March 26, 2024

expert reaction to RCT on effectiveness of ecig/quitting support offered to smokers at A&E

A study published in Emergency Medicine Journal looks at quitting support for smokers in A&E.

Dr Sarah Jackson, Principal Research Fellow at the UCL Tobacco and Alcohol Research Group and member of the independent Trial Steering Committee for this research, said:

“A growing number of studies have shown e-cigarettes to be effective for helping people to quit smoking. The COSTED trial found that approaching smokers in emergency department waiting rooms and offering them a free e-cigarette starter kit (along with brief advice and referral to stop smoking services) led to a 76% increase in quitting, compared with a control condition that provided written information on stop smoking services.

“This well-conducted trial provides further evidence that e-cigarettes can support smoking cessation. It also shows that people are receptive to smoking interventions being delivered in the emergency department: half (1443 out of 2888) of the smokers the researchers approached agreed to take part in the trial.

“Although the intervention led to a substantial increase in quitting, absolute quit rates were low (7.2% in the intervention group vs. 4.1% in the control group). This is not surprising: we know from other research that even when people are motivated to stop smoking and use the most effective treatments available, most are not successful in stopping. In this study, the researchers approached all smokers to take part, not just those with an interest in quitting.

“Bringing interventions like this to emergency department waiting rooms can help more people to stop smoking. It may be a particularly good way to help people from disadvantaged groups, who have high smoking rates and find it difficult to quit, but are often difficult to reach.

“It would be fantastic to see the COSTED intervention rolled out across UK emergency departments. However, as the authors note, this would only be viable if there is adequate funding to hire dedicated staff to deliver the intervention, so as not to overburden NHS staff.”

Prof Lion Shahab, Co-Director of the Tobacco and Alcohol Research Group, University College London, said:

“This large pragmatic randomised controlled trial adds further evidence that e-cigarettes can be an effective tool for smoking cessation, extending findings to delivery in emergency rooms. Of note, this brief intervention can be easily implemented in existing healthcare delivery to make use of the time spent waiting while being seen in Accidents & Emergency. This will likely have positive health equity effects as it will reach smokers from more disadvantaged backgrounds who are more likely to attend emergency rooms.

“While absolute abstinence rates were relatively low, this probably reflects the fact that this was a very brief intervention to fit into existing treatment delivery delivered to smokers who were not necessarily thinking about quitting. Importantly, at follow-up there was no evidence of any serious adverse effects being associated with e-cigarette use, underlining their relative safety even in the context of providing them as part of acute health events that require emergency room attendance.”

‘Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial’ by Ian Pope et al. was published in Emergency Medicine Journal at 23.30 UK time on Tuesday 26 March 2024.

DOI: 10.1136/emermed-2023-213824

Declared interests

Sarah Jackon: I was a member of the independent Trial Steering Committee

Lion Shahab: Previous joint publications with some of the authors of this study.

For all other experts, no reply to our request for DOIs was received.