Efficacy of emergency department-based smoking cessation interventions: A scoping review

ABSTRACT Background. Tobacco use is the single most preventable cause of morbidity and mortality in the United States. In 2018 emergency departments (ED) treated 143 million Americans annually while often serving as a safety net for the poor and uninsured, thus providing an opportunity for smoking cessation interventions. Little evidence exists on the efficacy of tobacco interventions in the emergency department. The objective of this scoping review is to identify and assess the current evidence on smoking cessation interventions in US emergency departments, their efficacy, shortfalls, and provide recommendations for the successful implementation of cessation programs. Methods. Systematic searches of EMBASE, PubMed databases, EBSCOhost, Ovid MEDLINE, and CINAHL were conducted with a comprehensive search string and included all English language peer reviewed journal articles, clinical guidelines, and government data from 2010 to May 15, 2021. Full text, peer-reviewed randomized control trials and systematic reviews involving adult and adolescent smokers encountered in EDs were reviewed. Databases, government reports, and journals were searched for relevant studies. The author assessed quality and assessed study risks of bias. Heterogeneity between studies precluded pooled or meta-analysis. Results. Of the 452 studies identified by a literature search, 29 full-text articles were retrieved and screened for eligibility. Of these, seven purposefully selected studies (4,065 participants) were included in the scoping review. The intervention duration ranged from 1 day to 12 months. The studies used behavioral interventions, outreach programs, referrals, pharmacological treatment, or a combination of each. Overall, only the Text2Quit study showed a significant abstinence rate but was not compared to a control, while the remaining studies showed no statistically significant difference in abstinence between intervention and control groups. Conclusions. Higher smoking cessation rates were seen in the interventions that utilized motivational interviewing compared to the usual care but did not show statistically significant differences compared to control groups. Although ED initiated smoking cessation interventions show promise, future research is needed to evaluate the efficacy of interventions. Key Words: Smoking cessation, interventions, emergency department, E