Physician advice for smoking cessation
Background Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. Objectives The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; t...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2013-05, Vol.2013 (5), p.CD000165-CD000165 |
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| creator | Stead, Lindsay F Buitrago, Diana Preciado, Nataly Sanchez, Guillermo Hartmann‐Boyce, Jamie Lancaster, Tim Stead, Lindsay F |
| description | Background
Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives
The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality.
Search methods
We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013.
Selection criteria
Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided.
Data collection and analysis
We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow‐up.
The main outcome measure was abstinence from smoking after at least six months follow‐up. We also considered the effect of advice on mortality where long‐term follow‐up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow‐up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta‐analysis using a Mantel‐Haenszel fixed‐effect model.
Main results
We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.
Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (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 |
| doi_str_mv | 10.1002/14651858.CD000165.pub4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7064045</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1364708575</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5264-87d5db484bcb8039fea2986547ff99b4ae3f7d29a282ae74b17d23846c1f7e633</originalsourceid><addsrcrecordid>eNqFUMtOwzAQtBCIlsIvVDkhLil-27kgQXlKleAAZ8tx7NaQxCVui_r3JGqLChdOu6uZndkdAIYIjhCE-BJRzpBkcjS-hRAizkbzZU4PQL8D0g453Ot74CTGdwgJz7A4Bj1MBJacoD44f5mtozde14kuVt7YxIUmiVX48PU0MTZGvfChPgVHTpfRnm3rALzd372OH9PJ88PT-HqSGoY5TaUoWJFTSXOTS0gyZzXOJGdUOJdlOdWWOFHgTGOJtRU0R-1EJOUGOWE5IQNwtdFtv6lsYWy9aHSp5o2vdLNWQXv1G6n9TE3DSgnIKaSsFbjYCjThc2njQlU-GluWurZhGRUinAoomeiofEM1TYixse7HBkHVhax2IatdyJ05bReH-0f-rO1SbQk3G8KXL-1amWBmTev_j-4fl288LoyR</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1364708575</pqid></control><display><type>article</type><title>Physician advice for smoking cessation</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Stead, Lindsay F ; Buitrago, Diana ; Preciado, Nataly ; Sanchez, Guillermo ; Hartmann‐Boyce, Jamie ; Lancaster, Tim ; Stead, Lindsay F</creator><creatorcontrib>Stead, Lindsay F ; Buitrago, Diana ; Preciado, Nataly ; Sanchez, Guillermo ; Hartmann‐Boyce, Jamie ; Lancaster, Tim ; Stead, Lindsay F</creatorcontrib><description>Background
Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives
The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality.
Search methods
We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013.
Selection criteria
Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided.
Data collection and analysis
We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow‐up.
The main outcome measure was abstinence from smoking after at least six months follow‐up. We also considered the effect of advice on mortality where long‐term follow‐up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow‐up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta‐analysis using a Mantel‐Haenszel fixed‐effect model.
Main results
We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.
Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (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). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow‐up.
Authors' conclusions
Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD000165.pub4</identifier><identifier>PMID: 23728631</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Behavioural therapy ; By treatment provider ; By treatment type ; Humans ; Interventions by specific providers ; Interventions to help smokers and other tobacco users to quit ; Lungs & airways ; Medicine General & Introductory Medical Sciences ; Patient Education as Topic ; Physician's Role ; Practice Patterns, Physicians ; Psychological approaches ; Randomized Controlled Trials as Topic ; Smoking ; Smoking - mortality ; Smoking Cessation ; Smoking Prevention ; Tobacco ; Tobacco, drugs & alcohol ; Treatment Outcome</subject><ispartof>Cochrane database of systematic reviews, 2013-05, Vol.2013 (5), p.CD000165-CD000165</ispartof><rights>Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5264-87d5db484bcb8039fea2986547ff99b4ae3f7d29a282ae74b17d23846c1f7e633</citedby><cites>FETCH-LOGICAL-c5264-87d5db484bcb8039fea2986547ff99b4ae3f7d29a282ae74b17d23846c1f7e633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23728631$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stead, Lindsay F</creatorcontrib><creatorcontrib>Buitrago, Diana</creatorcontrib><creatorcontrib>Preciado, Nataly</creatorcontrib><creatorcontrib>Sanchez, Guillermo</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><creatorcontrib>Lancaster, Tim</creatorcontrib><creatorcontrib>Stead, Lindsay F</creatorcontrib><title>Physician advice for smoking cessation</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives
The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality.
Search methods
We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013.
Selection criteria
Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided.
Data collection and analysis
We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow‐up.
The main outcome measure was abstinence from smoking after at least six months follow‐up. We also considered the effect of advice on mortality where long‐term follow‐up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow‐up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta‐analysis using a Mantel‐Haenszel fixed‐effect model.
Main results
We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.
Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (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). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow‐up.
