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Cited by 1,955Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

Physician advice for smoking cessation

Open access
Stead, Lindsay F, Buitrago, Diana, Preciado, Nataly, Sanchez, Guillermo, Hartmann-Boyce, Jamie, Lancaster, Tim·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd000165.pub4PMC PMC7064045
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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.

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Authors
Stead, L. F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J., & Lancaster, T.
Affiliations
  • University of Oxford (GB)
  • Universidad FUCS (CO)
  • Fundación Universitaria de Ciencias de la Salud, University; Research Division; Bogotá Colombia CRA 19 8 A 32
  • University of Oxford; Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2013-05-31
Volume
2013
Issue
5
Pages
CD000165-CD000165
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd000165.pub4
PMC
PMC7064045
OpenAlex
W1821872278
Cited by
1,955
References
202
Citations by year
2026: 32 · 2025: 61 · 2024: 88 · 2023: 84 · 2022: 90 · 2021: 109 · 2020: 94 · 2019: 104 · 2018: 99 · 2017: 107 · 2016: 126 · 2015: 134 · 2014: 104 · 2013: 110 · 2012: 89
FWCI
17.41
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Repositorio Digital de la Fundación Universitaria de Ciencias de la Salud (FUCSALUD) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
smoking cessation, physician recommendations, brief advice, intensive intervention, smoking abstinence, primary care, hospital-based intervention, nicotine replacement therapy, pharmacotherapy, all-cause mortality, disease-specific mortality, tobacco control, smoking cessation aids, bupropion, varenicline
MeSH terms
Smoking Prevention, Humans, Patient Education as Topic, Practice Patterns, Physicians', Physician's Role, Smoking, Randomized Controlled Trials as Topic, Smoking Cessation, Treatment Outcome

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