Cessation of Smoking Trial in the Emergency Department (COSTED): Long-Term Follow-Up of a Randomized Controlled Trial.

Introduction: Emergency Departments (EDs) offer a valuable opportunity to deliver smoking cessation interventions. Long-term abstinence confers the maximum health benefits.

Methods: Adults attending UK EDs who currently smoked were randomized to intervention (brief advice, e-cigarette and referral to local stop smoking services) or control (contact details for local stop smoking services). Participants were followed up at 1, 3 and 6 months as part of the main trial. Participants who consented to long term follow-up were also contacted at approximately 18 months post randomization. For an "all participants" analysis those who did not consent to long-term follow-up had their smoking status set at the value of the 6 month outcome. Those who did not respond were assumed to be smoking.

Results: Long-term follow-up occurred between 14 and 22 months, mean = 18 months. Long term follow-up for those who consented to this was 35% in the intervention group (n = 145) and 34% in the control group (n = 143). For those who consented to long term follow-up self-reported 7-day abstinence at 18 months was 12.8% in the intervention group (n = 53) and 8.33% in the control group (n = 35) (RR = 1.56, 95% CI 1.04-2.32, p=.031). For all participants self-reported 7-day abstinence at long term follow-up was 13.8% in the intervention group (n = 67) and 8.6% in the control group (n = 42) (RR = 1.61, 95% CI 1.12-2.31, p=.010).

Conclusions: Adults who smoke attending the ED who received a smoking cessation intervention were significantly more likely to report abstinence 18 months after randomization.

Implications: Emergency Departments should be considered as a location for smoking cessation interventions in order to increase long term abstinence.