Smoking: helping people stop and stopping them from starting

adviceSmoking, with its enormous implications for health, is a high profile health topic, and the spotlight is firmly on it this month as the Department of Health’s ‘Stoptober’ smoking cessation campaign continues. Sir Richard Peto, giving the Harveian Oration, Halving premature death, at the Royal College of Physicians on Thursday, named smoking as one of the “four corpsemen of the Apocalypse”, along with alcohol, obesity and HIV.

The Cochrane Tobacco Addiction Group, based here in Oxford, has published two new reviews on smoking cessation in the latest issue of the Cochrane Library. The first looks at whether combining behavioural approaches, such as counselling, with medication helps people stop smoking, and which seem to be the best combinations.  Medication included varenicline, buproprion and nicotine replacement therapies. The review includes 41 studies with over 20,000 people. One trial had almost 6000 participants and because the treatment programme was not typical it was dealt with separately from the other studies.

What did they find?

  • Combining medication and behavioural support was more effective in helping people quit smoking than brief advice or other minimal support such as self-help materials
  • Studies where most people used the treatments that were offered provide some evidence that increasing the amount of contact time or the number of sessions made interventions more effective. When all studies are considered, there is no clear evidence that increased contact time was beneficial and only weak evidence that offering more sessions was more effective
  • The large study of an unusually intensive intervention (including extended availability of nicotine gum, multiple groups sessions and long term contact) found this approach to be very effective.

How good is the evidence?

The authors judge the evidence to be good overall. They note that the results are largely consistent, even though the trials took place in a wide range of settings, with different people providing the care and amongst very different groups of smokers.

The bottom line?

Using a combination of medication and behavioural support might typically increase the chances of a smoker successfully quitting by 70% to 100% compared to their chance of success with just brief advice or support.

Currently, few smokers use combined support when attempting to quit.  The authors suggest that clinicians should encourage smokers to use both types of aid.

You can listen to author Lindsay Stead talking about the review in a podcast; click on the link below.

Links:

Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub2

Cochrane summary and podcast: http://summaries.cochrane.org/CD008286/does-a-combination-of-smoking-cessation-medication-and-behavioural-support-help-smokers-to-stop

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