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Combined pharmacotherapy and behavioural interventions for smoking cessation
Lindsay F Stead1, Tim Lancaster
1Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. lindsay.stead@phc.ox.ac.uk.
The Cochrane Database of Systematic Reviews
|October 19, 2012
Summary
Combining pharmacotherapy (medication) and behavioral support significantly boosts smoking cessation success rates compared to minimal interventions. This combination therapy is a highly effective strategy for helping individuals quit smoking.
Area of Science:
- Public Health
- Addiction Medicine
- Behavioral Science
Background:
- Both behavioral support and pharmacotherapies are established methods for smoking cessation.
- Combining these approaches is recommended, but their differential effects across settings and populations require clarification.
Purpose of the Study:
- To evaluate the efficacy of combined behavioral support and pharmacotherapy for smoking cessation.
- To compare this combined approach against minimal intervention or usual care.
- To identify factors influencing treatment effectiveness, including setting, intervention intensity, population characteristics, and treatment adherence.
Main Methods:
- Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searched specialized registers for studies on pharmacotherapies (NRT, bupropion, varenicline, nortriptyline).
- Included trials with at least six months follow-up, excluding those solely on pregnant women or adolescents.
- Primary outcome: smoking abstinence at six months, using rigorous and biochemically validated measures where available.
- Analyzed data using risk ratios (RR) and 95% confidence intervals (CI), employing a fixed-effect model for meta-analysis.
Main Results:
- Forty-one studies with over 20,000 participants met inclusion criteria; most involved healthcare settings or individuals with specific health needs.
- Combined pharmacotherapy and behavioral support demonstrated a significant benefit over usual care or less intensive support (RR 1.82, 95% CI 1.66 to 2.00).
- Higher cessation rates were observed in healthcare settings (RR 2.06) compared to community-based settings (RR 1.53).
- Effectiveness varied based on the type of behavioral support provider and treatment adherence, with some evidence of a dose-response relationship.
Conclusions:
- Interventions combining pharmacotherapy and behavioral support are effective in increasing smoking cessation success.
- The evidence strongly supports the use of combined treatment strategies.
- Further research may not significantly alter this conclusion, though optimal delivery of intensive interventions warrants continued investigation.
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