the initiate study: initiating nicotine dependence treatment for smokers admitted to emergency departments

Conditions: Nicotine Dependence, Cigarettes; Nicotine Withdrawal

Summary: the initiate study is a randomized controlled trial that is testing an intervention designed to increase long-term abstinence among tobacco smokers seen in emergency departments (ed) and other high-volume hospital and community ambulatory care settings. the intervention includes a behavioural incentive and tailored follow-up support on long-term smoking abstinence, health, healthcare utilization, and cost. tobacco-related illnesses cost the healthcare system millions each year. quitting smoking improves smoking-related outcomes, like the onset or management of heart disease, stroke, lung diseases, and several cancers. there are approximately 16 million visits to canadian eds each year; an estimated 3-4 million of these involve smokers. effective quit smoking interventions exist, but are underutilized. few hospital eds, community healthcare centers, and other inpatient and outpatient clinics in canada offer tobacco-use interventions. in order for clinicians to offer quit smoking support, interventions need to be simple given the realities of these high-volume environments. considering that stopping smoking improves health outcomes, that tobacco-use is an important cause of preventable ed use, and the volume of smokers, canadian eds and other high-volume hospital and community ambulatory care settings are a missed opportunity in the initiation of quit smoking support. our intervention has been designed to optimize uptake and smoking abstinence by including the most effective evidence-based behavioural and drug-related approaches, removing specific barriers and challenges that smokers face when trying to quit (e.g., affordability, low confidence and motivation), while packaging the intervention in a quick-to-initiate manner, making it ideal for fast-paced, complex environments.


Eligibility criteria:
inclusion criteria: * current daily smoker (smokes ≥ 5 cigarettes per day); * ≥ 18 years of age (the age of majority in ontario); * for ed sites only, assigned a ctas level of 2-5 (emergent to non-urgent); * able to read and understand english or french; * resides in ontario and eligible for ontario health insurance plan (to permit linkage with administrative data housed at the institute for clinical evaluative sciences \[ices\]); * available and willing to participate in follow-up assessments over the next 24 months; * has access to a telephone or computer; * able to provide informed consent exclusion criteria: * currently participating in this or another smoking cessation study; * for ed sites only, assigned a ctas level of 1 (resuscitation - the most seriously ill patients with highest likelihood of hospital admission) or in psychiatric emergency unit; * pregnant, planning to become pregnant over the next 2 years, or breastfeeding; * has morbid illness which will prevent completion of 26-week follow-up (e.g., receiving palliative care); * in the opinion of the attending physician, manifests acute physical and/or psychiatric illness or has cognitive impairment that would preclude participation in/benefit from the intervention. * scheduled for a known elected surgery, procedure, or future hospitalization during the study period.

Keywords: nicotine replacement therapy emergency department nicotine dependence tobacco abstinence tobacco treatment cigarette