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


In the identification stage, 3,718 records were identified through database searching: 370 in MEDLINE, 449 in the Cochrane Library, 1,301 in EMBASE, 452 in Scopus, 1,042 in ISI Web of Knowledge, 89 in PsycINFO, and 15 in LILACS. Five additional records were identified through other sources: none in Conference Proceedings Citation Index (included in ISI Web of Knowledge records), 5 in the International Clinical Trials Registry Platform, and none in the reference lists of included trials. In the screening stage, 3,451 records remained after automated duplicates were removed, and 2,532 records were left after manual duplicates were removed. Then, 2,504 records were excluded because they did not meet inclusion criteria. In the eligibility stage, 28 full-text articles were assessed for eligibility. Twenty-four were excluded for the following reasons: 3 were systematic reviews, 5 were noncontrolled intervention studies, 4 were cross-sectional studies, 3 were RCTs but had no ED patients, 5 were RCTs but had no data on smoking outcomes, 1 was an RCT outside the ED setting, and 3 were excluded for other reasons. In the inclusion stage, 4 studies were included in the qualitative synthesis: 1 abstract and 3 full-text articles. Four studies were included in the quantitative synthesis (meta-analysis).

Figure 1.
Flowchart showing the literature search in 7 electronic databases and the sequential study selection process. Abbreviations: ED, emergency department; EMBASE, Excerpta Medica database; LILACS, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Literature in the Health Sciences in Latin America and the Caribbean); MEDLINE, MEDical Literature Analysis and Retrieval System Online of the United States National Library of Medicine; PsycINFO, literature database of the American Psychological Association; RCT, randomized controlled trial.

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Figure 2.
Funnel plot showing the effect estimates (Mantel-Haenszel relative risks/benefits of emergency department–initiated tobacco control) on the x -axis and the standard errors of the effect estimates on the y -axis. The funnel plot used data from the final follow-up observation in 11 studies. Both axes are log-10 scales.

Study and Year Final Observation Mantel-Haenszel Relative Risk Standard Error
Antonacci and Eyck, 2000 6 month 0.33 1.97
Richman et al, 2000 3 month 1.14 0.82
Horn et al, 2007 6 month 0.83 3.24
Schiebel and Ebbert, 2007 6 month 9.00 39.90
Bock et al, 2008 6 month 1.04 0.27
Boudreaux et al, 2008 3 month 1.86 3.48
Neuner et al, 2009 12 month 1.25 0.21
Anders et al, 2011 3 month 0.62 0.41
Bernstein et al, 2011 3 month 1.12 0.32
Cheung et al, 2013 12 month 0.55 0.38
Bernstein et al, 2015 12 month 1.38 0.26

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

Page last reviewed: October 5, 2017