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, currently responsible for killing one in ten adults worldwide. This makes systematic reviews of methods of cessation and prevention of uptake of tobacco important. Cochrane Reviews of interventions for tobacco addiction provide guidance on their effectiveness and are essential for establishing evidence or the lack of it 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 community, institution, and school-based interventions as well as interventions by government policy on population health.
This Special Collection was first published to coincide with World No Tobacco Day 2010, was revised for 2011, and has since been updated for World No Tobacco Day 2012. It highlights a selection of Cochrane Reviews that address tobacco addiction in the general population. The full list of Cochrane Tobacco Addiction Group reviews can be browsed here. Recently updated Cochrane Reviews cover topics including interventions for smoking cessation delivered in the hospital setting, training health professionals in smoking cessation, and nicotine receptor partial agonists (such as varenicline).
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.
Nicotine receptor partial agonists, including varenicline and cytisine, 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 for smoking cessation, and considers the adverse events profile associated with their use. The April 2012 edition of Cochrane Journal Club also discusses nicotine receptor partial agonists for smoking cessation, including a podcast, PowerPoint slides, patient vignette and discussion questions.
The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes. This reduces both 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.
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.
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.
The Internet has become a regular part of daily life for most people in many parts of the world. It now offers an additional means of effecting changes to behaviour such as smoking. This review assesses the effectiveness of Internet-based interventions for smoking cessation and the effectiveness of tailored, interactive Internet-based interventions when compared to static sites.
It may be reasonable to try to reduce the harm from continued tobacco use amongst smokers unable or unwilling to quit. Possible approaches to reduce the exposure to toxins from smoking include reducing the amount of tobacco used and using less toxic products. The interventions evaluated in controlled trials have predominantly attempted to reduce the number of cigarettes smoked. This review assesses the effect of interventions intended to reduce the harm from smoking on the following: biomarkers of damage caused by tobacco; biomarkers of tobacco exposure; number of cigarettes smoked; quitting; and long-term health status.
The mass media have been used as a way of delivering preventive health messages. They have the potential to reach and to modify the knowledge, attitudes and behaviour of a large proportion of the community. This review evaluates the effectiveness of mass media interventions to reduce smoking uptake in young people, in addition to secondary outcomes including improved smoking outcomes, attitudes, behaviours, knowledge, self-efficacy, and perception.
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. It also compares adverse events in studies that use pharmacotherapy to aid reduction.
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.
The transtheoretical model is the most widely known of several stage-based theories of behaviour. It proposes that smokers move through a discrete series of motivational stages before they quit successfully. These are precontemplation (no thoughts of quitting), contemplation (thinking about quitting), preparation (planning to quit in the next 30 days), action (quitting successfully for up to six months), and maintenance (no smoking for more than six months). According to this influential model, interventions which help people to stop smoking should be tailored to their stage of readiness to quit, and are designed to move them forward through subsequent stages to eventual success. People in the preparation and action stages of quitting would require different types of support from those in precontemplation or contemplation. This review tests the evidence for the efficacy and applicability of these assumptions as they apply to smokers trying to quit.
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.
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.
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.
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, examining results by therapist, session duration, number of sessions, and number of follow-up calls.
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 with different intensities and within different settings and populations.
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.
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.
There is good evidence that brief interventions from health professionals can increase smoking cessation attempts. A number of trials have examined whether skills training for health professionals can lead them to have greater success in helping their patients who smoke. This review evaluates the effectiveness of training health care professionals in the delivery of smoking cessation interventions to their patients, and assesses the additional effects of training characteristics such as intervention content, delivery method, and intensity.
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 on sales to minors, self-reported ease of access, and prevalence of tobacco use.
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 the 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.
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.
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 evaluates the effectiveness of interventions aiming to reduce exposure of children to environmental tobacco smoke.
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, addressing: the effect of the interventions on the smoking status of children who reported no tobacco use at baseline; the effect on the smoking behaviour of parents and other family members; and the effect on immediate variables including changes in attitudes.
Most people who stop smoking gain weight. There are some interventions that have been designed to reduce weight gain when stopping smoking. Some smoking cessation interventions may also limit weight gain although their effect on weight has not been reviewed. 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.
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.
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.
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.
Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people. This review evaluates the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people.
Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking interventions may be effective in decreasing this risk. 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.
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, including systematic behavioural interventions, interventions that occur both in hospital and after discharge, and interventions that include pharmacotherapy.
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.
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.
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, including both behavioural and pharmacological interventions.
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.
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.
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.
Image Credit: Saturn Stills/Science Photo Library, M370/851
Date published: 14 June 2010; updated 9 May 2012 and 30 May 2012 with updated Cochrane Reviews
Contact: Cochrane Editorial Unit (firstname.lastname@example.org)