Brief smoking cessation advice and active referral to smoking cessation services: a cluster randomized controlled trial

Abstract

BACKGROUND AND OBJECTIVES: Although most smokers are aware of smoking cessation (SC) services, many have never used SC services. We aimed to develop simple, practical and substainable interventions to increase SC service use in the 2015 COSH “Quit to Win” Contest. METHODS: A single-blinded, parallel three-armed cluster randomized controlled trial randomly allocated biochemically validated daily smokers proactively recruited in the community into SC services referral (Group A) (n=402), brief advice (Group B) (n=416) and control group (Group C) (n=408). Smokers in both intervention groups (A & B) received brief SC advice (AWARD model) and a health warning leaflet. Smokers in Group A further recevied a pocket size SC referral card and were actively referred to SC service providers for a quick appointment. The control group received very brief general SC advice and a 12-page self-help booklet. Follow-up telephone SC advice was provided for the intervention groups at 1 and 2 months. Primary outcome was self-reported 7-day point prevalence quit rate at 6 months. Secondary outcomes were biochemically validated quit and smoking reduction rates (daily cigarette consumption reduced by ≥50%; excluding quitters). FINDINGS: Overall retention rate at 6 months was 72.3%. By intention to treat, the quit rate was 17.2% in Group A, 9.4% in Group B and 11.5% in Group C (A vs. B, p<0.001; A vs. C, p=0.02; B vs. C, p=0.31). Corresponding biochemically validated quit rates were 9.0%, 5.0% and 5.1% (A vs. B, p=0.03, A vs. C, p=0.03; B vs. C, p= 0.95). Smoking reduction rates were similar in the 3 groups (A: 22.9%, B: 23.3% and C: 24.5%, p=0.85). Logistic regression analysis found that smoking fewer cigarettes (odds ratio [OR] 0.95, 95% CI: 0.92-0.97), started smoking in later age (OR 1.03, 95% CI 1.00-1.07) and having more confidence for quitting (per unit OR increase 1.12, 95% CI 1.02-1.24) were associated with quit at 6-month. CONCLUSION: This study showed that proactive intervention with brief advice and active referral to SC service for smokers recruited in the community setting was effective in increasing quitting.