[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.225.194.144. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
1.
Rabe  GL, Wellmann  J, Bagos  P,  et al.  Efficacy of emergency department–initiated tobacco control: systematic review and meta-analysis of randomized controlled trials.  Nicotine Tob Res. 2013;15(3):643-655. doi:10.1093/ntr/nts212PubMedGoogle ScholarCrossref
2.
Lam  TH, Chan  SS, Abdullah  AS, Wong  VT, Chan  AY, Hedley  AJ.  Smoking reduction intervention for smokers not willing to quit smoking: a randomised controlled trial.  Hong Kong Med J. 2012;18(suppl 3):4-8.PubMedGoogle Scholar
3.
Wang  MP, Li  WHC, Cheung  YT,  et al.  Brief advice on smoking reduction versus abrupt quitting for smoking cessation in Chinese smokers: a cluster randomized controlled trial.  Nicotine Tob Res. 2017;20(1):67-72. doi:10.1093/ntr/ntx026PubMedGoogle ScholarCrossref
4.
Ho  KY, Li  WHC, Wang  MP, Lam  KKW, Lam  TH, Chan  SSC.  Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: a phase 2 randomized controlled trial.  Patient Educ Couns. 2018;101(5):885-893. doi:10.1016/j.pec.2018.02.003PubMedGoogle ScholarCrossref
5.
Deci  E, Ryan  R.  Handbook of Self-determination Research. Rochester, NY: University of Rochester Press; 2002.
6.
Bandura  A.  Self-Efficacy: The Exercise of Control. New York, NY: Freeman; 1997.
7.
Williams  GC, McGregor  HA, Zeldman  A, Freedman  ZR, Deci  EL.  Testing a self-determination theory process model for promoting glycemic control through diabetes self-management.  Health Psychol. 2004;23(1):58-66. doi:10.1037/0278-6133.23.1.58PubMedGoogle ScholarCrossref
8.
Chan  SS, Wong  DC, Cheung  YT,  et al.  A block randomized controlled trial of a brief smoking cessation counselling and advice through short message service on participants who joined the Quit to Win Contest in Hong Kong.  Health Educ Res. 2015;30(4):609-621. doi:10.1093/her/cyv023PubMedGoogle ScholarCrossref
9.
Williams  GC, McGregor  HA, Sharp  D,  et al.  Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.  Health Psychol. 2006;25(1):91-101. doi:10.1037/0278-6133.25.1.91PubMedGoogle ScholarCrossref
11.
Hospital Authority. Hospital Authority Statistical Report 2016-2017. http://www.ha.org.hk/haho/ho/stat/HASR16_17.pdf. Published February 2018. Accessed May 10, 2019.
12.
Hospital Authority. Service Guides: Accident & Emergency (A&E). A&E Waiting Time. http://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=235504&Lang=ENG. Last updated May 10, 2019. Accessed May 10, 2019.
13.
Chan  SSC, Leung  DYP, Abdullah  ASM, Wong  VT, Hedley  AJ, Lam  TH.  A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking.  Addiction. 2011;106(6):1155-1163. doi:10.1111/j.1360-0443.2011.03363.xPubMedGoogle ScholarCrossref
14.
Kadam  P, Bhalerao  S.  Sample size calculation.  Int J Ayurveda Res. 2010;1(1):55-57. doi:10.4103/0974-7788.59946PubMedGoogle ScholarCrossref
15.
Lam  TH, He  Y.  Lam and He respond to “The Challenge of Tobacco Control in China.”  Am J Epidemiol. 2014;179(9):1074-1075. doi:10.1093/aje/kwu013PubMedGoogle ScholarCrossref
16.
Wang  MP, Suen  YN, Li  WH,  et al.  Intervention with brief cessation advice plus active referral for proactively recruited community smokers: a pragmatic cluster randomized clinical trial.  JAMA Intern Med. 2017;177(12):1790-1797. doi:10.1001/jamainternmed.2017.5793PubMedGoogle ScholarCrossref
17.
Li  WHC, Wang  MP, Lam  TH,  et al.  Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial.  Sci Rep. 2017;7:45902. doi:10.1038/srep45902PubMedGoogle ScholarCrossref
18.
Li  WHC, Wang  MP, Ho  KY,  et al.  Helping cancer patients quit smoking using brief advice based on risk communication: a randomized controlled trial.  Sci Rep. 2018;8(1):2712. doi:10.1038/s41598-018-21207-1PubMedGoogle ScholarCrossref
19.
Leung  DY, Chan  SS, Lau  CP, Wong  V, Lam  TH.  An evaluation of the psychometric properties of the Smoking Self-Efficacy Questionnaire (SEQ-12) among Chinese cardiac patients who smoke.  Nicotine Tob Res. 2008;10(8):1311-1318. doi:10.1080/14622200802238928PubMedGoogle ScholarCrossref
20.
Lam  CL, Brazier  J, McGhee  SM.  Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population.  Value Health. 2008;11(2):295-303. doi:10.1111/j.1524-4733.2007.00233.xPubMedGoogle ScholarCrossref
21.