Authors' conclusions
Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.</description><subject>Behavioural therapy</subject><subject>By treatment provider</subject><subject>By treatment type</subject><subject>Humans</subject><subject>Interventions by specific providers</subject><subject>Interventions to help smokers and other tobacco users to quit</subject><subject>Lungs & airways</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Patient Education as Topic</subject><subject>Physician's Role</subject><subject>Practice Patterns, Physicians</subject><subject>Psychological approaches</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Smoking</subject><subject>Smoking - mortality</subject><subject>Smoking Cessation</subject><subject>Smoking Prevention</subject><subject>Tobacco</subject><subject>Tobacco, drugs & alcohol</subject><subject>Treatment Outcome</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUMtOwzAQtBCIlsIvVDkhLil-27kgQXlKleAAZ8tx7NaQxCVui_r3JGqLChdOu6uZndkdAIYIjhCE-BJRzpBkcjS-hRAizkbzZU4PQL8D0g453Ot74CTGdwgJz7A4Bj1MBJacoD44f5mtozde14kuVt7YxIUmiVX48PU0MTZGvfChPgVHTpfRnm3rALzd372OH9PJ88PT-HqSGoY5TaUoWJFTSXOTS0gyZzXOJGdUOJdlOdWWOFHgTGOJtRU0R-1EJOUGOWE5IQNwtdFtv6lsYWy9aHSp5o2vdLNWQXv1G6n9TE3DSgnIKaSsFbjYCjThc2njQlU-GluWurZhGRUinAoomeiofEM1TYixse7HBkHVhax2IatdyJ05bReH-0f-rO1SbQk3G8KXL-1amWBmTev_j-4fl288LoyR</recordid><startdate>20130531</startdate><enddate>20130531</enddate><creator>Stead, Lindsay F</creator><creator>Buitrago, Diana</creator><creator>Preciado, Nataly</creator><creator>Sanchez, Guillermo</creator><creator>Hartmann‐Boyce, Jamie</creator><creator>Lancaster, Tim</creator><creator>Stead, Lindsay F</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130531</creationdate><title>Physician advice for smoking cessation</title><author>Stead, Lindsay F ; Buitrago, Diana ; Preciado, Nataly ; Sanchez, Guillermo ; Hartmann‐Boyce, Jamie ; Lancaster, Tim ; Stead, Lindsay F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5264-87d5db484bcb8039fea2986547ff99b4ae3f7d29a282ae74b17d23846c1f7e633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Behavioural therapy</topic><topic>By treatment provider</topic><topic>By treatment type</topic><topic>Humans</topic><topic>Interventions by specific providers</topic><topic>Interventions to help smokers and other tobacco users to quit</topic><topic>Lungs & airways</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Patient Education as Topic</topic><topic>Physician's Role</topic><topic>Practice Patterns, Physicians</topic><topic>Psychological approaches</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Smoking</topic><topic>Smoking - mortality</topic><topic>Smoking Cessation</topic><topic>Smoking Prevention</topic><topic>Tobacco</topic><topic>Tobacco, drugs & alcohol</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stead, Lindsay F</creatorcontrib><creatorcontrib>Buitrago, Diana</creatorcontrib><creatorcontrib>Preciado, Nataly</creatorcontrib><creatorcontrib>Sanchez, Guillermo</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><creatorcontrib>Lancaster, Tim</creatorcontrib><creatorcontrib>Stead, Lindsay F</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stead, Lindsay F</au><au>Buitrago, Diana</au><au>Preciado, Nataly</au><au>Sanchez, Guillermo</au><au>Hartmann‐Boyce, Jamie</au><au>Lancaster, Tim</au><au>Stead, Lindsay F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Physician advice for smoking cessation</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2013-05-31</date><risdate>2013</risdate><volume>2013</volume><issue>5</issue><spage>CD000165</spage><epage>CD000165</epage><pages>CD000165-CD000165</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives
The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality.
Search methods
We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013.
Selection criteria
Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided.
Data collection and analysis
We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow‐up.
The main outcome measure was abstinence from smoking after at least six months follow‐up. We also considered the effect of advice on mortality where long‐term follow‐up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow‐up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta‐analysis using a Mantel‐Haenszel fixed‐effect model.
Main results
We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.
Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (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). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow‐up.
Authors' conclusions
Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>23728631</pmid><doi>10.1002/14651858.CD000165.pub4</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2013-05, Vol.2013 (5), p.CD000165-CD000165 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Cochrane Library |
| subjects | Behavioural therapy By treatment provider By treatment type Humans Interventions by specific providers Interventions to help smokers and other tobacco users to quit Lungs & airways Medicine General & Introductory Medical Sciences Patient Education as Topic Physician's Role Practice Patterns, Physicians Psychological approaches Randomized Controlled Trials as Topic Smoking Smoking - mortality Smoking Cessation Smoking Prevention Tobacco Tobacco, drugs & alcohol Treatment Outcome |
| title | Physician advice for smoking cessation |
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