Bernstein said. "Future research should focus on longer-term interventions, as well as mobile health technologies, such as texting."