Jarvis  MJ, Tunstall-Pedoe  H, Feyerabend  C, Vesey  C, Saloojee  Y.  Comparison of tests used to distinguish smokers from nonsmokers.  Am J Public Health. 1987;77(11):1435-1438. doi:10.2105/AJPH.77.11.1435PubMedGoogle ScholarCrossref
22.
Chatrchaiwiwatana  S, Ratanasiri  A.  Exhaled carbon monoxide levels among tobacco smokers by age.  Southeast Asian J Trop Med Public Health. 2017;48(2):429-437.PubMedGoogle Scholar
23.
Cooke  F, Bullen  C, Whittaker  R, McRobbie  H, Chen  MH, Walker  N.  Diagnostic accuracy of NicAlert cotinine test strips in saliva for verifying smoking status.  Nicotine Tob Res. 2008;10(4):607-612. doi:10.1080/14622200801978680PubMedGoogle ScholarCrossref
24.
Weinstein  MC, Siegel  JE, Gold  MR, Kamlet  MS, Russell  LB.  Recommendation of the panel of cost-effectiveness in health and medicine.  JAMA. 1996;276(15):1253-1258. doi:10.1001/jama.1996.03540150055031PubMedGoogle ScholarCrossref
25.
Cook  RJ, Sackett  DL.  The number needed to treat: a clinically useful measure of treatment effect.  BMJ. 1995;310(6977):452-454. doi:10.1136/bmj.310.6977.452PubMedGoogle ScholarCrossref
26.
Lee  CW, Kahende  J.  Factors associated with successful smoking cessation in the United States, 2000.  Am J Public Health. 2007;97(8):1503-1509. doi:10.2105/AJPH.2005.083527PubMedGoogle ScholarCrossref
27.
Royston  P.  Multiple imputation of missing values.  Stata J. 2004;4(3):227-241. doi:10.1177/1536867X0400400301Google ScholarCrossref
28.
Cromwell  J, Bartosch  WJ, Fiore  MC, Hasselblad  V, Baker  T; Agency for Health Care Policy and Research.  Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation.  JAMA. 1997;278(21):1759-1766. doi:10.1001/jama.1997.03550210057039PubMedGoogle ScholarCrossref
29.
Marseille  E, Larson  B, Kazi  DS, Kahn  JG, Rosen  S.  Thresholds for the cost-effectiveness of interventions: alternative approaches.  Bull World Health Organ. 2015;93(2):118-124. doi:10.2471/BLT.14.138206PubMedGoogle ScholarCrossref
30.
Woods  B, Revill  P, Sculpher  M, Claxton  K.  Country-level cost-effectiveness thresholds: initial estimates and the need for further research.  Value Health. 2016;19(8):929-935. doi:10.1016/j.jval.2016.02.017PubMedGoogle ScholarCrossref
31.
Heatherton  TF, Kozlowski  LT, Frecker  RC, Rickert  W, Robinson  J.  Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.  Br J Addict. 1989;84(7):791-799. doi:10.1111/j.1360-0443.1989.tb03059.xPubMedGoogle ScholarCrossref
32.
Verguet  S, Gauvreau  CL, Mishra  S,  et al.  The consequences of tobacco tax on household health and finances in rich and poor smokers in China: an extended cost-effectiveness analysis.  Lancet Glob Health. 2015;3(4):e206-e216. doi:10.1016/S2214-109X(15)70095-1PubMedGoogle ScholarCrossref
33.
Chan  SS, Leung  DY, Wong  DC, Lau  CP, Wong  VT, Lam  TH.  A randomized controlled trial of stage-matched intervention for smoking cessation in cardiac out-patients.  Addiction. 2012;107(4):829-837. doi:10.1111/j.1360-0443.2011.03733.xPubMedGoogle ScholarCrossref
34.
Hong Kong Council on Smoking and Health (COSH). Cessation Services. https://www.smokefree.hk/en/content/web.do?page=Services. Accessed May 10, 2019.
35.
Census and Statistics Department, Hong Kong Special Administration Region. Pattern of smoking: personal computer and Internet penetration. Thematic Household Survey Report 64. https://www.statistics.gov.hk/pub/B11302642018XXXXB0100.pdf. Published 2018. Accessed May 10, 2019.
36.
Tzelepis  F, Paul  CL, Walsh  RA, McElduff  P, Knight  J.  Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality.  J Natl Cancer Inst. 2011;103(12):922-941. doi:10.1093/jnci/djr169PubMedGoogle ScholarCrossref
37.
Tindle  HA, Daigh  R, Reddy  VK,  et al; Pennsylvania eReferral Workgroup.  eReferral between hospitals and quitlines: an emerging tobacco control strategy.  Am J Prev Med. 2016;51(4):522-526. doi:10.1016/j.amepre.2016.05.024PubMedGoogle ScholarCrossref
38.
Wang  MP, Wang  X, Lam  TH, Viswanath  K, Chan  SS.  The tobacco endgame in Hong Kong: public support for a total ban on tobacco sales.  Tob Control. 2015;24(2):162-167. doi:10.1136/tobaccocontrol-2013-051092PubMedGoogle ScholarCrossref
39.
West  R, Hajek  P, Stead  L, Stapleton  J.  Outcome criteria in smoking cessation trials: proposal for a common standard.  Addiction. 2005;100(3):299-303. doi:10.1111/j.1360-0443.2004.00995.xPubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Views 7,080
    Citations 0
    Original Investigation
    December 2, 2019

