Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation

Area of Science:

• Public Health
• Behavioral Science
• Pharmacology

Background:

• Smoking cessation pharmacotherapies are effective but quitting remains challenging.
• Higher levels of behavioral support may further enhance success rates.

Purpose of the Study:

• To evaluate the impact of increased behavioral support intensity for individuals using smoking cessation medications.
• To assess differential effects based on pharmacotherapy type or support levels.

Main Methods:

• Searched Cochrane Tobacco Addiction Group Register for trials on pharmacotherapy and behavioral support (May 2015).
• Included randomized/quasi-randomized controlled trials with pharmacotherapy and varying behavioral support intensities (person-to-person contact required for intervention).
• Analyzed smoking abstinence rates at ≥6 months follow-up using risk ratios and meta-analysis (Mantel-Haenszel fixed-effect model).

Main Results:

• 47 studies (18,000+ participants) showed a small but significant benefit from more intensive support (RR 1.17, 95% CI 1.11 to 1.24).
• Benefit was observed across most pharmacotherapies, though not statistically significant for nortriptyline or varenicline due to limited evidence.
• Subgroup analyses indicated potentially larger effects for at least four sessions of personal contact or telephone counseling.

Conclusions:

• Intensified behavioral support (in-person or via telephone) significantly aids smoking cessation when used with pharmacotherapy.
• Increased behavioral support is estimated to improve success rates by 10%–25%.
• The incremental benefit of additional support appears consistent across various baseline support levels.