World No Tobacco Day (31 May 2010)
World No Tobacco Day is held each year on 31 May and is organised by the World Health Organization (WHO). The WHO states that tobacco is the second major cause of deaths in the world, with approximately five million people dying from tobacco-related illnesses each year. This makes systematic reviews of methods of cessation and prevention of uptake of tobacco important. Cochrane Reviews into interventions for tobacco addiction provide guidance on their effectiveness and are essential for establishing evidence or the lack thereof for different treatment or prevention techniques.
The Cochrane Tobacco Addiction Group prepares Cochrane Reviews of pharmacotherapy; self-managed behavioural or life-style interventions; help from healthcare professionals for general or special groups; and the effectiveness of complementary therapies. The Group also prepares Cochrane Reviews that evaluate the effects of intervention by government policy on population health.
While the World No Tobacco Day 2010 theme emphasizes marketing to women, the Cochrane Tobacco Addiction Group does not subdivide populations by gender. Therefore this Special Collection for World No Tobacco Day highlights a selection of Cochrane Reviews that address tobacco addiction in the general population. The full list of Cochrane Tobacco Addiction Group can be browsed here.
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Pharmacotherapy interventions
Antidepressants for smoking cessation
There are at least three reasons to believe that antidepressants might help in smoking cessation. Nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode, and antidepressants may relieve these. Nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. Finally, some antidepressants may have a specific effect on neural pathways (e.g. inhibiting monoamine oxidase) or receptors (e.g. blockade of nicotinic-cholinergic receptors) underlying nicotine addiction. This review assesses the effect of antidepressant medications including bupropion and nortriptyline to aid long-term smoking cessation. [Download PDF]
Nicotine receptor partial agonists for smoking cessation
Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). Varenicline was developed as a nicotine-receptor partial agonist from cytisine, a drug widely used for smoking cessation in some eastern and central European countries. The first trial reports of varenicline were released in 2006, and further trials have now been published or are currently under way. This review assesses the efficacy and tolerability of nicotine-receptor partial agonists, including varenicline and cytisine, for smoking cessation. [Download PDF]
Nicotine replacement therapy for smoking cessation
The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes. This reduces the motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. This review determines the effect of NRT compared to placebo in aiding smoking cessation, and considers whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers, and tablets/lozenges) in achieving abstinence from cigarettes. The review also examines whether the effect is influenced by the dosage, form, and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated. [Download PDF]
Behavioural interventions
Biomedical risk assessment as an aid for smoking cessation
A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, such as measurement of exhaled carbon monoxide, lung function, or genetic susceptibility to lung cancer. This review evaluates the efficacy of biomedical risk assessment provided in addition to counselling, as an aid to smoking cessation. [Download PDF]
Competitions and incentives for smoking cessation
Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. This review aims to determine whether competitions and incentives lead to higher long-term quit rates. The review also examines the relationship between incentives and participation rates. [Download PDF]
Reduction versus abrupt cessation in smokers who want to quit
The standard way to stop smoking is to quit abruptly on a designated quit day. A number of smokers have tried unsuccessfully to quit this way. Reducing smoking before quitting could be an alternative approach to cessation. Before this method is adopted it is important to determine whether it is at least as successful as abrupt quitting. This review compares the success of reducing smoking to quit and abrupt quitting interventions. [Download PDF]
Self-help interventions for smoking cessation
Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully. This review evaluates the effectiveness of different forms of self-help materials, compared with no treatment and with other minimal contact strategies; of adjuncts to self-help, such as computer-generated feedback, telephone hotlines and pharmacotherapy; and of approaches tailored to the individual compared with non-tailored materials. [Download PDF]
Relapse prevention interventions for smoking cessation
A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke. This review assesses whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. [Download PDF]
Help from healthcare providers
Group behaviour therapy programmes for smoking cessation
Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. This review compares the effects of smoking cessation programmes delivered in a group format with self-help materials, no intervention or individual counselling; and the effect of adding group therapy to advice from a health professional or to nicotine replacement, compared with these interventions alone. [Download PDF]
Individual behavioural counselling for smoking cessation
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. This review evaluates the effects of individual counselling and examines trials of counselling by a trained therapist providing one or more face-to-face sessions, separate from medical care. [Download PDF]
Motivational interviewing for smoking cessation
Motivational interviewing is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit. The review evaluates the effects of motivational interviewing in promoting smoking cessation. [Download PDF]
Nursing interventions for smoking cessation
Nurses may advise patients to improve their health by stopping smoking. Such advice may be brief or part of more intensive interventions. This review evaluates the effectiveness of nursing-delivered smoking cessation interventions. [Download PDF]
Physician advice for smoking cessation
