Leah Ranney, PhD, MA; Cathy Melvin, PhD, MPH; Linda Lux, MPA; Erin McClain, MA, MPH; Kathleen N. Lohr, PhD
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.
While smoking cessation interventions have been shown to work, questions remain about how to increase their efficacy.
To examine strategies for effective tobacco treatment in adults and special populations.
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).
Systematic reviews; randomized, controlled trials; and observational studies.
Two reviewers independently abstracted data on study design, population, sample size, treatment, outcomes, and quality.
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.
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.
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.
Tobacco use: prevention, cessation, and control article disposition.
KQ = key question. *Two studies counted as one because they used the same sample. †One study addressed both KQ2 and KQ5. One study used adolescents and was excluded from the review.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Ranney L, Melvin C, Lux L, McClain E, Lohr KN. Systematic Review: Smoking Cessation Intervention Strategies for Adults and Adults in Special Populations. Ann Intern Med. 2006;145:845–856. doi: 10.7326/0003-4819-145-11-200612050-00142
Download citation file:
Published: Ann Intern Med. 2006;145(11):845-856.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use