    Effectiveness of a Brief Self-determination Theory–Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial

    Author Affiliations
    • 1School of Nursing, The University of Hong Kong, Hong Kong, China
    • 2School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
    • 3United Christian Hospital, Hospital Authority, Hong Kong, China
    • 4Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
    • 5School of Public Health, The University of Hong Kong, Hong Kong, China
    JAMA Intern Med. Published online December 2, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.5176
    Key Points

    Question  What is the effect of a brief intervention based on self-determination theory compared with a smoking cessation leaflet on promoting abstinence in smokers presenting at emergency departments?

    Findings  In this randomized clinical trial of 1571 smokers who presented at emergency departments, a self-determination theory–based intervention was effective in increasing the biochemically validated quit rate at 6 months compared with a smoking cessation leaflet (53 of 787 [6.7%] vs 22 of 784 [2.8%]).

    Meaning  The findings suggest that if delivered routinely, this brief self-determination theory–based intervention offers a cost-effective and sustainable approach to help smokers quit smoking.

    Abstract

    Importance  Clinicians have an opportunity to provide smoking cessation interventions to smokers who present to emergency departments (EDs). The effectiveness of a brief intervention based on self-determination theory for smoking cessation is uncertain.

    Objective  To examine the effectiveness of a brief intervention based on self-determination theory for smoking cessation (immediate or progressive) among Chinese smokers presenting at EDs in Hong Kong.

    Design, Setting, and Participants  This single-blind, multicenter intent-to-treat randomized clinical trial was conducted at the EDs of 4 major acute care hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major EDs between July 4, 2015, and March 17, 2017, were randomized into an intervention group (n = 787) and a control group (n = 784).

    Interventions  The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet.

    Main Outcomes and Measures  Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months.

    Results  Participants (N = 1571) included 1381 men (87.9%); the mean (SD) age at baseline was 47.4 (16.4) years. Among participants who self-reported abstinence at 6 months, 50.3% (85 of 169) had biochemical validation by both an exhaled carbon monoxide test and a saliva cotinine test. Compared with the control group, the intervention group had statistically higher biochemically validated abstinence at 6 months: 6.7% (53 of 787) vs 2.8% (22 of 784) (P < .001), with an adjusted relative risk of 3.21 (95% CI, 1.74-5.93; P < .001). The intervention group also had higher self-reported quit rates at 6 months (12.2% [96 of 787] vs 9.3% [73 of 784], P = .04) and 12 months (13.0% [102 of 787] vs 8.5% [67 of 784], P < .01), as well as higher biochemically validated abstinence at 12 months (7.0% [55 of 787] vs 3.7% [29 of 784], P < .001). The additional cost for each intervention group participant was US $0.47, with an estimated gain of 0.0238 quality-adjusted life-year. The incremental cost per quality-adjusted life-year (US $19.53) fell within acceptable thresholds.

    Conclusions and Relevance  This brief, low-cost self-determination theory–based intervention for smokers presenting at EDs effectively increased the biochemically validated quit rate at 6 months. If delivered routinely, such a simple intervention may offer a cost-effective and sustainable approach to help many smokers quit smoking.

    Trial Registration  ClinicalTrials.gov identifier: NCT02660957

    ×