Secondary analysis of an RCT on Emergency Department- Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up
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Department of Anesthesiology and Intensive Care Medicine, Charité– Universitätsmedizin Berlin, Berlin, Germany
Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, Los Angeles, United States
Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
Bruno Neuner   

Charité– Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Publish date: 2019-04-05
Tob. Induc. Dis. 2019;17(April):26
Emergency departments (EDs) are opportune places for tobacco control interventions. The ‘Tobacco Control in an Urban Emergency Department’ (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study’s aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome).

At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes.

Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01–1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p<0.05).

A conventional analysis failed to confirm a significant effect of the EDinitiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier.

WJ McCarthy was supported by National Institute of Health grant U54 CA 143931 during the time that this article was written. We acknowledge further support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité– Universitätsmedizin Berlin. The authors thank two anonymous reviewers for their helpful comments on an earlier version of this manuscript.
The authors declare that they have no competing interests, financial or otherwise, related to the current work. C Spies received funding from Deutsche Krebshilfe (DKH-111507) during the conduct of the present work. C Spies also received funding outside the present work from European Union Seventh Framework research program [FP7/2007- 2013], under the grant agreement No. HEALTH-F2-2014-60246, BioCog. C Spies reports grants outside this work from: Dr F. Köhler Chemie GmbH, AppAdventure, J&P Medical Research Ltd., Pharmaceutical Research Associates GmbH, Delcath Systems Inc., INC Research UK Ltd., La Jolla Pharmaceutical Company, Aridis Pharmaceutical Inc., B. Braun Melsungen AG, Drägerwerk AG & Co. KGaA, Grünenthal GmbH, Infectopharm GmbH, Sedana Medical Ltd., Arbeitsgemeinschaft industrieller Forschungsvereinigungen ‘Otto von Guericke’ e.V., Berufsverband Deutscher Anästhesisten e.V., Deutsche Forschungsgemeinschaft, Deutsches Zentrum für Luftund Raumfahrt e.V., Einstein Stiftung Berlin, European Society of Anaesthesiology, Gemeinsamer Bundesausschuss, Inneruniversitäre Forschungsförderung, Projektträger im DLR, Stifterverband, WHOCC, Westfälische Wilhelms-Universität Münster/DFG, AbbVie Deutschland GmbH & Co. KG, Aguettant Deutschland GmbH, MAQUET Vertrieb und Service Deutschland GmbH, Orion Pharma GmbH, Philips Electronics Nederland B.V., Sintetica GmbH, Baxter Deutschland GmbH, Biotest AG, Cytosorbents Europe GmbH, Edwards Lifesciences Germany GmbH, Fresenius Medical Care, Grünenthal GmbH, Masimo Europe Ltd., Medtronic GmbH, Pfizer Pharma PFE GmbH, European Commission, Bundesministerium für Umwelt, Naturschutz und nukleare Sicherheit. C Spies also reports personal fees from Georg Thieme Verlag outside this work. In addition, C Spies has a patent 10 2014 215 211.9 pending, a patent Application No. PCT/EP2015/067730 pending to Graft Gesellschaft von Architekten mbH, and a patent Application No. PCT/ EP2015/067731 pending to Graft Gesellschaft von Architekten mbH. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
The Laocoon study was financed by the German Cancer Foundation (Deutsche Krebshilfe), Bonn, Germany (Grant DKH-111507), and by institutional resources of the Charité–Universitätsmedizin Berlin.
Not commissioned; externally peer reviewed.
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