Copy of Willingness to Engage in Tobacco Cessation Among Emergency Department Patients

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Authors: Jo-Ann Rammal, Kayla Orow, Yasin Almri, Yara Chamaa, Nasser Mahdi, Eva

Quigley, Jeremiah Vidal, Keith Bradley, Joseph Miller, Matthew T. Ball, Howard A. Klausner

Objectives: To assess willingness to contact the Quitline among emergency department

(ED) patients identified as tobacco users, identify demographic factors associated with

cessation engagement, and evaluate the impact of offering scheduling assistance.

Methods: This multicenter cross-sectional survey was conducted across 11 EDs in the

National Alliance of Research Associate Programs (NARAP) network. A convenience

sample of patients was surveyed by research students between March 2017 and

December 2025 on tobacco use history. Patients who reported using tobacco products for more than 30 days in a row, excluding those who used only smokeless tobacco, were

assessed for likelihood of scheduling a call to the Quitline within 30 days using a five-point Likert scale. Those reporting very unlikely, unlikely, or not sure were assessed for barriers and whether assistance would change their likelihood. Multivariable ordinal logistic regression evaluated associations between demographics (age, sex, race, ethnicity, education, insurance) and scheduling likelihood, adjusting for site.

Results: Among 31,740 patients surveyed, 10,110 were flagged for tobacco cessation.

Only 19.7% reported being likely or very likely to schedule a Quitline call (likely 12.2%, very likely 7.5%), while 73.3% reported being unlikely or very unlikely. Older age was associated with lower likelihood of scheduling (OR 0.99, p<0.001). Sex was not a significant predictor (OR 0.98, p=0.641). African American/Black participants had significantly higher odds of scheduling (OR 1.66, p<0.001) and Asian American and Pacific Islander (AAPI)/Other participants also had significantly higher odds (OR 1.41, p<0.001) versus White participants. Hispanic/Latino participants had significantly higher odds of scheduling versus non-Hispanic/Latino participants (OR 1.23, p<0.001). Notably, lower education was associated with higher scheduling likelihood: participants with less than a high school diploma (OR 1.57, p<0.001), GED or high school diploma (OR 1.26, p<0.001), and some college (OR 1.14, p=0.019) all had higher odds than college graduates. Participants with no or other insurance had higher odds (OR 1.32, p<0.001), and Medicare/Medicaid participants had higher odds (OR 1.12, p=0.005) compared to privately insured participants. Among those reporting barriers (N=8,117), the most frequently endorsed was unspecified “other” reasons (50.6%), followed by not being ready (20.4%), already having quit tobacco (17.6%), and lack of time (9.5%). Fear of results (1.0%), lack of transportation (0.4%), and need for childcare (0.2%) were rarely endorsed. Offering scheduling assistance

Commented [MJ1]: Do we need to add other site PIs? had minimal impact, with only 10.3% of initially reluctant participants reporting likely or very likely to call with help (likely 7.9%, very likely 2.4%).

Conclusion: Fewer than one in five ED patients identified as tobacco users expressed

willingness to contact the Quitline. Minority race, lower education, and non-private

insurance were associated with higher willingness to engage in cessation. Offering

assistance had limited effect on willingness, indicating that alternative cessation engagement strategies may be needed in the ED setting. These findings reflect self- reported willingness rather than completed Quitline calls, and the lifetime-use screening criterion likely included former users no longer requiring cessation, both of which may affect these engagement estimates.