Successful Tobacco Dependence Treatment in Low-Income Emergency Department Patients: A Randomized Trial.
OBJECTIVE
Tobacco use is common among emergency department (ED) patients, many of whom have low income. Our objective is to study the efficacy of an intervention incorporating motivational interviewing, nicotine replacement, and quitline referral for adult smokers in an ED.


METHODS
This was a 2-arm randomized clinical trial conducted from October 2010 to December 2012 in a northeastern urban US ED with 90,000 visits per year. Eligible subjects were aged 18 years or older, smoked, and were self-pay or had Medicaid insurance. Intervention subjects received a motivational interview by a trained research assistant, 6 weeks' worth of nicotine patches and gum initiated in the ED, a faxed referral to the state smokers' quitline, a booster call, and a brochure. Control subjects received the brochure, which provided quitline information. The primary outcome was biochemically confirmed tobacco abstinence at 3 months. Secondary endpoints included quitline use.


RESULTS
Of 778 enrolled subjects, 774 (99.5%) were alive at 3 months. The prevalence of biochemically confirmed abstinence was 12.2% (47/386) in the intervention arm versus 4.9% (19/388) in the control arm, for a difference in quit rates of 7.3% (95% confidence interval 3.2% to 11.5%). In multivariable logistic modeling controlling for age, sex, and race or ethnicity, study subjects remained more likely to be abstinent than controls (odds ratio 2.72; 95% confidence interval 1.55 to 4.75).


CONCLUSIONS
An intensive intervention improved tobacco abstinence rates in low-income ED smokers. Because approximately 20 million smokers, many of whom have low income, visit US EDs annually, these results suggest that ED-initiated treatment may be an effective technique to treat this group of smokers.
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Cancer Center, New Haven, CT. Electronic address: steven.bernstein@yale.edu.
Steven L
SL
Bernstein
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Gail
G
D'Onofrio
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
June
J
Rosner
Department of Psychiatry, Yale School of Medicine, New Haven, CT.
Stephanie
S
O'Malley
Yale School of Public Health, New Haven, CT.
Robert
R
Makuch
Yale School of Public Health, New Haven, CT.
Susan
S
Busch
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
Michael V
MV
Pantalon
Department of Psychiatry, Yale School of Medicine, New Haven, CT; Yale Cancer Center, New Haven, CT.
Benjamin
B
Toll
D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods; D011203:Poverty; D012017:Referral and Consultation; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*; D016896:Treatment Outcome