Study Details Study Design Outcome measures Main findings Results Evidence Grading Include/ Exclude NICE, 2008 Smoking cessation services Smoking Cessation Whole population Systematic Review Not specified – smoking cessation There are an extensive number of recommendation in this guideline, this is a summary of the recommendations (refer to full guidance for detail) NHS Stop Smoking Services should be Based on an understanding of local population of smokers including those from minority ethnic and socially disadvantaged groups Have adequate staffing and a full time Have realistic performance targets relating to uptake and cessation rates or at least 5% of smokers per year and 35% quit rates at 4 weeks validated by CO monitoring The guidance is based on a series of evidence reviews and evidence statements – refer to the Full guideline and NICE website for details ++ Include
Review and reduce barriers to access Provide information, inc to those who opt out Provide evidence based interventions e.g. CBT, MI and structured self help support Use NRT and other pharmacological support Take steps to reduce barriers to access by disadvantaged pregnant smokers Offer multi-component interventions to partners Ensure all those engaged in providing support are appropriately trained et al 2012 Combined behavioural and pharma interventions Smoking Cessation Systematic Review Smoking Cessation minimum 6 months FUP Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care. Further trials would be unlikely to change this conclusion. We did not find strong evidence from indirect comparisons that offering more intensive behavioural support was associated with 41 studies more than 20,000 participants. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, 4-8 sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. One large study contributed heterogeneity due to a substantially larger treatment ++ Include Trial,
Smoking Cessation Adults individual counselling. There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included. Bryant,J. et al, 2011. Behavioural smoking cessation interventions in selected groups. Smoking Cessation Adults Systematic Review Abstinence rates at short-term (< 3 months) and long-term (6 months or the longest) follow-up. There is some evidence of effective interventions in the short term with low income female smokers and in the longer term with individuals with mental illness. Thirty-two relevant studies were included. The majority (n=20) were of low quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at female smokers at follow-up [RR 1.68, CI 1.21-2.33] behavioural support interventions targeted at individuals with a mental illness at long-term follow-up (RR 1.35, CI 1.01-1.81). Results of the narrative review showed several promising interventions that increased cessation at 6-month or longer follow-up. +/- Grimshaw G, et al, 2010 Systematic Review Primary: change in smoking behaviour There is insufficient evidence to recommend an approach. Complex approaches show promise, especially those incorporating elements 24 trials involving over 5000 young people met inclusion criteria (11 cluster-RCTs, 11 RCTs and 2 CTs). 0 Include
What makes for an effective stop smoking service? Smoking Cessation specialist smoking cessation services the target quit date, CO verified support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options. The most effective of intervention are uncommon, many services do not offer the optimal options. Smokers using the more successful intervention options tend to be more dependent, so higher success rates are unlikely to be due to an ‘easier’ clientele. success rates, adjusting for key smoker characteristics. There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99). Coleman T et al ,2010 Relapse prevention in UK Stop Smoking Services: smokers recently quit Qualitative research with 16 health from SSS, systematic review and economic analyses Long term cessation on the totality of evidence, RPIs are expected to be effective and cost-effective if incorporated into routine treatment within the NHS SSS. While staff within the NHS SSS were largely favourably inclined towards providing RPIs, guidance would be needed to Qualitative research indicated that there was no shared understanding of what relapse prevention meant or the kinds of interventions that should be used. ‘Self-help’ behavioural interventions delivered to abstainers who had achieved abstinence unaided were effective for preventing relapse + Include
were performed encourage the adoption of the most effective RPIs, as incentives that focused on the importance of sustaining quit attempts beyond the currently monitored 4-week targets. to smoking at long term [OR 1.52, 95% CI 1.15 to 2.01]. pharmacotherapy’s were also effective as RPIs after their successful use as cessation treatments: bupropion at long term follow-up (pooled OR 1.49, 95% CI 1.10 to 2.01); NRT at medium- (pooled OR 1.56, 95% CI 1.16 to 2.11) and long-term follow-ups (pooled OR 1.33, 95% CI 1.08 to 1.63) and one of varenicline also indicated effectiveness. Thomsen et al, 2010 Interventions for preoperative smoking cessation Working age adults Systematic review Smoking at the time of surgery, 12 months and post operative complications is evidence that preoperative smoking interventions including NRT increase short-term smoking cessation and may reduce postoperative morbidity. The optimal preoperative intervention intensity remains unknown. Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling, and use NRT are more likely to have an impact on complications 8 trials, 1156 people met the inclusion criteria.. 2 face to face intensive; 6 brief intervention. NRT offered or recommended to some or all participants in 7 trials. 5 trials detected significantly increased smoking cessation at the time of surgery, and one approached significance. Subgroup analyses showed that both intensive and intervention significantly increased smoking cessation at the time of surgery; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) + Include up
