A Pragmatic Randomized Controlled Trial of Physicians’ Very Brief (30-Second) Smoking Cessation Intervention in China

Abstract

Background and Objectives: Three to 10 minutes of smoking cessation advice by physicians is effective but not routinely practiced in most countries, partly because it is not brief enough and not feasible. We tested if a very brief (about 30 seconds) intervention during outpatient consultations effectively increased cessation. Methods: This was a pragmatic two-arm randomized controlled trial. Participants were adult current smokers recruited by 424 physicians from 72 medical outpatient departments of hospitals or community health centers in Guangdong, China. The intervention group (n=7,015) received a standard 30-second intervention, which included a physician’s brief warning, specifying “the WHO warned that one in two smokers will be killed by smoking but new research updated the risk to 2 in 3 smokers”, a leaflet with strong graphic warnings, explicit images of serious diseases and motivational messages to quit, and a small card showing the telephone numbers of available cessation services. The control group (n=6,656) received a card and an information leaflet about eating fruits and vegetables. The primary outcome was self-reported tobacco abstinence in the past 7 days at the 12-month follow-up. Secondary outcomes included 30-day self-reported abstinence, carbon monoxide and saliva cotinine validated abstinence, quit attempts, smoking reduction by 50% or more, and the use of smoking cessation services. Results: By intention-to-treat, the intervention (vs. control) group had greater self-reported 7-day abstinence (9.1% vs 7.8%; odds ratio [OR]=1.14; 95% confidence interval [CI], 1.03-1.26; P = .007), 30-day abstinence (8.0% vs 6.9%; OR=1.14; 95%CI, 1.03-1.27; P = .01), and smoking reduction (18.% vs 16.6%; OR=1.12; 95%CI, 1.04-1.20; P=.003) at the 12-month follow-up. Other outcomes were not significantly different between the 2 groups. Conclusions: The very brief smoking cessation intervention effectively increased tobacco abstinence by about 14% at the 12-month follow-up. If delivered widely, it can be more impactful than all prior brief interventions.