Smoking cessation intervention programs

Additional file 7: Cochrane risk of bias tool. DOCX 29 kb. DOCX 26 kb. Additional file 9: Stakeholder feedback. DOCX 34 kb. Abstract Background Tobacco smoking is the leading cause of cancer, preventable death, and disability. Methods The evidence review will consist of two stages. Discussion The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults.

Electronic supplementary material The online version of this article Stop smoking interventions Approved pharmacotherapies Nicotine replacement therapy NRT and cytisine are available over-the-counter while varenicline and bupropion are available by prescription [ 32 ].

Electronic cigarettes Electronic cigarettes, also known as e-cigarettes, electronic nicotine or non-nicotine delivery systems, or vaporizers, represent another potential intervention strategy by which individuals employ behaviour substitution in their efforts to quit smoking.

Behavioural therapies There are various behavioural interventions used for tobacco cessation. Exercise Some therapies, such as exercise-based interventions, have been used alone or as adjuncts to other interventions.

Alternative therapies Alternative therapies for smoking cessation include hypnosis, acupuncture including acupressure and electrostimulation , and laser therapy [ 59 , 61 ]. Objective and key questions The goal of this evidence review is to determine the effectiveness of stop smoking strategies for adults. Stage 1: Overview of systematic reviews of stop smoking interventions The overview will evaluate the benefits and harms of stop smoking interventions among adults.

Open in a separate window. Stage 2: Updated systematic review on e-cigarette use for smoking cessation This update will evaluate the benefit and harms of e-cigarettes to promote cessation of tobacco smoking among adults. Stage 1: Overview of systematic reviews of stop smoking interventions Guidelines for the conduct of overviews of reviews are currently lacking [ 79 ]. Literature search The search strategy will be developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team.

Eligibility criteria KQ1a and KQ1b will examine interventions that can be delivered or referred to in the primary care setting. Table 1 Inclusion and exclusion criteria for key question 1a and 1b. The overview of reviews will seek information on the effects of variations in the delivery of stop smoking interventions e. Nicobrevin, Nicobloc, nicotine vaccines, mecamylamine Broader public health interventions e.

It was also decided that this outcome is most important for KQ1b h Although initially rated as being of limited importance by the WG, based on discussions with WG members, it was decided that this outcome should be considered as important. Clinical experts and patients rated this outcome as important i Reviews will be considered systematic if they meet the four following criteria: 1 searches at least one database, 2 reports their selection criteria, 3 conducts quality or risk of bias assessment on included studies, and 4 provides a list and synthesis of included studies j Overviews will included if they meet the following criteria: 1 search at least one database, 2 report their selection criteria and how they will handle the inclusion of overlapping reviews, 3 provide information on the quality or risk of bias assessment of studies included in reviews, 4 provide a list of relevant reviews, 5 report the synthesized evidence from the included reviews, and 6 explicit declaration that the decision to undertake the network meta-analysis was made with firsthand knowledge of the primary studies, to ensure appropriateness of the analysis.

Table 2 Inclusion and exclusion criteria for Key Question 1c. We will seek information on intervention characteristics which may moderate the effectiveness of behavioural change techniques e.

Clinical experts and patients rated this outcome as important e Reviews will be considered systematic if they meet the four following criteria: 1 searches at least one database, 2 reports their selection criteria, 3 conducts quality or risk of bias assessment on included studies, and 4 provides a list and synthesis of included studies 6 Overviews will included if they meet the following criteria: 1 search at least one database, 2 report their selection criteria and how they will handle the inclusion of overlapping reviews, 3 provide information on the quality or risk of bias assessment of studies included in reviews, 4 provide a list of relevant reviews, 5 report the synthesized evidence from the included reviews, and 6 explicit declaration that the decision to undertake the network meta-analysis was made with firsthand knowledge of the primary studies, to ensure appropriateness of the analysis.

Study selection Duplicates will be identified and removed using Reference Manager [ 91 ]. Data mapping and overlap detection Given the proliferation of systematic reviews [ 81 ], we anticipate that we will encounter multiple systematic reviews covering the same research question i.

Quality assessment of systematic reviews The methodological quality of reviews will be evaluated according to the AMSTAR 2 instrument Additional file 3. Data extraction and management Data extraction forms will be developed a priori in DistillerSR and pilot tested on a sample of studies to adjust forms, where needed, to maximize efficiency.

Subgroup analysis The overview will seek information on various factors that would typically be considered variables for effect modification. Populations Fewer versus more quit attempts specific groupings will depend on what is found in the literature Opportunistic versus individuals seeking treatment Baseline level of nicotine dependence e. Evidence synthesis While there are both simple e. Quality of the body of evidence The Task Force endorses the use of GRADE methodology for assessing the quality of the body of evidence for critical and important outcomes [ ].

