An Analysis of the Effectiveness of Interventions Intended to Help People Stop Smoking

Abstract

In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following personal advice and encouragement to stop smoking given by physicians during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P < .001) of all smokers stopped smoking and did not relapse up to 1 year as a direct consequence of the advice. The effect is modest but cost-effective: the cost of saving a life is about $1500. Supplementary interventions (follow-up letters or visits, demonstration of spirometry, etc) have an additional effect--variable in extent. Advice and encouragement are particularly effective for smokers at special risk--pregnant women (efficacy; 8%) and patients with ischemic heart disease. Behavior modification techniques (relaxation, rewards and punishment, avoiding "trigger" situations, etc), in group or individual sessions led by a psychologist, have an effect that is statistically significant (P = .05) but no greater than simple advice by a physician (2%); yet, these techniques are several times more expensive. The effect of hypnosis is unproved (no trials have used biochemical markers). Nicotine replacement therapy is effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouraged to use nicotine replacement therapy.

Cardiovascular Disease Reduction in the Outpatient Kidney Transplant Clinic

“…Physicians in the clinic caring for transplant recipients with diabetes mellitus should also strive to have A1C measured regularly and direct therapy to control this measure at or below recommended targets (33). In addition to these strategies, repetitive attempts to encourage cessation of smoking with or without adjunctive therapy would also be worthwhile (34)(35)(36).…”

A Randomized Controlled Pilot Trial of the Functional Assessment Screening Tablet to Engage Patients at the Point of Care

“…Brief physician encouragement and counseling increases physical activity 1 and decreases smoking behavior. 2 Similarly, health-related quality of life (HRQoL) can be improved when physicians address conditions that cause impairment. [3][4][5] While there are differences between patient and physician reports of counseling, even during the same encounter, 6 physicians' rates of behavior change counseling for physical inactivity and tobacco use are low, regardless of the reporter and despite the clear need to address such behaviors.…”

Anger and psychobiological changes during smoking abstinence and in response to acute stress: Prediction of smoking relapse

“…Smoking relapse rates remain disturbingly high, with approximately 50% of smokers relapsing within 3 days and 75% within the first 2 weeks (Garvey et al 1992;Law and Tang 1995;Rose 1996). Studies have shown that personality traits (e.g., related to depression and anxiety) may also predict risk for smoking relapse (Hall et al 1993;Hughes et al 1991;Killen and Fortmann 1997).…”