Background and challenges to implementation:
Studies found that actively referring smokers to smoking cessation (SC) services increased quitting. We compared 2 different intensities of SC active referral for community smokers in Hong Kong.

Intervention or response:
A single-blinded, parallel three-armed cluster randomized controlled trial was conducted among smokers who joined 2016 “Quit-to-Win” Contest organized by the Hong Kong Council on Smoking and Health. Biochemically validated (CO >4ppm) daily smokers were proactively recruited and randomly assigned to onsite SC active referral (Group A) (n= 395), text messaging on promoting and encouraging smokers to attend SC services (Group B) (n=385) and control group on general brief SC advice (Group C) (n=383). Group A and B also received model guided (AWARD) brief SC advice with a warning leaflet and a referral card at baseline and telephone brief advice at 1-month and 2-month. Telephone survey at 3-month (retention rate 63.4%) to assess primary outcome: self-reported 7-day point prevalence abstinence (PPA) and secondary outcomes: smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (CO < 4ppm). Analyses were done by intention to treat.

Results and lessons learnt:
Group A, B and C had self-reported PPA: 14.4%, 13.0% and 8.6% (A vs. C; B vs. C, p<0.05) and validated quit rates: 6.8%, 6.0% and 4.7% (all p>0.05), respectively. Corresponding SRRs were 18.7%, 16.9% and 16.2% (all p>0.05). Compared with Group C, Group A had a higher odds ratio (OR) of 1.65 (95% CI 1.08-2.52) and Group B smokers had a higher OR of 1.56 (95% CI 1.02 - 2.04) for self-reported PPA, adjusting for baseline intention to quit and clustering effect.

Conclusions and key recommendations:
Proactive intervention with AWARD guided brief SC advice and onsite active referral or text messaging may be effective in increasing quitting at 3-month compared with general brief SC advice in community smokers.