Cessation of Smoking Trial in the Emergency Department (COSTED): a multi-centre, randomised controlled trial

Background: Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED based smoking cessation intervention can help people to quit smoking.  

Methods: In this multi-centre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at six months.  

Results: An intention-to-treat analysis included 972 of 1443 people screened for inclusion (intervention= 484, control= 488). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The six month biochemically verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk, 1.76; 95% confidence interval [CI] 1.03 to 3.01; p=0.038]). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk, 1.80; 95% CI 1.36 to 2.38; p<0.001]). No serious adverse events related to taking part in the trial were reported.  

Conclusions: An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events.