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Prev Chronic Dis. 2017 Oct 5;14:E89. doi: 10.5888/pcd14.160434.

Emergency Department-Initiated Tobacco Control: Update of a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Author information

Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany.
Krankenhaus der Augustinerinnen, Department of Internal Medicine, Cologne, Germany.
Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
Department of Emergency Medicine, Yale University School of Medicine; Yale Cancer Center; Department of Health Policy, Yale School of Public Health, New Haven, Connecticut.
Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
University of California Los Angeles, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.
University Hospital of Copenhagen, Rigshospitalet, Department of Urology, Copenhagen, Denmark.
Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany. Email:



A 2012 systematic review and meta-analysis of randomized controlled trials on emergency department-initiated tobacco control (ETC) showed only short-term efficacy. The aim of this study was to update data through May 2015.


After registering the study protocol on the international prospective register of systematic reviews (PROSPERO) in May 2015, we searched 7 databases and the gray literature. Our outcome of interest was the point prevalence of tobacco-use abstinence at 1-month, 3-month, 6-month, or 12-month follow-up. We calculated the relative risk (RR) of tobacco-use abstinence after ETC at each follow-up time separately for each study and then pooled Mantel-Haenszel RRs by follow-up time. These results were pooled with results of the 7 studies included in the previous review. We calculated the effect of ETC on the combined point prevalence of tobacco-use abstinence across all follow-up times by using generalized linear mixed models.


We retrieved 4 additional studies, one published as an abstract, comprising 1,392 participants overall. The 1-month follow-up point prevalence of tobacco-use abstinence after ETC resulted in an RR of 1.49 (95% confidence interval [CI], 1.08-2.05) across 3 studies; 3-month follow-up, an RR of 1.38 (95% CI, 1.12-1.71) across 9 studies; 6-month follow-up, an RR of 1.09 (95% CI, 0.84-1.41) across 6 studies; and 12-month follow-up, an RR of 1.26 (95% CI, 1.00-1.59) across 3 studies. The effect on the combined point prevalence of abstinence was an RR of 1.40 (95% CI, 1.06-1.86) (P = .02).


ETC is effective in promoting continual tobacco-use abstinence up to 12 months after intervention. ETC may be a critically important public health strategy for engaging hard-to-reach smokers in tobacco-use cessation.

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