Stage 2: Updated systematic review on electronic cigarettes for smoking cessation Literature search The search strategy for this update will be developed using the search strategy of the candidate systematic review, once identified.

Eligibility criteria Studies will be selected for inclusion using the criteria outlined in Table 3. Table 3 Inclusion and exclusion criteria for an updated review on e-cigarettes. It was also decided that this outcome is most important for KQ1b c Although initially rated as being of limited importance by the WG, based on discussions with WG members, it was decided that this outcome should be considered as important.

Study selection and data extraction Study selection and data extraction will follow the same process described for the overview of reviews. Refer to Additional file 6 for a list of draft items to be collected during data extraction We will consult studies included in the original review to ensure that all outcomes of interest Table 3 have been captured.

Analysis Study characteristics will be summarized narratively and presented in summary tables. Meta-analysis We will examine the extent of clinical and methodological heterogeneity to determine appropriateness of performing meta-analysis. Sparse binary data and studies with zero events Results will be synthesized narratively if studies report rare events. Subgroup analysis If there are sufficient data, the following subgroup analyses will be conducted: Fewer versus more quit attempts specific groupings will depend on what is found in the literature Opportunistic versus individuals seeking treatment Baseline level of nicotine dependence e.

Sensitivity analysis Sensitivity analyses restricted to low risk of bias studies may be performed. Software The Cochrane Review Manager software version 5. Grading the quality of evidence and interpretation For critical and important outcomes, the GRADE framework [ , ] will be used to assess the quality of the evidence. Additional file 2: 20K, docx Search strategy for the overview of reviews. Additional file 5: 14K, docx Draft data extraction items for the overview of reviews. Additional file 6: 13K, docx Draft data extraction items for the updated review of e-cigarettes for smoking cessation.

Additional file 7: 29K, docx Cochrane risk of bias tool. Additional file 9: 35K, docx Stakeholder feedback. Funding Funding for this protocol and subsequent evidence review is provided by the Public Health Agency of Canada. Availability of data and materials Not applicable. Notes Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent to publish was obtained from the stakeholders who provided feedback on the protocol.

Competing interests BH has received consultancy fees from Cornerstone Research Group for methodologic advice related to systematic reviews and meta-analysis and is a member of the Editorial team for Systematic Reviews. Contributor Information Mona Hersi, Email: ac.

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Cochrane Database of Systematic Reviews , Issue 5. Group behaviour therapy programmes for smoking cessation. Reducing smoking behaviour before quitting could be an alternative approach to cessation. However, before this method can be recommended it is important to ensure that abrupt quitting is not more effective than reducing to quit, and to determine whether there are ways to optimise reduction methods to increase the chances of cessation.

Objectives: To assess the effect of reduction-to-quit interventions on long-term smoking cessation. We also searched trial registries to identify unpublished studies. Date of the most recent search: 29 October Selection criteria: Randomised controlled trials in which people who smoked were advised to reduce their smoking consumption before quitting smoking altogether in at least one trial arm.

This advice could be delivered using self-help materials or behavioural support, and provided alongside smoking cessation pharmacotherapies or not. We excluded trials that did not assess cessation as an outcome, with follow-up of less than six months, where participants spontaneously reduced without being advised to do so, where the goal of reduction was not to quit altogether, or where participants were advised to switch to cigarettes with lower nicotine levels without reducing the amount of cigarettes smoked or the length of time spent smoking.

We also excluded trials carried out in pregnant women. Objective: To update its recommendation, the USPSTF commissioned a review to evaluate the benefits and harms of primary care interventions on tobacco use cessation in adults, including pregnant persons. Population: This recommendation statement applies to adults 18 years or older, including pregnant persons. Evidence assessment: The USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated FDA -approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial.

The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined.

Pharmacies offer a wide range of smoking cessation aids and alternatives to smoking, and pharmacists can provide information and advice on their use [ 4 ]. Previous studies have shown that attending training programs on smoking cessation support enabled pharmacists to improve their counseling skills [ 5 , 6 ] and increase smoking cessation rates [ 6 — 8 ].

Evidence also suggests that such training programs lead to behavioral changes in pharmacists that result in long-term persistence of provision of smoking cessation support [ 9 ] and result in savings in treatment costs [ 10 ]. In a meta-analysis of seven research articles, community pharmacists provided weekly counseling compared to control groups that received only a few minutes of face-to-face support.

The meta-analysis revealed that the support provided to the intervention groups was more effective compared to that provided to the control groups [ 4 ]. However, no clear benefit of nicotine replacement therapy was found [ 11 ]. A meta-analysis of 16 research articles revealed that the most common intervention method was the provision of individual counseling in an appointment-based manner [ 12 ]. However, all reviews indicated that accumulation of more evidence studies in which intervention methods are clear and variability and bias are controlled as much as possible is needed to draw more robust conclusions [ 3 , 4 , 11 , 12 ].

