Efficacy of Emergency DepartmentInitiated Tobacco ControluSystematic Review and Meta-analysis of Randomized Controlled Trials

Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of emergency departmentinitiated tobacco control (ETC). Literature search in 7 databases and gray literature sources. Point prevalence tobacco abstinence at 1-, 3-, 6-, and/or 12-month follow-up was abstracted from each study. The proportionate effect (relative risk) of ETC on tobacco abstinence was calculated separately for each study and follow-up time and pooled, at different follow-up times, by Mantel-Haenszel relative risks. The effects of ETC on combined point prevalence tobacco abstinence across all follow-up times were calculated using generalized linear mixed models. Seven studies with overall 1,986 participants were included. The strongest effect of ETC on point prevalence tobacco abstinence was found at 1 month: Relative risk (RR) 1.47 (3 studies) (95% confidence interval [CI]: 1.062.06), while the effect at 3, 6, and 12 months was RR 1.24 (6 studies) (95% CI: 0.931.65); 1.13 (5 studies) (95% CI: 0.861.49); and 1.25 (1 study) (95% CI: 0.911.72). The benefit on combined point prevalence tobacco abstinence was RR 1.33 (7 studies) (95% CI: 0.961.83), p .08; with RR 1.33 (95% CI: 0.921.92), p .10, for the 5 studies combining motivational interviewing and booster phone calls. ETC combining motivational interviewing and booster phone calls showed a trend toward increased episodically measured tobacco abstinence up to 12 months. More methodologically rigorous trials are needed to effectively evaluate the impact of ETC.