Emergency department interventions for smoking cessation: a systematic review and meta-analysis

Pope, Ian, Gentry, Sarah, Livingstone-Banks, Jonathan, Iqbal, Hassan, Rashid, Simrun, Corbett, Christopher and Notley, Caitlin (2025) Emergency department interventions for smoking cessation: a systematic review and meta-analysis. Emergency Medicine Journal. ISSN 1472-0205 (In Press)

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Abstract

Background Emergency Departments (EDs) offer a valuable opportunity to intervene to support people to quit smoking. We sought to determine the effectiveness of smoking cessation interventions delivered in the ED setting on rates of abstinence at the longest follow‐up. Methods We undertook a systematic review according to the PRISMA guidelines considering only RCTs, based in the ED, where the goal of the intervention was smoking cessation and follow-up was at least 3 months. We systematically searched electronically published literature and trial registries from inception to May 2025. We pooled data using a Mantel-Haenszel random-effects model for behavioural interventions without pharmacotherapy, and using a fixed-effects model for interventions incorporating nicotine replacement therapy (NRT), with results reported as risk ratios (RR) and 95% confidence intervals. The primary outcome was smoking cessation using the strictest available measure, biochemically validated where possible. Risk of bias was assessed using the Cochrane risk of bias tool. Certainty of overall evidence was assessed using GRADE. Results Nineteen RCTs met inclusion criteria, of which 17 were deemed suitable for incorporating into meta-analyses. Participants randomized to receive a smoking cessation intervention involving NRT in the emergency department were significantly more likely to achieve abstinence (RR 1.55, 95% CI 1.27 to 1.89, p<0.0001, 6 RCTs, n=3528, I2=46%). Trials involving behavioural support alone delivered in the ED had a RR of quitting compared with controls of 1.18 (95% CI 0.85 to 1.64, p=0.32, 11 RCTs, N=4711, I2=37%). Of the 17 studies included in the meta-analyses 14 were at high risk of bias, 1 at low risk and 2 where the risk was unclear. One study incorporated e-cigarettes and was not incorporated in the meta-analysis but demonstrated evidence of effectiveness. Conclusion There is moderate certainty evidence that smoking cessation interventions incorporating pharmacotherapy delivered in the ED are effective in supporting smoking cessation.

Item Type:	Article
Additional Information:	Data availability statement: All data relevant to the study are included in this article or uploaded as supplementary material.
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School Faculty of Medicine and Health Sciences > School of Health Sciences
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	23 Dec 2025 11:30
Last Modified:	23 Dec 2025 11:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101494
DOI:	issn:1472-0205

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