A Randomized Controlled Trial of Directed Smoking Cessation Intervention in the Emergency Care Population

Smoking is a public health epidemic. Over 20% of adults in the USA smoke according to the American Heart Association. Benefits of smoking cessation are realizable and readily apparent: reductions in the risk of heart, kidney, and lung disease, reduction in the risk of stroke and certain cancers, blood pressure improvement, increased life expectancy, economic benefits, and the positive externality in secondhand smoke reduction are some of the more common benefits cited by public health experts. Smoking remains the leading preventable cause of chronic illness in our country, and, despite the well-publicized benefits, quitting smoking remains difficult. Many smokers do not wish to undergo the negative physiological effects of detoxification from nicotine dependence. Others lack the resources, support and motivation to make this lifestyle change. Providers, moreover, struggle to find a simple, effective intervention that will help their smoking population kick the habit.

Given this background, our research proposal has the following specific aims:

1. The ED is an effective location within the domestic health system to provide preventive medical care, including counseling on smoking cessation.
2. A simple intervention where ED patients who were motivated to quit smoking were put in direct phone contact with a trained smoking cessation counselor, during their ED stay, will have a realizable benefit in rates of smoking cessation beyond the placebo rate of cessation.
3. We hypothesize that smokers who are motivated to quit will react positively to the national quit line and will have a higher rate of cessation at two months time compared to other motivated smokers in the ED department who are not put in immediate contact with a smoking cessation counselor.

A background statistical analysis and literature review has already been conducted. A literature review has been attached for reference (see Appendix A). We have discussed this topic with our biostatistical liaison and we believe such a study can show statistical significance with appropriate power based on a target enrollment of 150 patients.

Following anticipated IRB approval, we expect this study to be ready for enrollment. Mr. Pelster will be the lead enrollee within the Adult Emergency Department and has the full support of the ED faculty and staff for this work. He will be supervised directly by Dr. Benjamin Heavrin, Assistant Professor of Emergency Medicine, who will function as his faculty sponsor through the VUSM emphasis program. All patients presenting to the Adult Emergency Department are asked about smoking status through the triage note. Mr. Pelster will have access to this triage note and will approach patients who meet inclusion criteria. Our inclusion criteria includes: verbally consenting patients of the Adult ED who actively smoke, have normal vital signs, and are not emergency will based on triage criteria. Exclusion criteria includes patients unable to provide consent, unable to verbally communicate, patients with emergent illness defined by ESI triage protocols, patients with unstable vitals, and patients under the age of 18. Mr. Pelster will then approach these patients for possible enrollment. Prior to the beginning of this study, Mr. Pelster will become well read on current smoking statistics and on the medical and health related benefits of smoking cessation, should patient questions arise. He will be supervised in these verbal patient discussions by Dr. Heavrin.