Handing out vapes in A&E helps smokers quit
Giving out free e-cigarette starter packs in hospital emergency departments to people who smoke helps more people quit – according to research from the University of East Anglia.
The trial, funded by the National Institute for Health and Care Research (NIHR), offered advice, an e-cigarette starter pack and referral to stop smoking services to people attending A&E for any reason, to help them to stop smoking.
Six months later, almost one in four people given the starter packs said they had quit smoking. And those who received the packs but didn’t quit altogether, were more likely to have reduced the number of cigarettes they smoked.
The trial, which was run by the Norwich Clinical Trials Unit at UEA, took place across six UK hospitals, and the research team now hope that the initiative will be rolled out to hospitals nation-wide.
Dr Ian Pope, from UEA’s Norwich Medical School and an emergency physician, said: “Emergency departments in England see more than 24 million people each year of whom around a quarter are current smokers.
“Attending the emergency department offers a valuable opportunity for people to be supported to quit smoking, which will improve their chances of recovery from whatever has brought them to hospital, and also prevent future illness.
“Smoking killed almost 75,000 people in the UK in 2019 and it is the leading cause of preventable death and disease in the UK.
“Swapping to e-cigarettes could save thousands of lives. We believe that if this intervention was widely implemented it could result in more than 22,000 extra people quitting smoking each year.”
Trial co-lead Prof Caitlin Notley, also from UEA’s Norwich Medical School, said: “Many people who smoke want to quit, but find it difficult to succeed in the long term.
“Electronic cigarettes mimic the experience of cigarette smoking because they are hand-held and generate a smoke-like vapour when used. They can be an attractive option for helping people switch from smoking, even if they have tried and failed in the past.
“We know that they are much less harmful than smoking tobacco, and that they have been shown to help smokers quit.
“About half of all people who smoke will die prematurely, losing on average 10 years of life, and for every death caused by smoking, approximately 30 more people are suffering from a smoking-related disease.
“Smoking-related cancers, respiratory and cardiovascular diseases severely impact people’s quality of life as they get older and are a huge cost burden for the NHS.”
The study, co-designed and managed with the help of Norwich Clinical Trials Unit, ran over 30 months across six hospitals in England and Scotland – at the Norfolk and Norwich University Hospital, the Royal London Hospital and Homerton University Hospital in London, Leicester Royal Infirmary, Addenbrooke’s hospital in Cambridge and the Royal Infirmary of Edinburgh.
A total of 972 people who smoked who agreed to take part were randomly assigned to receive either smoking advice, an e-cigarette starter pack and referral to local stop smoking services - or just ‘usual care’ written information about locally available stop smoking services.
Both groups of patients were asked if they were still smoking one, three and six months after they attended hospital. Those who reported quitting after six months were asked to undergo a carbon monoxide breath test.
Dr Pope said: “Those recruited were from neighbourhoods with high levels of deprivation and more people were unemployed or unable to work due to sickness or disability than the average.
“23.4 per cent of the vape intervention group reported having quit smoking six months after they attended the emergency department, compared to 12.9 per cent of the usual care group. This shows that people were twice as likely to quit smoking having received the intervention than not.
“7.2 per cent of those in the vape intervention group and 4.1 per cent of those in usual care group were confirmed to have quit smoking by undergoing a carbon monoxide breath test1.
“We also found that people who had received the vape intervention but did not quit smoking were more likely to reduce the number of cigarettes they smoked and more likely to have tried to quit compared to the usual care group.
“This shows that helping people quit smoking whilst they wait in the emergency department is effective.
“It also shows that the emergency department offers a chance to reach people who may not otherwise be motivated to quit, or who might not have the knowledge or resources to access stop smoking services.
“It also confirms that e-cigarettes are effective at helping people to quit smoking,” he added.
“Based on these results we feel hospital emergency departments are a valuable opportunity to support people to quit smoking and policy makers should seriously consider it as a location for smoking cessation interventions.”
This research was led by UEA and the Norfolk and Norwich University Hospital in collaboration with the University of York, the University of Leicester, the University of Edinburgh, University Hospitals of Leicester NHS Trust, Barts NHS Trust, Cambridge University Hospitals Foundation Trust, NHS Lothian, Homerton University Hospital NHS Trust, and Nuffield Department of Primary Care Health Sciences.
‘Cessation of Smoking Trial in the Emergency Department (COSTED): a multi-centre, randomised controlled trial’ is published in the Emergency Medicine Journal.
