Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 6;25(5):849-858.
doi: 10.1093/ntr/ntac262.

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Naomi A van Westen-Lagerweij  1   2 , Bethany J Hipple Walters  1   3 , Franziska Potyka  1 , Esther A Croes  1 , Marc C Willemsen  1   2
Affiliations

Proactive Referral to Behavioral Smoking Cessation Programs by Healthcare Staff: A Systematic Review

Naomi A van Westen-Lagerweij et al. Nicotine Tob Res. .

Abstract

Introduction: Behavioral smoking cessation programs are an effective tool for quitting smoking, yet remain underused by smokers. Proactive referral may be a promising strategy for healthcare staff to connect smokers to such programs.

Aims and methods: The aim of this study was to gain insight into the effectiveness and implementability of proactive referral of smokers to behavioral smoking cessation programs by healthcare staff. A systematic review was conducted using five databases. Effectiveness of proactive referral was defined as the proportion of referred smokers who enrolled in a behavioral smoking cessation program. To determine the implementability of proactive referral, measures of feasibility, acceptability, adoption, and referral rates were included as variables of interest. Out of 6686 screened records, 34 articles were eligible for review. A narrative synthesis approach was used.

Results: The majority of the included studies investigated proactive referral within an e-referral system, combined with one or more intervention components that enhance implementation. Overall, proactive referral resulted in higher enrollment rates, especially among low-income smokers, and was found to be feasible, adoptable, and acceptable to healthcare staff. E-referral systems performed better in terms of implementability compared to fax referral systems. About half of the studies were of good quality. Many studies lacked information which resulted in lower-quality scores.

Conclusions: The literature provides evidence that the proactive referral of smokers to behavioral smoking cessation programs by healthcare staff is effective and implementable across different settings. Based on the results, e-referral systems may be preferable to fax referral systems in terms of implementability.

Implications: This systematic review demonstrated that proactive referral has the potential to increase the reach of smoking cessation programs and reduce inequalities in access to such programs. In the selection and implementation of behavioral smoking cessation programs with a proactive referral component, stakeholders (eg, policymakers, healthcare funders, and healthcare professionals) may benefit from taking different aspects of proactive referral systems into account, such as the type of proactive referral system used and additional strategies which can enhance the implementability of the system.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
See this image and copyright information in PMC

References

    1. Reitsma MB, Kendrick PJ, Ababneh E, et al. . Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021;397(10292):2337–2360. - PMC - PubMed
    1. Royal College of Physicians. Hiding in Plain Sight: Treating Tobacco Dependency in the NHS. London: Royal College of Physicians; 2018. https://www.rcplondon.ac.uk/file/23966/download. Accessed September 14, 2022.
    1. U.S. Office on Smoking and Health. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Centers for Disease Control and Prevention; 2006. https://www.ncbi.nlm.nih.gov/books/NBK44324/. Accessed September 14, 2022. - PubMed
    1. Yousuf H, Hofstra M, Tijssen J, et al. . Estimated worldwide mortality attributed to secondhand tobacco smoke exposure, 1990–2016. JAMA Netw Open. 2020;3(3):e201177–e201177. - PMC - PubMed
    1. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf. Accessed September 14, 2022.

Publication types