A Cochrane review [Abstract] 1 included 42 studies with a total of over 31 000 smokers. The most common setting for delivery of advice was primary care. Pooled data from 17 trials of brief advice versus no advice (or usual care) revealed a small but significant increase in the odds of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56; 15 trials, n=9775), in high risk populations this effect of intensive advice was stronger (RR 1.65, 95% CI 1.35 to 2.03; 5 trials, n=3773). Direct comparison also suggested a small benefit of follow-up visits in 12 months follow-up: With-in trial comparison with follow-up vs. single visit (RR 1.52, 95% CI 1.08 to 2.14; 5 trials, n=1254) and subgroup of interventions including multiple visits ( RR 2.22, 95% CI 1.84 to 2.68; 6 trials, n=4511). In one study, no significant differences in death rates at 20 years follow-up was.
Another Cochrane review [Abstract] 3 included 83 studies with a total of over 29 000 participants. Studies were pooled to compare more versus less support. There was a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was a statistically significant benefit from additional support (RR 1.15, 95% CI 1.08 to 1.22; 65 trials, n=23 331, I²=8%) for abstinence at longest follow-up, and this effect was not different when we compared subgroups by type of pharmacotherapy or intensity of contact. Increasing the amount of behavioural support increased the chance of success by about 10% to 20%. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43; n=4018, I²=20%). 17 studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed.
A review and meta-analysis 4 included 19488 smoking subjects. The combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings.
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