Behavioural Programmes for Cigarette Smoking Cessation: Investigating Interactions Between Behaviour
Thursday, August 18, 2022
Posted by: Natalia Gromov
Hartmann-Boyce J,
Ordóñez-Mena JM, Livingstone-Banks J, et al.
Behavioural Programmes for
Cigarette Smoking Cessation: Investigating Interactions Between Behavioural,
Motivational and Delivery Components in a Systematic Review and Component Network
Meta-analysis.
Addiction. 2022;117(8):2145-2156. doi:10.1111/add.15791
Aims. To
investigate the comparative and combined effectiveness of four types of
components of behavioural interventions for cigarette smoking cessation:
behavioural (e.g. counselling), motivational (e.g. focus on reasons to quit),
delivery mode (e.g. phone) and provider (e.g. nurse).
Design. Systematic
review and component network meta-analysis of randomised controlled trials
identified from Cochrane reviews. Interventions included behavioural
interventions for smoking cessation (including all non-pharmacological
interventions, e.g. counselling, exercise, hypnotherapy, self-help materials),
compared with another behavioural intervention or no support. Building on a
2021 review (CD013229), we conducted three analyses, investigating: comparative
effectiveness of the components, whether models that allowed interactions
between components gave different results to models assuming additivity, and
predicted effect estimates for combined effects of components that had showed
promise but where there were few trials.
Setting. Community
and health-care settings.
Participants. Adults
who smoke tobacco.
Measurements. Smoking
cessation at ≥6 months, preferring sustained, biochemically validated outcomes
where available.
Findings. Three
hundred and twelve trials (250 563 participants) were included. Fifty were at
high risk of bias using Cochrane risk of bias tool, V1 (ROB1); excluding these
studies did not change findings. Head-to-head comparisons of components
suggested that support via text message (SMS) compared with telephone (OR 1.48,
95% CrI 1.13-1.94) or print materials (OR 1.44, 95% CrI 1.14-1.83) was more
effective, and individual delivery was less effective than delivery as part of
a group (OR 0.78, 95% CrI 0.64-0.95). There was no conclusive evidence of
synergistic or antagonistic interactions when combining components that were
commonly used together. Adding multiple components that are commonly used in
behavioural counselling suggested clinically relevant and statistically
conclusive evidence of benefit. Components with the largest effects that could
be combined, but rarely have been, were estimated to increase the odds of
quitting between two and threefold. For example, financial incentives delivered
via SMS, with tailoring and a focus on how to quit, had an estimated OR of 2.94
(95% CrI 1.91-4.52).
Conclusions. Among
the components of behavioural support for smoking cessation, behavioural
counselling and guaranteed financial incentives are associated with the
greatest success. Incorporating additional components associated with
effectiveness may further increase benefit, with delivery via text message
showing particular promise.
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