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5 December 2006 | Volume 145 Issue 11 | Pages 845-856
Background: While smoking cessation interventions have been shown to work, questions remain about how to increase their efficacy.
Purpose: To examine strategies for effective tobacco treatment in adults and special populations.
Data Sources: MEDLINE, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane Library, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts (1 January 1980 to 10 June 2005).
Study Selection: Systematic reviews; randomized, controlled trials; and observational studies.
Data Extraction: Two reviewers independently abstracted data on study design, population, sample size, treatment, outcomes, and quality.
Data Synthesis: Findings from systematic reviews were summarized and compared with findings from original research published beyond date ranges included in the reviews. Strength of evidence was used to assess the body of evidence. Our review included studies evaluating the efficacy of cessation strategies, such as self-help, counseling, single pharmaceutical agents, combined pharmacotherapies, and pharmacotherapies combined with psychological counseling. Research findings consistent with previous reviews show that self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve rates of success with quit attempts. Two studies of self-help materials reported discrepancies across effects. Five studies provided mixed results for counseling interventions. Fourteen studies provided sufficient evidence of the efficacy of single pharmacotherapy, combined pharmacotherapy, and psychological interventions either with or without pharmacotherapy.
Few studies focused on ways to reach or treat special populations. Three studies with hospitalized patients had findings consistent with a previous review showing no strong evidence that clinical diagnosis affected the likelihood of quitting. New evidence was insufficient to address the effectiveness of interventions for persons with coexisting psychiatric conditions and substance abuse problems.
Limitations: Previous systematic reviews variably cover the range of issues we addressed. More recent studies do not fill all gaps, especially those for persons with coexisting disease.
Conclusions: Although self-help strategies alone marginally affect quit rates, individual and combined pharmacotherapies and counseling either alone or in combination can significantly increase cessation. Using effective smoking treatments is strongly encouraged for all populations, especially those with high and heavy rates of smoking, such as psychiatric and substance abuse populations.
Author and Article Information
From Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, and RTI International, Research Triangle Park, North Carolina.
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
Acknowledgments: The authors thank their colleagues from the University of North Carolina at Chapel Hill: Gerald Gartlehner, MD, MPH, for clinical and methods assistance; Lynn Whitener, DrPH, MSLS, for information services; and Patricia Thieda and Laura Morgan, BA, for research assistance. They also thank colleagues from RTI International: Tammeka Swinson, BA, for research assistance and project management and Loraine Monroe for word processing.
Grant Support: By a contract from the Agency for Healthcare Research and Quality to the RTI International-University of North Carolina Evidence-based Practice Center (contract 290-02-0016).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Leah M. Ranney, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Boulevard, Chapel Hill, NC 27599.
Current Author Addresses: Drs. Ranney, Melvin, and McClain: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Boulevard, Chapel Hill, NC 27599.
Ms. Lux and Dr. Lohr: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709. NIH CONFERENCE
Systematic Review: Smoking Cessation Intervention Strategies for Adults and Adults in Special Populations
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