Physicians may advise patients to improve their health by stopping smoking. This advice may be brief or part of more intensive interventions. This review evaluates the effectiveness of advice from physicians in promoting smoking cessation; compares minimal interventions by physicians with more intensive interventions; assesses the effectiveness of various adjunctive aids to advice in promoting smoking cessation (such as demonstration of expired carbon monoxide or pulmonary function tests, self-help manuals); and determines the effect of anti-smoking advice on disease-specific and all-cause mortality. [Download PDF]
Telephone counselling for smoking cessation
Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. This review evaluates the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. [Download PDF]
Government policy
Interventions for preventing tobacco sales to minors
Laws restricting sales of tobacco products to minors exist in many countries, but young people may still purchase cigarettes easily. This review assesses the effects of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales. [Download PDF]
Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption
Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of second-hand smoke. They also offer the potential to influence social norms and smoking behaviour of those populations they affect. This review assesses the extent to which legislation-based smoking bans or restrictions: reduce exposure to second-hand smoke; help people who smoke to reduce tobacco consumption or reduce smoking prevalence; and affect the health of those in areas which have a ban or restriction in place. [Download PDF]
Interventions based on life style management
Exercise interventions for smoking cessation
Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. This review determines whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. [Download PDF]
Children's exposure to other people's cigarette smoke (environmental tobacco smoke) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to environmental tobacco smoke. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. This review aimed to determine the effectiveness of interventions aiming to reduce exposure of children to environmental tobacco smoke. [Download PDF]
Family-based programmes for preventing smoking by children and adolescents
There is evidence that children's decisions to smoke are influenced by family and friends. This review assesses the effectiveness of interventions to help family members to strengthen non-smoking attitudes and promote non-smoking by children and other family members. [Download PDF]
Interventions for preventing weight gain after smoking cessation
Most people who stop smoking gain weight – on average about 7 kg in the long term. There are some interventions that have been specifically designed to tackle smoking cessation while also limiting weight gain. Many smoking cessation pharmacotherapies and other interventions may also limit weight gain. This review examines: interventions designed specifically to aid smoking cessation and limit post-cessation weight gain; and interventions designed to aid smoking cessation that may also plausibly have an effect on weight. [Download PDF]
Mobile phone-based interventions for smoking cessation
Innovative effective smoking cessation interventions are required to appeal to those who are not accessing traditional cessation services. Mobile phones are widely used and are now well integrated into the daily lives of many, particularly young adults. Mobile phones are a potential medium for the delivery of health programmes such as smoking cessation. This review evaluates whether mobile phone-based interventions are effective at helping people who smoke, to quit. [Download PDF]
Interventions for smokeless tobacco use cessation
Use of smokeless tobacco can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease and cancer. This review assesses the effects of behavioural and pharmacologic interventions for the treatment of smokeless tobacco use. [Download PDF]
Tobacco cessation interventions for young people
Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This review evaluates the effectiveness of strategies that help young people to stop smoking tobacco. [Download PDF]
Interventions for specific groups and environments
Interventions for preoperative smoking cessation
Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. In addition, the preoperative period may be a well-chosen time to offer smoking cessation interventions due to increased patient motivation. This review assesses the effect of preoperative smoking intervention on smoking cessation in the postoperative period and longer term. It also evaluates the effect of smoking cessation on the incidence of postoperative complications. [Download PDF]
School-based programmes for preventing smoking
Smoking rates in adolescents are rising in some countries. Helping young people to avoid starting smoking is a widely endorsed goal of public health, but there is uncertainty about how to do this. Schools provide a route for communicating with a large proportion of young people, and school-based programmes for smoking prevention have been widely developed and evaluated. This review evaluates the use of behavioural interventions in schools to prevent children (aged 5 to 12 years) and adolescents (aged 13 to 18 years) starting smoking. [Download PDF]
Workplace interventions for smoking cessation
The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. This review aims to categorize workplace interventions for smoking cessation, and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption. [Download PDF]
Interventions for smoking cessation and reduction in individuals with schizophrenia
Patients with schizophrenia smoke more heavily than the general population and this contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit or reduce smoking. This review evaluates the benefits and harms of different treatments for nicotine dependence in schizophrenia.
Interventions for smoking cessation in hospitalised patients
An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt. This review determines the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. [Download PDF]
Complementary therapies
Acupuncture and related interventions for smoking cessation
Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms. This review aims to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy, and electrostimulation, in smoking cessation in comparison with no intervention, sham treatment, or other interventions. [Download PDF]
Hypnotherapy for smoking cessation
Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is proposed to act on underlying impulses to weaken the desire to smoke or strengthen the will to stop. This review aims to evaluate the effects of hypnotherapy for smoking cessation. [Download PDF]
