[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.240.35. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
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 8,242
    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: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

    ×