Better control of cancer in China by helping people quit smoking

Abstract

Background

Smoking causes multiple types of cancers and chronic respiratory diseases. Evidence also shows that exposure to second-hand smoke for non-smoking spouses of smokers increases their risk of developing lung cancer by 20-30%. To better prevent the growth of cancer, it is crucial to help people quit smoking. We evaluated the effectiveness of a brief self-determination theory-based smoking cessation for smokers at emergency departments (ED) in China Hong Kong in real-world settings.

Methods

A multicentre, single-arm, open-label, nonrandomized trial was conducted at four EDs of public hospitals in China Hong Kong. Current smokers aged 18 years or older and triaged as semi-urgent or non-urgent were included. Participants received brief counselling using the AWARD (Ask, Warn, Advise, Refer and Do-it-again) model, and active referral provided by trained health care professionals (HCPs). Referred participants received proactive telephone calls offering cessation counselling from the referred smoking cessation service provider. The primary outcome was biochemically validated abstinence at 6 months. The trial was prospectively registered in ClinicalTrials.gov (Identifier NCT03818360).

Findings

Between 30 August 2019 and 26 November 2021, 1601 eligible individuals were enrolled and included in the analyses. Most participants were males (1443/1601, 90%) and participants' mean age was 48 (standard deviation=15) years. By intention-to-treat analysis, biochemically validated abstinence in the referred group was significantly higher than that in the unreferred group at the 6- (5·3% vs. 3·6%; adjusted OR 1·88, 95% CI, 1·01–3·41; p=0·04) and 12-month follow-up (8·1% vs. 3·5%; adjusted OR 2·98, 95% CI, 1·70–5·19; p<0·001).

Interpretation

This trial demonstrated that brief advice and active referral for smokers attending the ED were effective and feasible in real-world settings. This innovative and cost-effective approach could motivate HCPs to assist more smokers with cessation in routine clinical settings and improve smoking abstinence levels. This research could have significant long-term implications for the healthcare industry, particularly in preventing the development of cancers caused by smoking. It will help reduce healthcare expenditure and socioeconomic burden by reducing the risk of morbidity and mortality. Importantly, in the long term, this will help improve the physical health and health-related quality of life of the Chinese public, especially vulnerable groups such as women and children, by avoiding exposure to second-hand smoke. This will ultimately save more lives, protect the environment and promote sustainable development.

Funding

Health Care Promotion Scheme, Food and Health Bureau, Hong Kong SAR Government (02180648). National Natural Science Foundation of China (72104259), Natural Science Foundation of Guangdong Province (2024A1515012147).