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Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers

Esther K Choo1*, Ashley F Sullivan2, Frank LoVecchio3, John N Perret4, Carlos A Camargo2 and Edwin D Boudreaux5

Author Affiliations

1 Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd Floor, Providence, RI 02903, USA

2 Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA

3 Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85006, USA

4 Department of Emergency Medicine, LSU Health Sciences Center/Earl K. Long Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805, USA

5 Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA

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Addiction Science & Clinical Practice 2012, 7:4  doi:10.1186/1940-0640-7-4

Published: 15 March 2012



The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling.


ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling.


Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p < 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling.


In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.

Smoking; Tobacco; Cigarettes; Emergency medicine; Counseling; Patient preference