Behavioural interventions for smoking cessation: A meta-analysis of randomized controlled trials

Division of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite A-118, Montreal, Quebec, Canada.
European Heart Journal (Impact Factor: 15.2). 03/2009; 30(6):718-30. DOI: 10.1093/eurheartj/ehn552
Source: PubMed


Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling.
We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84-2.78], individual counselling (OR 1.49, 95% CrI 1.08-2.07), group counselling (OR 1.76, 95% CrI 1.11-2.93), and telephone counselling (OR 1.58, 95% CrI 1.15-2.29).
Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

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    • "These results should be interpreted with caution, as researchers and participants were not blind to drug treatment conditions, and no control group was employed. However, it is noteworthy that the most successful current treatments for smoking cessation generally show far less efficacy, with typical abstinence rates below 35% at 6 months [23] [24]. "
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    • "The use of interventions for modification of health-related behaviors is advocated in the search for smoking cessation [12]. A meta-analysis has demonstrated the efficacy of intensive behavioral interventions in encouraging smoking cessation, with odds ratios (ORs) of 1.49 (95%CI 1.08 -2.07) for individual counseling, 1.76 (95%CI 1.11 -2.93) for group counseling, and 1.58 (95%CI 1.15 -2.29) for telephone counseling; all were associated with superior rates of smoking cessation as compared with a control group [13]. Another meta-analysis found that nurse-led interventions were significantly more effective in encouraging smoking cessation (OR 1.43, 95%CI 1.24 -1.66) than a control group. "
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