In this system, support for smoking cessation is explicitly stated as a role to be played by pharmacists [ 13 ]. However, the effectiveness of smoking cessation support by community pharmacists in Japan has not been clearly elucidated. There is one report examining the supportive effect of teaching smoking cessation aids, but no clear results have been obtained [ 14 ].

To implement smoking cessation support in busy Japanese pharmacies in the future, two main issues need to be addressed: 1 the development of a practical and systematic training program for community pharmacists and 2 the establishment of a simple support method that can be implemented in a short period of time in between dispensing operations.

Therefore, the authors developed and confirmed the feasibility of a training program on smoking cessation support for community pharmacists to ensure easy implementation of personalized smoking cessation support [ 15 ]. The purpose of this pilot study was to investigate the effectiveness of the smoking cessation support program. Community pharmacies were directly recruited via explanatory meetings, resulting in the participation of 11 pharmacies in Osaka Prefecture.

The participant exclusion criteria were as follows: intolerance to smoking cessation aids due to an allergy or adverse reaction , major neurocognitive disorder under DSM-5, a temporomandibular joint disorder, or pregnancy. Pharmacies were considered to be clusters and divided into categories according to size stratified by the number of prescriptions per month: small, ; medium, 1,,; and large, more than 2, The stratified random allocation sequence was generated using computer-generated random numbers by a biostatistician at the Kyoto Medical Center Clinical Research Center.

Pharmacists in each collaborative pharmacy enrolled and assigned participants. The pharmacists who participated in the study displayed posters and introduced the program to those visiting the pharmacies. They also asked those who visited the pharmacies to fill out a smoking status questionnaire, approached those who were interested in quitting smoking, explained the program verbally to them, and obtained written consent for participation in the current study.

The recruitment period extended from April to June , with the goal of enrolling four patients per cluster pharmacy. The intervention was assumed to be behavioral, and the pharmacists were not blinded. However, the participants and analysts were blinded to group assignment. All participating pharmacists were required to complete training prior to study commencement [ 15 ]. Pharmacists who completed the e-learning course then participated in an additional 4-h training program developed by the investigators.

Any questions were addressed by the investigators, who also discussed practical aspects of smoking cessation support. Finally, the pharmacists were trained by the investigators in communication skills for all of the above interpersonal tasks see Table 1 [ 15 ].

The pharmacists provided smoking cessation support to each participant as soon as they enrolled in the study, and the last participant completed a 3-month follow-up in September Eighteen pharmacists performed the interventions. The participants in the FINE program received an original guidebook that included a smoking diary, an explanation of how to use and record the start date of using a smoking cessation aid, and how to measure the CO concentration in exhaled air this activity was voluntary.

Then, on day 3, the pharmacists telephoned the participants asking if they had been smoking or had experienced nicotine withdrawal symptoms and followed up with encouragement, counseling, and advice at weeks 2, 4, 6, and 8, either in person or over the phone. Furthermore, the pharmacists determined whether the participant used their smoking diaries and continued to refrain from smoking.

They also checked whether the participants were smoking and measured the CO concentration in their breath at 12 weeks see Table 2. Seventeen participating pharmacists completed the same e-learning course as did the participating pharmacists catering to the intervention group.

Pharmacists who completed the e-learning course were only taught how to use nicotine patches and the piCO smokerlyzer and how to recruit participants by using a questionnaire by the investigators. The pharmacists provided usual interventions, such as asking patients to confirm that they had quit smoking when they visited the pharmacy and giving them smoking cessation pamphlets prepared by a pharmaceutical company. The primary outcome was the percentage of participants who had quit smoking at the end of the 3-month follow-up period 3-month quit rate.

Due to the wide range of results from previous studies on the effectiveness of smoking cessation support in community pharmacies, the effect size was set based on the work of [ 16 ].

A two-tailed significance test was used to calculate the sample size required for each group. Using an intraclass correlation of 0. Continuous variables are presented as mean and standard deviation SD values, and categorical variables are presented as numbers and percentages. The difference in the primary outcome between the groups was compared using the test. Chi-square test adjustment for clusters pharmacies was performed using the clchi2 command in Stata.

A value of less than 0. The analysis was performed using Stata 13 and. The study was approved by the ethics committee of Osaka University of Pharmaceutical Sciences All participants provided written informed consent for participation in the study before enrollment, which was in compliance with the principles of the Declaration of Helsinki.

Furthermore, the Consolidated Standards of Reporting Trials statement was followed for the reporting of the study [ 17 ]. Eleven pharmacies participated in the recruitment, which began on April 15, ; patient assignment is shown in Figure 1.