As this was only a trial, people who smoke are reminded that A&E departments are not currently handing out free vapes. Help to stop smoking is available at https://www.nhs.uk/better-health/quit-smoking/
ENDS
EDITOR’S NOTES
For some FAQs on the COSTED Trial, please see below
1/ Regarding the difference in percentages between participants reporting they had quit smoking, and those who went on to take a carbon monoxide test, The research paper says: “Successfully encouraging our trial participants to submit a CO reading at six months proved to be very challenging. This may in part be due to the transient and sometimes chaotic nature of the lives of many ED attendees, the large geographical catchment area of participating EDs and transportation complexities. Thus, the biochemically confirmed cessation rates (whilst statistically significant) may underestimate the true effect size.”
2/ For more information or to request an interview, please contact the UEA communications office by emailing communications@uea.ac.uk.
Prof Caitlin Notley – c.notley@uea.ac.uk
Dr Ian Pope – i.pope@uea.ac.uk
3/ The University of East Anglia (UEA) is a UK Top 25 university (Complete University Guide and HESA Graduate Outcomes Survey) and a UK Top 30 university in the Sunday Times Good University Guide. It also ranks in the UK Top 20 for research quality (Times Higher Education REF2021 Analysis) and the UK Top 10 for impact on Sustainable Development Goals. Known for its world-leading research and good student experience, its 360-acre campus has won seven Green Flag awards in a row for its high environmental standards. The University is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk
4/ The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
· Funding high quality, timely research that benefits the NHS, public health and social care;
· Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
· Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
· Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
· Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
· Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK Aid from the UK government. www.nihr.ac.uk
5/ Norwich Clinical Trials Unit
The Norwich Clinical Trials Unit (NCTU) is a leading academic clinical trials unit based within Norwich Medical School at the University of East Anglia. It has expertise in conducting multi-centre randomised controlled trials and works with industry, researchers, and clinicians across the UK to design and deliver high-quality studies that aim to improve patient care and advance medical knowledge. Key areas of research include investigating new treatments and medical interventions for respiratory disease, addiction, infection, mental health, dementia, diabetes, stroke, gastrointestinal diseases including cancer, and interventions to improve the health outcomes of care home residents and people in social care. Currently, its research studies involve more than 400 sites around the UK and include more than 28,000 research participants. https://norwichctu.uea.ac.uk/
FAQs on the COSTED trial
Q. Isn’t vaping harmful to health?
A. A government review led by a team of experts examined all the evidence and found that vaping resulted in significantly lower exposure to harmful substances compared with smoking, as shown by biomarkers associated with the risk of cancer, respiratory and cardiovascular conditions and that vaping is likely to pose a small fraction of the risks of smoking. Therefore, while we cannot be certain of the long-term consequences of vaping we can be very confident that the potential harms are considerably less than smoking.
https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update
Q. What are the long-term health effects of vaping?
A. Although we are not yet certain of the long-term health effects of vaping, given the current evidence we can be confident that they will be smaller than those posed by people continuing to smoke.
https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update
Q. Why is vaping better than smoking?
A. People who vape are exposed to far fewer harmful chemicals compared to smoking. Therefore, vaping offers a much less harmful alternative to smoking.
https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update
Q. Is the next step looking at how people can be encouraged to give up vaping?
A. While supporting people to quit vaping will be important in the future, given 6.4 million people continue to smoke in the UK and we know smoking tobacco is one of the most harmful things people can do, the focus at the moment is on supporting as many people as possible to give up smoking tobacco.
Q. How realistic is it to expect busy staff in overflowing A&E departments to be able to deliver this extra service?
A. It is not realistic to expect busy A&E staff to deliver this sort of intervention, which is why we are advocating for additional staff to be brought in to deliver smoking cessation interventions in A&E. This will avoid burdening existing staff and in the long term will reduce the burden on A&Es by preventing further attendances due to smoking-related diseases. We estimate that widespread implementation of the COSTED intervention in A&Es would conservatively be expected to result in 22,908 extra quits per year with a cost per quit of £477.75. This has the potential to have a significant impact on the population smoking prevalence.
Q. Why should the NHS pay for vapes for smokers? Shouldn’t they buy their own?
A. Supporting people to quit smoking is very cost-effective because it avoids the future costs to the tax payer from smoking-related diseases and loss of work, therefore if an intervention successfully manages to support people to quit smoking this is an excellent use of public funds. We know that most people who smoke want to quit but providing them with a vape can provide the nudge to support them to make the change.
https://thorax.bmj.com/content/53/suppl_5/S2
Q. How did you choose which e-cigarettes to use in the trial?
A. We went through an extensive process working with experts in the field and members of the public to identify a device which was most likely to support people to quit. We intentionally chose a device that was not funded by the tobacco industry.
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