title: A randomized trial of a multicomponent cessation strategy for emergency department smokers.
abstract: OBJECTIVE
  The objective was to determine the efficacy of an emergency department (ED)-based smoking cessation intervention.
  
  
  METHODS
  This study was a randomized trial conducted from January 2006 to September 2007 at an urban ED that treats 90,000 adults per year. Discharged adults who smoked at least 10 cigarettes per day were randomized to 1) usual care, receiving a smoking cessation brochure; or 2) enhanced care, receiving the brochure, a motivational interview (MI), nicotine patches, and a phone call at 3 days. Interventions were performed by a peer educator trained in tobacco treatment. Blinded follow-up was performed at 3 months.
  
  
  RESULTS
  A total of 338 subjects were enrolled, mean (±SD) age was 40.2 (±12.0) years, 51.8% were female, and 56.5% were either self-pay or Medicaid. Demographic and clinical variables were comparable between groups. Enhanced and usual care arms showed similar cessation rates at 3 months (14.7% vs. 13.2%, respectively). The proportion of subjects making a quit attempt (69.2% vs. 66.5%) and decrease in daily cigarette use (five vs. one; all p > 0.05) were also similar. In logistic modeling, factors associated with quitting included any tobacco-related International Classification of Diseases, ninth revision (ICD-9), code for the ED visit (odds ratio [OR]= 3.42, 95% confidence interval [CI] = 1.61 to 7.26) or subject belief that the ED visit was tobacco-related (OR = 2.47, 95% CI = 1.17 to 5.21). Conversely, subjects who reported having a preexisting tobacco-related illness were less likely to quit (OR = 0.22, 95% CI = 0.10 to 0.50).
  
  
  CONCLUSIONS
  The primary endpoint was negative, reflecting a higher-than-expected quit rate in the control group. Subjects whose ED visit was tobacco-related, based either on physician diagnosis or subject perception, were more than twice as likely to quit. These data suggest that even low-intensity screening and referral may prompt substantial numbers of ED smokers to quit or attempt to quit.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, New York, USA. Steven.bernstein@yale.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.forename: Polly
authors.initials: P
authors.lastname: Bijur
authors.forename: Nina
authors.initials: N
authors.lastname: Cooperman
authors.forename: Saba
authors.initials: S
authors.lastname: Jearld
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
authors.forename: Alyson
authors.initials: A
authors.lastname: Moadel
authors.forename: E John
authors.initials: EJ
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D054521:Cultural Competency; D004636:Emergency Service, Hospital; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome