Cited by 171Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

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Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials

Mottillo, Salvatore, Filion, Kristian B., Bélisle, Patrick, Joseph, Lawrence, Gervais, André, O'Loughlin, Jennifer, Paradis, Gilles, Pihl, Robert, Pilote, Louise, Rinfret, Stephane, Tremblay, Michèle, Eisenberg, Mark J.·2009·European Heart Journal

DOI 10.1093/eurheartj/ehn552

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Abstract

AIMS: Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling. METHODS AND RESULTS: We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84-2.78], individual counselling (OR 1.49, 95% CrI 1.08-2.07), group counselling (OR 1.76, 95% CrI 1.11-2.93), and telephone counselling (OR 1.58, 95% CrI 1.15-2.29). CONCLUSION: Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

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BackgroundMethod
Trends in Smoking Among Adults From 1980 to 2009: The Minnesota Heart Survey
Filion, K. B., Steffen, L. M., Duval, S., Jacobs, D. R., BLACKBURN, H. W., & Luepker, R. V. (2011) · American Journal of Public Health · doi:10.2105/ajph.2011.300162 · Cited by 25
Self-citation
Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention
Malbos, É., Borwell, B., Einig-Iscain, M., Korchia, T., Cantalupi, R., Boyer, L., & Lançon, C. (2022) · Psychological Medicine · doi:10.1017/s0033291722002070 · Cited by 24
“The primary measure was the proportion of individuals with maintenance of their tobacco abstinence at the completion of the protocol (Lancaster, Stead, & Cahill, 2008; Mottillo et al., 2009).”
Background
Predictors of Adherence to Behavioral Counseling and Medication Among Female Prisoners Enrolled in a Smoking Cessation Trial
Berg, C. J., Ahluwalia, J. S., & Cropsey, K. L. (2013) · Journal of Correctional Health Care · doi:10.1177/1078345813499307 · Cited by 23
An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement
Williams, J. M., Steinberg, M. L., Kenefake, A., & Burke, M. V. (2016) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000239 · Cited by 23
“, 2008), although the average total duration of group or individual tobacco counseling is rarely more than 15 hours (Mottillo et al., 2009).”
Background
Cognitive-behavioral treatment with behavioral activation for smokers with depressive symptomatology: study protocol of a randomized controlled trial
Becoña, E., Martínez-Vispo, C., Senra, C., López‐Durán, A., Rodríguez‐Cano, R., & del Río, E. F. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1301-7 · Cited by 25
“Previous studies of cognitive behavioral interventions for smoking cessation [20, 33] and studies of cognitive behavioral interventions for smoking cessation with components targeting depressive symptoms [24, 31] suggest that quit rates after treatment may range between 28% and 61.”
Background
Smoking Cessation in Patients With Acute Coronary Syndrome
Franck, C., Filion, K. B., & Eisenberg, M. J. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.01.017 · Cited by 23
Self-citation
Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study
Jawad, A., Patel, D., Brima, N., & Stephenson, J. (2019) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2019.100461 · Cited by 23
“No qualifications 3(10) 3(13) 2(2) 7(3)”
BackgroundInfluential
Finding the Right Match: Mindfulness Training May Potentiate the Therapeutic Effect of Nonjudgment of Inner Experience on Smoking Cessation
Schuman‐Olivier, Z., Hoeppner, B. B., Evins, A. E., & Brewer, J. A. (2014) · Substance Use & Misuse · doi:10.3109/10826084.2014.850254 · Cited by 23
“…MA Address correspondence to: Zev Schuman-Olivier, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; E-mail: zschuman@cha.harvard.edu only about 5% to 20% of smokers remain abstinent 6 months after a cessation attempt (Mottillo et al., 2009).”
Background
Environmental and Genomic Factors as well as Interventions Influencing Smoking Cessation: A Systematic Review of Reviews and a Proposed Working Model
de Viron, S., Malats, N., der Heyden, J. V., Oyen, H. J. V., & Brand, A. M. (2013) · Public Health Genomics · doi:10.1159/000351453 · Cited by 21
Text messaging in smoking cessation: the txt2stop trial
Bennett, D., & Emberson, J. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60882-9 · Cited by 20
Attempting Tobacco Cessation - An Oral Physician's Perspective
Pai, A., & Prasad, S. (2012) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2012.13.10.4973 · Cited by 19
Two brief valid measures of therapeutic alliance in counseling for tobacco dependence
Warlick, C. A., Richter, K. P., Catley, D., Gajewski, B. J., Martin, L. E., & Mussulman, L. M. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.12.010 · Cited by 19
“Counseling is an effective intervention for smoking cessation, increasing the likelihood of quitting by 40–60% compared to minimal support (Mottillo et al., 2008).”
The Therapeutic Potential of Psychedelics in Treating Substance Use Disorders: A Review of Clinical Trials
Hogea, L., Tabugan, D. C., Costea, I., Albai, O., Nussbaum, L. A., Cojocaru, A., Corsaro, L., & Anghel, T. (2025) · Medicina · doi:10.3390/medicina61020278 · Cited by 19
“Additionally, in concordance with older studies, many participants noted that the acute effects of psilocybin, including heightened emotional awareness and introspection, overshadowed any withdrawal symptoms they might have experienced, making it easier to abstain from smoking [77,78].”
Predicting use of assistance when quitting: A longitudinal study of the role of quitting beliefs
Myers, M. G., Strong, D. R., Linke, S., Hofstetter, C. R., & Al‐Delaimy, W. K. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.02.003 · Cited by 18
“Unassisted quitting, where the smoker does not employ any evidence-based treatment, is thus the norm, despite better cessation outcomes when using smoking cessation assistance (Fiore et al., 2008; Mottillo et al., 2009; Piper et al., 2009).”
Background
Multiple-vs Non-or Single-Imputation Based Fuzzy Clustering for Incomplete Longitudinal Behavioral Intervention Data
Zhang, Z., & Fang, H. (2016) · IEEE/ACM Conference on Connected Health: Applications, Systems and Engineering Technologies · doi:10.1109/chase.2016.19 · Cited by 18
Le tabagisme des médecins généralistes a-t-il une influence sur l’abord du tabac en consultation en 2008 ? Enquête auprès de 332 médecins généralistes du Maine-et-Loire
Col, P. D., Baron, C., Guillaumin, C., Bouquet, É., & Fanello, S. (2010) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2010.03.001 · Cited by 18
MIFuzzy clustering for incomplete longitudinal data in smart health
Fang, H. (2017) · Smart Health · doi:10.1016/j.smhl.2017.04.002 · Cited by 18
Stable and momentary psychosocial correlates of everyday smoking: An application of Temporal Self-Regulation Theory
Jones, C. M., & Schüz, B. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00248-4 · Cited by 16
Actitud y eficacia de los cardiólogos frente al tabaquismo de los pacientes tras un síndrome coronario agudo
Cordero, A., Bertoméu, V., Mazón, P., Cosín, J., Galve, E., Lekuona, I., de la Guía-Galipienso, F., & González‐Juanatey, J. R. (2012) · Revista Española de Cardiología · doi:10.1016/j.recesp.2012.03.012 · Cited by 17
Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered Acceptance and Commitment Therapy
Vilardaga, R., Heffner, J. L., Mercer, L. D., & Bricker, J. B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.008 · Cited by 17
“Unfortunately, although there has been considerable innovation in pharmacotherapeutic interventions for smoking cessation over the past 25 years, behavioral interventions have seen little change during this time (Mottillo et al., 2009).”
Background
A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations
Kotsen, C., Santorelli, M. L., Bloom, E. L., Goldstein, A. O., Ripley‐Moffitt, C., Steinberg, M. B., Burke, M. V., & Foulds, J. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty162 · Cited by 17
“Second, Mottillo et al. 16 conducted a meta-analysis of individual, group, and telephone counseling outcomes from 50 RCTs ( N = 26 927) conducted in Europe, North America, and Australia.”
Background
Reporting Treatment Fidelity in Behavioral Tobacco Treatment Clinical Trials: Scoping Review and Measurement Recommendations
Salloum, R. G., Rojewski, A. M., Piper, M. E., Blalock, J. A., Borrelli, B., Boyce, L. M., Minnix, J. A., Dogar, O. F., Tomko, R. L., Jorenby, D. E., et al. (2021) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntab140 · Cited by 15
A bstinence R einforcement T herapy (ART) for rural veterans: Methodology for an mHealth smoking cessation intervention
Wilson, S. M., Hair, L. P., Hertzberg, J. S., Kirby, A. C., Olsen, M. K., Lindquist, J. H., Maciejewski, M. L., Beckham, J. C., & Calhoun, P. S. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.08.008 · Cited by 14
LGBTQ Youth and Young Adult Perspectives on a Culturally Tailored Group Smoking Cessation Program
Baskerville, N. B., Shuh, A., Wong, K., Dash, D., & Abramowicz, A. (2017) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntx011 · Cited by 14
Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country
Figueiró, L. R., Barros, H. M. T., Ferigolo, M., & Dantas, D. C. M. (2017) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2016-0041 · Cited by 13
Multiple Perspectives on Tobacco Use among Youth with Mental Health Disorders and Addictions
Morris, C. D., May, M. G., Devine, K., Smith, S. M., DeHay, T. L., & Mahalik, J. L. (2011) · American Journal of Health Promotion · doi:10.4278/ajhp.100610-qual-179 · Cited by 13
Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit
Batra, A., Petersen, K. U., Hoch, E., Mann, K. F., Kröger, C. B., Schweizer, C., Jähne, A., Rüther, T., Thürauf, N., & Mühlig, S. (2015) · Der Nervenarzt · doi:10.1007/s00115-015-0037-1 · Cited by 13
HIV-related pneumococcal disease prevention in adults
Feldman, C. H., Anderson, R., & Rossouw, T. M. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1289841 · Cited by 12
“Pharmacotherapy, such as nicotine replacement therapy, bupropion, and varenicline, do not seem to have significant interactions with cART [164] and may have additional benefits when combined with behavioral interventions although not all meta-analyses support this view [155,161,165].”
Background
The efficacy and acceptability of pharmacological monotherapies and e-cigarette on smoking cessation: a systemic review and network meta-analysis
Meng, Y., Xiang, S., Qu, L., & Li, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1361186 · Cited by 15
“However, inconsistent effectiveness reported by RCTs and meta-analysis of the above pharmacological therapies is not excellent enough, and the relapse rate remains high (3).”
Background
Intervenciones de consejería para la cesación de la adicción al tabaco: revisión sistemática de la literatura
Alba, L. H., Murillo, R., & Castillo, J. S. (2013) · Salud Pública de México · doi:10.1590/s0036-36342013000200012 · Cited by 10
Feasibility, acceptability and impact of a telephone support service initiated in primary medical care to help Arabic smokers quit
Girgis, S. T., Adily, A., Velasco, M.-J., Zwar, N. A., Jalaludin, B. B., & Ward, J. (2011) · Australian Journal of Primary Health · doi:10.1071/py10066 · Cited by 10
“Further, there is accumulating evidence to suggest that telephone counselling, whether or not initiated by calls to help lines, result in substantial increases in smoking abstinence (Stead et al. 2006; Mottillo et al. 2009).”
Background
A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland
Bartels, C., AbuHaliga, A. R. Y., McGee, H. M., Morgan, K., McElvaney, N. G., & Doyle, F. (2012) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-011-0792-3 · Cited by 10
The effect of a very brief smoking-reduction intervention in smokers who have no intention to quit: study protocol for a randomized controlled trial
Wu, L., He, Y., Jiang, B., Zhang, D., Tian, H., Zuo, F., Lam, T. H., & Cheung, Y. T. D. (2015) · BMC Public Health · doi:10.1186/s12889-015-1749-7 · Cited by 9
“In general, commonly used behavioral intervention categories fall into two categories: brief or minimal interventions and intensive interventions [9].”
Background
Determinants of Smoking Cessation Outcomes and Reasons for Relapse in Patients Admitted to a Smoking Cessation Outpatient Clinic in Turkey
Acar, T., Gallagher, C., Gören, Y., Erbas, B., & Özkara, A. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21030310 · Cited by 9
“Accordingly, the importance of cognitive behavioral therapy in quitting smoking was found to be high in our study, similar to previous studies [41,42].”
BackgroundResult
Smoking Cessation Strategies After Acute Coronary Syndrome
Nazir, A., Ujjar, S. S., Seddiki, M., Jheinga, M., & Fan, L. M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14041388 · Cited by 9
“A meta-analysis of four RCTs showed that intensive behavioural therapy resulted in better smoking cessation [21].”
Harm reduction in tobacco control: where do we draw the line?
Al‐Hamdani, M., & Manly, E. (2022) · Journal of Public Health Policy · doi:10.1057/s41271-021-00327-5 · Cited by 9
An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk
Salisbury, C., O’Cathain, A., Thomas, C., Edwards, L., Montgomery, A. A., Hollinghurst, S. P., Large, S., Nicholl, J. P., Pope, C. J., Rogers, A. E., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05010 · Cited by 9
Reflexive reaction to feelings predicts failed smoking cessation better than does lack of general self-control.
Hooper, M. W., & Carver, C. S. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000109 · Cited by 9
“Among the best approaches for smoking cessation is CBT with adjuvant pharmacotherapy (Fiore et al., 2008; Lemmens, Oenema, Knut, & Brug, 2008; Moore et al., 2009; Mottillo et al., 2009; Webb, 2008).”
Background
The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome
Kim, B. S., Lim, Y., Shin, J., Kim, S. H., Roh, S., Choi, Y. W., Shin, J., Park, J., & Kim, K.-S. (2019) · Global Heart · doi:10.1016/j.gheart.2019.04.001 · Cited by 9
“There are several well-known smoking cessation treatments, including behavioral and pharmacological treatment [7,8].”
Background
Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals
Tseng, T., Celestin, M. D., Yu, Q., Li, M., Luo, T., & Moody‐Thomas, S. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.712635 · Cited by 8
“A 2009 meta-analysis found that intensive interventions such as behavioral group counseling were more likely to promote smoking cessation compared to controls (10).”
Background

Authors: Mottillo, S., Filion, K. B., Bélisle, P., Joseph, L., Gervais, A., O'Loughlin, J., Paradis, G., Pihl, R., Pilote, L., Rinfret, S., Tremblay, M., & Eisenberg, M. J.
Affiliations: Jewish General Hospital (CA)
McGill University Health Centre (CA)
McGill University (CA)
Corresponding author: Eisenberg, Mark J.
ORCID: Filion, Kristian B.
Bélisle, Patrick
Joseph, Lawrence
Paradis, Gilles
Pilote, Louise
Eisenberg, Mark J.
Venue: European Heart Journal
Publisher: Oxford University Press (OUP)
Published: 2008-12-24
Volume: 30
Issue: 6
Pages: 718-730
ISSN: 0195-668X (ISSN-L)
1522-9645
DOI: 10.1093/eurheartj/ehn552
OpenAlex: W2025716661
Cited by: 171
References: 78
Citations by year: 2026: 4 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 14 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 10 · 2017: 11 · 2016: 9 · 2015: 18 · 2014: 13 · 2013: 19 · 2012: 14
FWCI: 1.04
Type: journal article
Language: en
Open access: closed
Locations: European Heart Journal (publishedVersion)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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, behavioral interventions, brief advice, individual counseling, group counseling, telephone counseling, smoking abstinence, treatment efficacy
MeSH terms: Smoking Prevention, Behavior Therapy, Female, Humans, Male, United States, Randomized Controlled Trials as Topic, Smoking Cessation

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Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials

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