title: Emergency department-initiated tobacco control: a randomised controlled trial in an inner city university hospital.
abstract: OBJECTIVE
  Emergency department (ED) patients show high smoking rates. The effects of ED-initiated tobacco control (ETC) on 7-day abstinence at 12 months were investigated.
  
  
  METHODS
  A randomised controlled intention-to-treat trial (trials registry no.: ISRCTN41527831) was conducted with 1044 patients in an urban ED. ETC consisted of on-site counselling plus up to four telephone booster sessions. Controls received usual care. Analysis was by logistic regression.
  
  
  RESULTS
  In all, 630 (60.7%) participants were males, the median age was 30 years (range 18-81) and the median smoking intensity was 15 (range 1-60) cigarettes per day. Overall, 580 study participants (55.6%) were unmotivated, 331 (31.7%) were ambivalent and 133 (12.7%) were motivated smokers. ETC (median time 30 (range 1-99) min) was administered to 472 (91.7% out of 515) randomised study participants. At follow-up, 685 study participants (65.6% of 1044) could be contacted. In the ETC group, 73 out of 515 (14.2%) in the ETC group were abstinent, whereas 60 out of 529 (11.3%) controls were abstinent (OR adjusted for age and gender = 1.31 (95% CI 0.91 to 1.89, p = 0.15). Stratified for motivation to change behaviour, the adjusted ORs for ETC versus usual care were OR = 1.00 (95% CI 0.57 to 1.76) in unmotivated smokers, respectively OR = 1.37 (95% CI 0.73 to 2.58) in ambivalent smokers and OR = 2.19 (95% CI 0.98 to 4.89) in motivated smokers, p for trend = 0.29.
  
  
  CONCLUSIONS
  ETC, in the form of on-site counselling with up to four telephone booster sessions, showed no overall effect on tobacco abstinence after 12 months. A non-significant trend for a better performance of ETC in more motivated smokers was observed.
authors.affiliation: Charité - Universitaetsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charitéplatz 1, Berlin, Germany. bruno.neuner@charite.de
authors.forename: B
authors.initials: B
authors.lastname: Neuner
authors.forename: E
authors.initials: E
authors.lastname: Weiss-Gerlach
authors.forename: P
authors.initials: P
authors.lastname: Miller
authors.forename: P
authors.initials: P
authors.lastname: Martus
authors.forename: D
authors.initials: D
authors.lastname: Hesse
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006785:Hospitals, University; D015277:Hotlines; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009042:Motivation; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult