Emergency Department–Initiated Tobacco Control: Update of a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lemhoefer, Christina; Rabe, Gwen Lisa; Wellmann, Jürgen; Bernstein, Steven L.; Cheung, Ka Wai; McCarthy, William J.; Lauridsen, Susanne Vahr; Spies, Claudia; Neuner, Bruno

doi:10.5888/pcd14.160434

Cited by 37 publications

(45 citation statements)

References 45 publications

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“…A follow-up study of 778 low-income emergency department patients found that patients in the intervention group, who received a brief intervention, 6 weeks of nicotine replacement therapy, referral to a quitline had significantly higher rates of biochemically confirmed abstinence at 3 months (12.2%) compared to those who only received a brochure (4.9%). An updated meta-analysis containing 11 studies (10 published studies, 1 abstract) found a significant effect on the 1-year combined point prevalence of (RR of 1.40 (95% CI 1.06–1.86) ( P = 0.02) [ 64 ]. Together, these results suggest that the ED provides a teachable moment about the relationship between a patients symptoms and his or her tobacco use, which can lead to sustained changes in tobacco-related behaviors.…”

Section: Ed Interventions For Tobaccomentioning

confidence: 99%

Emergency department screening and interventions for substance use disorders

Hawk

D’Onofrio

2018

Addict Sci Clin Pract

137

102

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The emergency department (ED) has long been recognized as providing critical access to the health care system for many, yet only in the past few decades has the ED visit been recognized as an opportunity to identify and link patients to care for substance use disorders (SUDs). This review explores the evidence for ED-based screening, psychosocial and pharmacological interventions, and linkage to treatment for the spectrum of SUDs including high risk alcohol use and alcohol, opioid, tobacco and other SUDs. Despite knowledge gaps, methodological challenges and some inconsistency across interventions studied, opportunities for EDs to improve the care of patients across the spectrum of SUDs are robust.

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Section: Ed Interventions For Tobaccomentioning

confidence: 99%

Emergency department screening and interventions for substance use disorders

Hawk

D’Onofrio

2018

Addict Sci Clin Pract

137

102

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“…In sum, exposure to tobacco is a significant problem in this population, and an alarming burden of disease is attributable to tobacco alone. 24 The WHO Tobacco Free Initiative highlights the role for brief tobacco interventions in healthcare settings, which have demonstrated effectiveness in US-based ED populations, 5 but there are no studies to date on interventions in an African ED.…”

Section: Discussionmentioning

confidence: 99%

The last frontier for global Non-Communicable Disease action: the Emergency Department – a cross-sectional study from East Africa

Ngaruiya

Wambua

Kedera

et al. 2020

Preprint

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Background Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients, to inform interventions targeting patients with NCDs in emergency care settings. Methods Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED), the largest hospital in East Africa between May-October 2018. We used descriptive statistics and covariate-adjusted logistic analysis to analyze results. We included the following socio-demographic variables in our models: age, income, household size (t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher's exact test). Findings More than a third of respondents had hypertension (35.8%, n=225/628), one in five had raised blood sugar or diabetes (18.3%, n=61/333), and more than one in ten reported having cardiovascular disease (11.7%, n=90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808-12.618, p < 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386-0.994, p = 0.0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n=630/772), blood sugar (42.6%, n=334/767) or cholesterol (13.9%, n=109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication(51.6%, n=116/225). Determinants of disease burden were age, sex, and income. Interpretation Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations. Patient-driven interventions, and collaboration with community-based stakeholders such as patient navigators, are ideal considerations to sustainably address NCDs leveraging the ED in the resource-limited setting. Funding Hecht-Albert Global Health Pilot Innovation Award for Junior Faculty, Global Health Leadership Institute, Yale University.

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“…More than 4 million visits to emergency departments (EDs) annually involve treatment of children with complaints that are potentially related to tobacco smoke exposure (TSE) 1 . Over 30% of children who visit the pediatric ED (PED) for TSE-related illnesses live with parents who smoke 2,3 . The economic costs attributable to lost productivity due to smoking and TSE are estimated to be $190.7 billion and $7.2 billion, respectively.…”

Section: Introductionmentioning

confidence: 99%