Research published in the British Medical Journal (BMJ) has explored whether an opportunistic stop-smoking intervention (advice, a vape starter pack and a referral to stop smoking services) was effective for people attending A&E.

At six months, more people who received the intervention had quit smoking compared with people who received advice only. Researchers have said this suggests that A&E could be a useful setting in which to help people quit smoking.

The findings may encourage the implementation of stop-smoking initiatives wherever people interact with the health service, including in A&E.

Smoking services in A&E

According to the Office for National Statistics in 2022, around 6.4m 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 from 2022 to 2023 in England.

Encouraging people to stop smoking prevents premature deaths, reduces healthcare use and addresses health inequalities. According to government statistics, smoking accounts for about half the difference in life expectancy between the poorest and the richest in society (about 4.5 years of the total nine-year life expectancy difference).

The research

Researchers from the University of East Anglia invited 972 adults attending one of six emergency departments in the UK to take part in the trial in 2022. All participants smoked daily and did not use a vape daily.

Half (484 people) received an intervention delivered by a smoking cessation advisor, including verbal advice tailored to the patient, a vape starter kit and advice on how to use it and a referral to stop smoking services. The other 488 participants received written information signposting them to stop smoking services.

At six 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 six months:

  • In the intervention group, 113 (23 per cent) said they had quit; this was confirmed in 35 people (seven per cent of the original 484)
  • In the signposting group, 63 (13 per cent) said they had quit; this was confirmed in 20 people (four per cent of the original 488)

The researchers assumed that those who did not submit a carbon monoxide reading at six months were still smoking. The intervention therefore led to confirmed quitting in seven per cent of people at six months, compared with four per cent of those given signposting only.

Helping people to quit smoking

The research is the first of its kind to show that a stop smoking intervention delivered in emergency departments including vapes helped people quit smoking, even among a group not actively looking to give up.

According to the NHS, 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.

Ian Pope, honorary associate professor at the University of East Anglia, said, “We found emergency departments represent a valuable opportunity to intervene to support people to quit smoking because people waiting there are thinking about their health and are bored. Therefore, they are much more open to receiving an intervention.

“It is clear that emergency department clinical staff do not have capacity to deliver a smoking cessation intervention in addition to their clinical duties. For this intervention to be successfully implemented, it requires additional staff time.

“If this intervention was implemented in all large emergency departments, in England it could result in 22,908 extra quits per year. This could have a significant impact on population smoking rates and help to combat health inequalities in a cost-effective way.”

Future research

The researchers held a webinar on this research with Action on Smoking and Health (ASH) and have set up a group to help trusts roll-out the intervention. From 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.

Sophia Papadakis, academic and health systems consultant for the National Centre for Smoking Cessation and Training, said, “Many of the 25m visits to emergency departments in England are due to smoking-related illness, or a condition exacerbated by smoking. The Costed study has shown that brief opportunistic advice coupled with stop-smoking treatments, such as nicotine vapes, can increase the likelihood of patients stopping smoking. This is important as helping patients to stop smoking will reduce the likelihood of future emergency department visits, hospital admissions, and the burden on local health systems.

“We hope to see these study results support the rollout of similar interventions in emergency departments across the country, particularly in communities where smoking rates are high.”

References available on request.

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