• Emerg Med J · Apr 2024

    Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial.

    • Ian Pope, Lucy V Clark, Allan Clark, Emma Ward, Pippa Belderson, Susan Stirling, Steve Parrott, Jinshuo Li, Tim Coats, Linda Bauld, Richard Holland, Sarah Gentry, Sanjay Agrawal, Benjamin Michael Bloom, Adrian A Boyle, Alasdair J Gray, M Geraint Morris, Jonathan Livingstone-Banks, and Caitlin Notley.
    • Norwich Medical School, University of East Anglia Norwich Medical School, Norwich, UK i.pope@uea.ac.uk.
    • Emerg Med J. 2024 Apr 22; 41 (5): 276282276-282.

    BackgroundSupporting 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.MethodsIn 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.ResultsAn 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.ConclusionsAn 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 NumberNCT04854616.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

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