This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers explored whether an opportunistic stop smoking intervention (advice, a vape starter pack and a referral to stop smoking services), was effective for people attending the emergency department (A&E).
At 6 months, more people who received the intervention had quit smoking compared with people who received advice only. This suggests that emergency departments could be a useful setting in which to help people quit smoking, the researchers say.
The findings may encourage the implementation of stop smoking initiatives wherever people interact with the health service, including in emergency departments.
More information about quitting smoking can be found on the NHS website.
The issue: are stop smoking services in emergency departments effective?
In 2022, around 6.4 million people in the UK smoked. Smoking-related illnesses (including respiratory diseases, cancer and heart disease) caused around 74,600 deaths in 2019 and more than 408,000 hospital admissions in 2022 – 2023 in England.
Encouraging people to stop smoking prevents premature deaths and reduces healthcare use. It also addresses health inequalities: smoking accounts for about half the difference in life expectancy between the poorest and the richest (about 4.5 years of the total 9 year life expectancy difference).
People who attend emergency departments are more likely than others to smoke. Stop smoking interventions in this setting have shown promise. Researchers compared an intervention (vape starter pack, advice and referral) with written information about stop smoking services.
What’s new?
Researchers invited 972 adults attending 1 of 6 emergency departments in the UK to take part in the trial in 2022. All smoked daily and none used a vape daily.
Half (484 people) received an intervention delivered by a smoking cessation advisor: up to 15 minutes’ advice tailored to the patient, a vape starter kit and advice on how to use it and a referral to stop smoking services. The others (488 people) received written information signposting them to stop smoking services.
At 6 months, researchers sent participants surveys asking about their smoking status. The main outcome was abstinence, confirmed by a carbon monoxide reading (but few supplied this).
At 6 months:
- in the intervention group, 113 (23%) said they had quit; this was confirmed in 35 people (7% of the original 484)
- in the signposting group, 63 (13%) said they had quit; this was confirmed in 20 people (4% of the original 488).
The researchers assumed that those who did not submit a carbon monoxide reading at 6 months were still smoking. The intervention therefore led to confirmed quitting in 7% people at 6 months, compared with 4% of those given signposting only.
No serious adverse events related to the intervention were reported.
Why is this important?
This is the first trial to show that a stop smoking intervention delivered in emergency departments including vapes helps people quit smoking, even among a group not actively looking to give up.
Smoking accounts for more years of life lost than any other modifiable risk factor. Half of those who smoked agreed to take part in the trial, which suggests that emergency departments are an acceptable setting for an opportunistic intervention. People who attend emergency departments are more likely than others to smoke and to come from deprived communities. Stop smoking interventions in emergency departments could therefore reduce health inequalities.
The researchers assumed that people who did not respond were still smoking. This may not be true, and the intervention might have more impact in practice than in the trial. In addition, the signposting-only group discussed smoking with the researchers, which is not typical of care in the emergency department. The signposting-only group might therefore have been more likely to quit than others who received typical care (no discussion about smoking).
What’s next?
The researchers held a webinar on this research with Action on Smoking and Health (ASH), and set up a group to help trusts roll-out the intervention. As of June 2024, the group had 61 members representing local authorities and NHS trusts from 30 areas across England. The researchers are developing a toolkit to help with implementation.
This intervention required dedicated staff (smoking cessation advisors who were not necessarily clinicians), training, and vape starter kits. The research team is evaluating the cost-effectiveness of the intervention.
You may be interested to read
This is a summary of: Pope I, and others. Cessation of smoking trial in the emergency department (COSTED): a multicentre randomised controlled trial. Emergency Medicine Journal 2024; 41: 276 – 282.
A YouTube video sharing the experiences of participants who took part in the study.
A podcast detailing the findings of the study.
A related paper from the same research group: Ward E, and others. How do people quit smoking using e-cigarettes? A mixed-methods exploration of participant smoking pathways following receiving an opportunistic e-cigarette-based smoking cessation intervention. Addiction 2024; 10.1111/add.16633.
An NIHR news story based on this study: Handing out vapes in A&E helps smokers quit
Funding: NIHR Health Technology Assessment Commissioned Call.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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