Comparing 2 different intensities of active referral to smoking cessation services: a cluster randomized controlled trial
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University of Hong Kong, School of Nursing, Hong Kong
University of Hong Kong, Department of Psychiatry, Hong Kong
Hong Kong Council on Smoking and Health, Hong Kong
University of Hong Kong, School of Public Health, Hong Kong
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A351
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Background and challenges to implementation:
Studies found that actively referring smokers to smoking cessation (SC) services increased quitting. We compared 2 different intensities of SC active referral for community smokers in Hong Kong.

Intervention or response:
A single-blinded, parallel three-armed cluster randomized controlled trial was conducted among smokers who joined 2016 “Quit-to-Win” Contest organized by the Hong Kong Council on Smoking and Health. Biochemically validated (CO >4ppm) daily smokers were proactively recruited and randomly assigned to onsite SC active referral (Group A) (n= 395), text messaging on promoting and encouraging smokers to attend SC services (Group B) (n=385) and control group on general brief SC advice (Group C) (n=383). Group A and B also received model guided (AWARD) brief SC advice with a warning leaflet and a referral card at baseline and telephone brief advice at 1-month and 2-month. Telephone survey at 3-month (retention rate 63.4%) to assess primary outcome: self-reported 7-day point prevalence abstinence (PPA) and secondary outcomes: smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (CO < 4ppm). Analyses were done by intention to treat.

Results and lessons learnt:
Group A, B and C had self-reported PPA: 14.4%, 13.0% and 8.6% (A vs. C; B vs. C, p<0.05) and validated quit rates: 6.8%, 6.0% and 4.7% (all p>0.05), respectively. Corresponding SRRs were 18.7%, 16.9% and 16.2% (all p>0.05). Compared with Group C, Group A had a higher odds ratio (OR) of 1.65 (95% CI 1.08-2.52) and Group B smokers had a higher OR of 1.56 (95% CI 1.02 - 2.04) for self-reported PPA, adjusting for baseline intention to quit and clustering effect.

Conclusions and key recommendations:
Proactive intervention with AWARD guided brief SC advice and onsite active referral or text messaging may be effective in increasing quitting at 3-month compared with general brief SC advice in community smokers.

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