significant effect (RR 0.96 (95% CI 0.74 to 1.25) for any complication, RR 0.99 (95% CI 0.70 to 1.40) for wound complications). J et al, 2009 Interventions in Pregnancy Smoking Cessation Prenatal, maternal health and early years Systematic Review Smoking Behaviour and Perinatal Outcomes Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported 72 trials are included. 56 RCTs (over 20,000 pregnant women) and 9 cluster-RCTs (over 5000 pregnant women) provided data on smoking cessation outcomes. Significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I2 > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I2 = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse. Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and + Include
• given a follow-up appointment • counselled • materials • offered nicotine therapy • prescribed a quit date, and • cost effectiveness for interventions smoking cessation than untrained controls, 2006 Brief for Smoking Cessation Smoking Cessation Whole population Systematic Review Not specified – smoking cessation In summary: Everyone who should be advised to quit People who smoke should be asked how interested they are in quitting and given advice tailored to their circumstances GPs and Nurses in Primary Care and other health professionals should advise all patients who smoke to quit and provide referral to an intensive support service; provide pharmacotherapy Level 1+ evidence directly applicable to UK health care settings supports the efficacy of physician advice as a BI for smoking cessation Level 1+ evidence directly applicable to UK settings supports the efficacy of nurse structured advice as BI for smoking cessation (in the studies the contact was opportunistic and studies report poor uptake). Insufficient evidence to indicate whether opportunistic advice increases quit rates ++ Include help
costs per additional quitter ranging from $119 to $6450. T and Stead, LF, 2005. Self-help interventions e.g. written materials, or videotape or computer programmes Smoking Cessation population Systematic Review Sustained abstinence, or two-point prevalence Standard self-help materials may increase quit compared to no intervention, but the effect is small. There is evidence that materials that are tailored for individual smokers are more effective than untailored materials, although the absolute size of effect is still small. 68 trials were identified, 34 compared self-help materials to no intervention or tested materials used in addition to advice. In 12 trials in which self was compared to no intervention (N = 15,711;RR 1.21; 95% CI 1.05 to 1.39). There was no evidence of benefit from adding self-help materials to face-to-face advice, or to nicotine replacement therapy. 25 trials using materials tailored for the characteristics of individual smokers, (N = 28,189; RR 1.31; 95% CI 1.20 to 1.42, I² = 19%). +/- Exclude - relevance K et al, 2011 Competitions and incentives for smoking cessation. Smoking Cessation Systematic Review Cessation rates, point prevalence and sustained abstinence, for a minimum of 6 months from start of the intervention, whether With the exception of one recent trial, incentives and competitions have not been shown to enhance long-term cessation rates. Early success tended to dissipate when the rewards were no longer offered. Seventeen studies were included. None of the studies demonstrated significantly higher quit rates for the incentives group than for the control group beyond the 6 month assessment. There was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that different types of +/- Exclude Relevance
Adults or not they are biochemically validated incentives were more or less effective. There is some evidence that, recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. M et al, 2010 interventions Smoking Cessation Whole Population Systematic Review Primary Smoking cessation at least 6 months after the start of the intervention User satisfaction There is a small number of studies which provide very limited evidence of long-term benefits for programmes delivered only by the Internet compared to controls. There is some evidence that tailored Internet interventions are more effective than interventions. Internet intervention v non-internet comparison, 4/9 trials reported positive effect for intervention at longest follow up; 2/6 studies reported positive effect at term follow up. Comparison of different internet interventions, 1/6 studies demonstrated positive effect for intervention at longest follow up; 2/8 studies demonstrated positive effect at short term follow up. Meta-analysis of tailored v non tailored/non internet interventions, 10 studies, RR 1.25 (1.18 – 1.34) at term follow up and 8 studies, RR 1.22 (1.08 – 1.38) short term follow up. +/- Exclude Relevance R, et al ,2009 Systematic Review Smoking abstinence at >6months The current evidence shows no effect of mobile smoking cessation Four trials (reported in five papers) are included: - Exclude Relevance
economic evaluations showing cost-benefits as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation economic evaluations showing cost-benefits as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation showing cost-benefits as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation showing mixed evidence of cost-benefits as appraised by Drummond et al’s 2005 Checklist for a sound economic evaluation intervention was not cost-benefits as appraised by Drummond et al’s Checklist for a sound economic evaluation