A systematic review of smoking cessation interventions in the emergency setting.
OBJECTIVE
Cigarette smoking remains the leading cause of preventable death in the United States, and tobacco use rates are known to be higher among emergency department (ED) patients than in the general population. Despite recommendations from the Society for Academic Emergency Medicine and the American College of Emergency Physicians, many emergency clinicians remain uncertain about the benefits of providing ED-based smoking cessation interventions. To address this gap in knowledge, we performed a systematic review of cessation interventions initiated in the adult or pediatric ED setting.


METHODS
We conducted an electronic search of the MEDLINE and CINAHL databases through February 2014 and hand searched references from potentially relevant articles. We identified eligible studies, evaluated bias and validity, and extracted data and synthesized findings.


RESULTS
Seventeen studies underwent critical appraisal, with 13 included in qualitative synthesis. The majority (11/13, 85%) of investigations did not report significant differences in tobacco abstinence between cessation intervention groups. The 2 studies reporting significant differences in cessation both used motivational interviewing-based interventions. Two studies evaluated patient satisfaction with ED-based tobacco cessation interventions, and both reported greater than 90% satisfaction.


CONCLUSIONS
Findings indicate that ED visits in combination with ED-initiated tobacco cessation interventions are correlated with higher cessation rates than those reported in the National Health Interview Survey. Clear data supporting the superiority of one intervention type were not identified. Lack of a standardized control group prevented quantitative evaluation of pooled data, and future research is indicated to definitively evaluate intervention efficacy.
Maine Medical Center Research Institute, Maine Medical Center, Department of Emergency Medicine, Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102. Electronic address: pellej2@mmc.org.
Jonathan H
JH
Pelletier
Maine Medical Center, Department of Emergency Medicine, Tufts University School of Medicine, 47 Bramhall Street, Portland, ME 04102. Electronic address: strout@mmc.org.
Tania D
TD
Strout
Maine Medical Center, Department of Emergency Medicine, Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102. Electronic address: baumam@mmc.org.
Michael R
MR
Baumann
D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D062405:Motivational Interviewing / Q000379:methods; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction; D012017:Referral and Consultation; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome