Biomedical subjects

L F Stead

Publications and source records attributed to L F Stead.

At least 19 recordsLinked to original sources

PubMed2001

Updating a systematic review--what difference did it make? Case study of nicotine replacement therapy.

AIMS: To examine the effect of updating a systematic review of nicotine replacement therapy on its contents and conclusions. METHODS: We examined the effects of regular updating of a systematic review of nicotine replacement therapy for smoking cessation. We considered two outcomes. First, we assessed the effect of adding new data to meta-analyses, comparing results in 2000 with the results in 1994. Second, we assessed qualitatively the ways in which the nature of the questions addressed by the review had changed between the two dates. For the first outcome, we compared the number of trials, the pooled estimate of effect using the odds ratio, and the results of pre-specified subgroup analyses, for nicotine gum and patch separately. Using a test for interaction, we assessed whether differences between estimates were statistically significant. RESULTS: There were ten new trials of nicotine gum between 1994 and 2000, and the meta-analytic effect changed little. For the nicotine patch the number of trials increased from 9 to 30, and the meta-analytic effect fell from 2.07 (95% CI 1.64 - 2.62) to 1.73 (95% CI 1.56 - 1.93). Apparent differences in relative effect in sub-groups found in 1994 were not found in 2000. The updated systematic review addressed a number of questions not identified in the original version. CONCLUSIONS: Updating the meta-analyses lead to a more precise estimate of the likely effect of the nicotine patch, but the clinical message was unchanged. Further placebo controlled NRT trials are not likely to add to the evidence base. It is questionable whether updating the meta-analyses to include them is worthwhile. The content of the systematic review has, however, changed, with the addition of data addressing questions not considered in the original review. There is a tension between the principle of identifying the important questions prior to conducting a review, and keeping the review up to date as primary research identifies new avenues of enquiry.

Humans↗

PubMed2001

Use of systematic reviews in clinical practice guidelines: case study of smoking cessation.

OBJECTIVE: To examine the extent to which recommendations in the national guidelines for the cessation of smoking are based on evidence from systematic reviews of controlled trials. DESIGN: Retrospective analysis of recommendations for the national guidelines for the cessation of smoking. MATERIALS: National guidelines in clinical practice on smoking cessation published in English. MAIN OUTCOME MEASURES: The type of evidence (systematic review of controlled trials, individual trials, other studies, expert opinion) used to support each recommendation. We also assessed whether a Cochrane systematic review was available and could have been used in formulating the recommendation. RESULTS: Four national smoking cessation guidelines (from Canada, New Zealand, the United Kingdom, and the United States) covering 105 recommendations were identified. An explicit evidence base for 100%, 89%, 68%, and 98% of recommendations, respectively, was detected, of which 60%, 56%, 59%, and 47% were based on systematic reviews of controlled studies. Cochrane systematic reviews could have been used to develop between 39% and 73% of recommendations but were actually used in 0% to 36% of recommendations. The UK guidelines had the highest proportion of recommendations based on Cochrane systematic reviews. CONCLUSIONS: Use of systematic reviews in guidelines is a measure of the "payback" on investment in research synthesis. Systematic reviews commonly underpinned recommendations in guidelines on smoking cessation. The extent to which they were used varied by country and there was evidence of duplication of effort in some areas. Greater international collaboration in developing and maintaining an evidence base of systematic reviews can improve the efficiency of use of research resources.

Controlled Clinical Trials as Topic↗

PubMed2001

Interventions for smoking cessation in hospitalised patients.

BACKGROUND: 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. Providing smoking cessation services during hospitalisation may help more people to attempt and sustain a quit attempt. OBJECTIVES: To determine the effectiveness of interventions for smoking cessation in hospitalised patients. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group register, CINAHL and the Smoking and Health database for studies of interventions for smoking cessation in hospitalised patients. SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters. We excluded studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS: Intensive intervention (inpatient contact plus follow-up for at least one month) was associated with a significantly higher quit rate compared to control (Peto Odds Ratio 1.82, 95% CI 1.49-2.22). There was insufficient evidence to judge the effect of interventions delivered only during the hospital stay. Although the interventions increased quit rates irrespective of whether nicotine replacement therapy was used, the results for nicotine replacement therapy (NRT) were compatible with other data indicating that it increases quit rates. There was no strong evidence that clinical diagnosis affected the likelihood of quitting. REVIEWER'S CONCLUSIONS: High intensity behavioural interventions that include at least one month of follow-up contact are effective in promoting smoking cessation in hospitalised patients. The findings of the review were compatible with research in other settings showing that NRT increases quit rates.

Hospitalization↗

PubMed2001

Telephone counselling for smoking cessation.

BACKGROUND: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES: To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone'. Date of the most recent search: August 2000. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS: Trials were identified and data extracted by one person and checked by a second. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Participants lost to follow-up were considered to be continuing smokers. Where interventions were similar, we performed meta-analysis using a fixed effects model to give an odds ratio. MAIN RESULTS: Twenty three trials met inclusion criteria. Ten trials compared proactive counselling to a minimal intervention control. There was statistical heterogeneity, with three trials showing a significant benefit, and seven showing non significant differences. Four trials adding telephone support to a face to face intervention control failed to detect a significant effect on long term quit rates. Four trials failed to detect an additional effect of telephone support in users of nicotine replacement therapy. Providing access to a hotline showed a significant benefit in one trial and no significant difference in two. Varying the type of counselling provided has not been shown to affect outcome. REVIEWER'S CONCLUSIONS: Proactive telephone counselling can be effective compared to an intervention without personal contact. There was heterogeneity between trials so the size of effect is uncertain. The available evidence neither confirms nor rules out a benefit of telephone counselling as an adjunct to face to face counselling or pharmacotherapy. Further trials randomising access to helplines are unlikely to be done but indirect evidence suggests they can be a useful part of a smoking cessation service.

Counseling↗

PubMed2001

Opioid antagonists for smoking cessation.

BACKGROUND: The reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. Smokers report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking. OBJECTIVES: To evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. The drugs include naloxone and the longer-acting opioid antagonist naltrexone. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for trials of naloxone, naltrexone and other opioid antagonists and conducted an additional search of Medline using '"Narcotic antagonists" and smoking terms in March 2001. We also contacted, when possible, investigators for information on unpublished studies. SELECTION CRITERIA: We considered randomized controlled trials comparing opioid antagonists to placebo or an alternative therapeutic control for smoking cessation. We included only trials reporting data on abstinence of a minimum of 6 months in the meta-analyses. We also reviewed, for descriptive purposes, results from short-term laboratory-based studies of opioid antagonists designed to evaluate psychobiological mediating variables associated with nicotine dependence. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was cotinine or carbon monoxide verified abstinence from smoking after at least six months follow-up in patients smoking at baseline. Where appropriate, we performed meta-analysis using a fixed effects model (Peto method). MAIN RESULTS: Two trials of naltrexone met inclusion criteria for meta-analyses for long term cessation. Both trials failed to detect a significant difference in quit rates between naltrexone and placebo. In a pooled analysis there was no significant effect of naltrexone on long-term abstinence, and confidence intervals were wide (OR 1.34, 95% CI 0.49,3.63). No trials of naloxone or buprenorphine reported long term follow-up REVIEWER'S CONCLUSIONS: Based on limited data from two trials it is not possible to confirm or refute whether naltrexone helps smokers quit. The confidence intervals are compatible with both clinically significant benefit and possible negative effects of naltrexone in promoting abstinence. Data from larger trials of naltrexone are needed to settle the question of efficacy for smoking cessation.

Buprenorphine↗

PubMed2000

Anxiolytics and antidepressants for smoking cessation.

BACKGROUND: There are two reasons to believe antidepressants and anxiolytics might help in smoking. First, anxiety and depression are symptoms of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, smoking appears to be due, in part, to deficits in dopamine, serotonin and norepinephrine, all of which are increased by anxiolytics and antidepressants. OBJECTIVES: The aim of this review is to assess the effectiveness of such drugs in aiding long term smoking cessation. The drugs include bupropion; buspirone; diazepam; doxepin; fluoxetine; imipramine; meprobamate; moclobemide; nortriptyline; tryptophan; ondansetron; venlafaxine and the beta-blockers metoprolol, oxprenolol and propanolol. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in Medline, Embase, SciSearch and PsycLit, and meetings abstracts. SELECTION CRITERIA: We considered randomized trials comparing anxiolytic or antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. We excluded trials with less than 6 months follow-up. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: There was one trial each of the anxiolytics diazepam, meprobamate, metoprolol and oxprenolol. There were two trials of the anxiolytic buspirone. None of these showed evidence of effectiveness in helping smokers to quit. There was one trial each of the antidepressants fluoxetine and moclobemide, two of nortriptyline, and four trials of bupropion. Nortriptyline and bupropion increased cessation and other antidepressants might also be effective. One trial found combined bupropion and nicotine patch produced higher quit rates than patch alone. REVIEWER'S CONCLUSIONS: There is little evidence that anxiolytics aid smoking cessation. Some antidepressants (bupropion and nortriptyline) can aid smoking cessation. It is not clear whether these effects are specific for individual drugs, or a class effect.

Anti-Anxiety Agents↗

PubMed2000

Clonidine for smoking cessation.

BACKGROUND: Clonidine was originally used to lower blood pressure. It acts on the central nervous system and may reduce withdrawal symptoms in various addictive behaviours, including tobacco use. OBJECTIVES: The aim of this review is to determine clonidine's effectiveness in helping smokers to quit. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search: October 1998. SELECTION CRITERIA: We considered randomised trials of clonidine versus placebo with a smoking cessation endpoint assessed at least 12 weeks following the end of treatment. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and duration of clonidine therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least twelve weeks follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: Six trials met the inclusion criteria. There were three trials of oral, and three of transdermal clonidine. Some form of behavioural counselling was offered to all participants in five of the six trials. There was a statistically significant effect of clonidine in one of these trials. The pooled odds ratio for success with clonidine vs placebo was 1.89 (95% confidence interval 1.30 to 2.74). There was a high incidence of dose-dependent side-effects, particularly dry mouth and sedation. REVIEWER'S CONCLUSIONS: Based on a small number of trials, in which there are potential sources of bias, clonidine is effective in promoting smoking cessation. Prominent side-effects limit the usefulness of clonidine for smoking cessation.

Clomiphene↗

PubMed2000

Lobeline for smoking cessation.

BACKGROUND: Lobeline is a partial nicotine agonist, which has been used in a variety of commercially available preparations to help stop smoking. OBJECTIVES: The objective of this review was to assess the effects of lobeline on long term smoking cessation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: Randomized trials comparing lobeline to placebo or an alternative therapeutic control, which reported smoking cessation with at least six months follow-up. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and form of lobeline, the outcome measures, method of randomisation, and completeness of follow-up. MAIN RESULTS: We identified no trials meeting the full inclusion criteria including long term follow-up. REVIEWER'S CONCLUSIONS: There is no evidence available from long term trials that lobeline can aid smoking cessation.

Humans↗

PubMed2000

Physician advice for smoking cessation.

BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation and to determine the effect of anti-smoking advice on disease specific and all cause mortality. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register and the Cochrane Controlled Trials Register. Date of the most recent searches: October 1998. SELECTION CRITERIA: Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of followup. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, meta-analysis was performed using a fixed effects model. MAIN RESULTS: We identified thirty-one trials, conducted between 1972 and 1997, including over 26,000 smokers. In some trials, subjects were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 16 trials of brief advice versus no advice (or usual care) revealed a small but significant increase in the odds of quitting (odds ratio 1.69, 95% confidence interval 1.45 to 1.98). This equates to an absolute difference in the cessation rate of about 2.5%. There was insufficient evidence, from indirect comparisons, to establish a significant difference in the effectiveness of physician advice according to the intensity of the intervention, the amount of follow-up provided, and whether or not various aids were used at the time of the consultation in addition to providing advice. However, direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (odds ratio 1.44, 95% confidence interval 1.23 to 1.68). In one study which determined the effect of smoking advice on mortality at twenty years, there were no statistically significant differences in death rates in the group receiving advice. REVIEWER'S CONCLUSIONS: Simple advice has a small effect on cessation rates. Additional manoeuvres appear to have only a small effect, though more intensive interventions are marginally more effective than minimal interventions.

Humans↗

PubMed2000

Silver acetate for smoking cessation.

BACKGROUND: Silver acetate produces an unpleasant taste when combined with cigarettes, thereby producing an aversive stimulus. It has been marketed in various forms with the aim of extinguishing the urge to smoke, by pairing the urge with an unpleasant stimulus. OBJECTIVES: The aim of this review was to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: We included randomised trials of silver acetate for smoking cessation with reports of smoking status at least six months after the beginning of treatment. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and form of silver acetate, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was biochemically validated abstinence from smoking after at least six months follow-up in patients smoking at baseline. Subjects lost to follow-up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: Two studies provided long-term follow-up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The combined odds ratio for quitting for silver acetate vs placebo was 1.05 (95% confidence interval 0.63 to 1.73). REVIEWER'S CONCLUSIONS: Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation. The confidence intervals for the ratio are quite wide. However, the upper limit of the confidence intervals for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%. Any effect of this agent is therefore likely to be smaller than nicotine replacement therapy. The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus.

Acetates↗

PubMed2000

Aversive smoking for smoking cessation.

BACKGROUND: Aversion therapy pairs the pleasurable stimulus of smoking a cigarette with some unpleasant stimulus. The objective is to extinguish the urge to smoke. OBJECTIVES: This review has two aims. First, to determine the efficacy of rapid smoking and other aversive methods in helping smokers stop smoking. Second, to determine whether there is a dose-response effect on smoking cessation at different levels of aversive stimulation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies which evaluated any technique of aversive smoking. SELECTION CRITERIA: Randomised trials which compared aversion treatments with 'inactive' procedures or which compared aversion treatments of different intensity for smoking cessation. Trials must have reported follow-up of least 6 months from beginning of treatment. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the study population, the type of aversion treatment, the outcome measure, method of randomisation and completeness of follow-up. The outcome measure was abstinence from smoking at maximum follow-up, using the strictest measure reported by the authors. Subjects lost to follow-up were regarded as smokers. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: Twenty four trials met the inclusion criteria. Ten included rapid smoking and ten used other aversion methods. Ten trials included two or more conditions allowing assessment of a dose-response to aversive stimulation. The odds ratio for abstinence following rapid smoking compared to control was 2.08 (95% confidence interval 1.39 to 3.12). Several factors suggest that this finding should be interpreted cautiously. A funnel plot of included studies was asymmetric, due to the relative absence of small studies with negative results. Most trials had a number of serious methodological problems likely to lead to spurious positive results. The only trial using biochemical validation of all self reported cessation gave a non significant result. Other aversion methods were not shown to be effective (odds ratio 1.19, 95% confidence interval 0.77 to 1.83). There was a borderline dose-response to the level of aversive stimulation (odds ratio 1.66, 95% confidence interval 1.00 to 2.78). REVIEWER'S CONCLUSIONS: The existing studies provide insufficient evidence to determine the efficacy of rapid smoking, or whether there is a dose-response to aversive stimulation. Milder versions of aversive smoking seem to lack specific efficacy. Rapid smoking is an unproven method with sufficient indications of promise to warrant evaluation using modern rigorous methodology.

Aversive Therapy↗

PubMed2000

Group behaviour therapy programmes for smoking cessation.

BACKGROUND: Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. OBJECTIVES: The aims of this review were to determine the effects of smoking cessation programmes delivered in a group format compared to self-help materials, or to no intervention; to compare the effectiveness of group therapy and individual counselling; to determine the effect of adding group therapy to advice from a health professional or nicotine replacement and to determine the rate at which offers of group therapy are taken up. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: We considered randomised trials which compared group therapy with self-help, individual counselling, another intervention or usual care or waiting list control. We also considered trials which compared two group programmes with manipulation of the group interaction and social support components. We included those trials with a minimum of two group meetings, and follow-up of smoking status at least six months after the start of the programme. We excluded trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies, unless they had a factorial design. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the nature of the groups and the controls, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, we performed meta-analysis using a fixed effects model. MAIN RESULTS: Thirteen studies compared a group programme with a self-help programme. There was an increase in cessation with the use of a group programme (odds ratio 2.10, 95% confidence interval 1.64 to 2.70). Group programmes were more effective than no intervention or minimal contact interventions (odds ratio 1.91, 95% confidence interval 1.20 to 3. 04). There was no evidence from two trials that group therapy was more effective than a similar intensity of individual counselling. There was no evidence that manipulating the social interactions between participants in a group programme had an effect on outcome. There was limited evidence that the addition of group therapy to other forms of treatment, including advice from a health professional or nicotine replacement produced extra benefit. There was variation in the extent to which those offered group therapy accepted the treatment. REVIEWER'S CONCLUSIONS: There is evidence that groups are better than self-help, and other less intensive interventions. There is not enough evidence on their effectiveness compared to intensive individual counselling.

Behavior Therapy↗

PubMed2000

Hypnotherapy for smoking cessation.

BACKGROUND: 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. OBJECTIVES: The objective of this review was to evaluate the effects of hypnotherapy for smoking cessation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: We considered randomised trials of hypnotherapy which reported smoking cessation rates at least six months after the beginning of treatment. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data on the type of subjects, the type and duration of the hypnotherapy, the nature of the control group,the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, we performed meta-analysis using a fixed effects model. MAIN RESULTS: Nine studies compared hypnotherapy with 14 different control interventions. There was significant heterogeneity between the results of the individual studies, with conflicting results for the effectiveness of hypnotherapy compared to no treatment or to advice. We therefore did not attempt to calculate pooled odds ratios for the overall effect of hypnotherapy. There was no evidence of an effect of hypnotherapy compared to rapid smoking or psychological treatment. REVIEWER'S CONCLUSIONS: We have not shown that hypnotherapy has a greater effect on six month quit rates than other interventions or no treatment. The effects of hypnotherapy on smoking cessation claimed by uncontrolled studies were not confirmed by analysis of randomised controlled trials.

Humans↗

PubMed2000

Mecamylamine (a nicotine antagonist) for smoking cessation.

BACKGROUND: Mecamylamine is a nicotine antagonist (that is it blocks the effect of nicotine). The rationale for its use in smoking cessation is that it may block the rewarding effect of nicotine and thus reduce the urge to smoke. OBJECTIVES: The objective of this review was to determine the effectiveness of mecamylamine in promoting smoking cessation, either alone or in combination with nicotine replacement therapy. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: Randomised trials of mecamylamine, either alone or in combination with nicotine replacement therapy, which reported smoking cessation rates at least six months after intervention. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and duration of the mecamylamine and nicotine treatments, side-effects of treatment, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was sustained abstinence from smoking (biochemically validated) after at least six months follow-up in patients smoking at baseline. Smokers lost to follow-up were regarded as being continuing smokers. Because of the preliminary nature of available data, we did not perform meta-analysis but report the results narratively. MAIN RESULTS: We identified two studies, both from the same investigators. In a study of 48 volunteers, a combination of mecamylamine plus nicotine patch was more effective than nicotine patch alone (abstinence rate at one year 37.5% vs 4.2%). In a second study, 80 volunteers were treated for four weeks prior to cessation with one of four treatments: 1. Nicotine patch plus mecamylamine capsules 2. Nicotine alone 3. Mecamylamine alone 4. No active drug. All four groups received combination treatment with nicotine and mecamylamine after the scheduled quit date. The abstinence rates in these four groups were respectively 40%, 20%, 15% and 15%. The higher abstinence rate in the group treated with combination therapy was not statistically significant. The authors reported a statistically significant benefit of mecamylamine using Kaplan-Meier survival analysis. In the doses used, mecamylamine was well tolerated, although up to 40% of subjects required reductions in dose, usually because of constipation. REVIEWER'S CONCLUSIONS: Data from two small studies suggest that the combination of nicotine and mecamylamine may be superior to nicotine alone in promoting smoking cessation. However, these results require confirmation in larger studies before the treatment can be recommended clinically.

Administration, Cutaneous↗

PubMed2000

Self-help interventions for smoking cessation.

BACKGROUND: Many smokers give up smoking on their own, but provision of materials giving advice and information may assist them and increase the number who quit successfully. OBJECTIVES: The aims of this review were to determine the effectiveness of different forms of self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to self-help, such as computer generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search September 1999. SELECTION CRITERIA: We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested a self-help intervention. We defined self-help as structured programming for smokers trying to quit without intensive contact with a therapist. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the nature of the self-help materials, the amount of face to face contact given to subjects and to controls, outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: We identified forty-five trials. Twenty seven compared self-help materials to no intervention or tested materials as an adjunct to advice. In nine trials in which self-help was compared to no intervention there was a pooled effect which just reached statistical significance (odds ratio 1.23, 95% confidence interval 1.02 to 1.49). There was no evidence of benefit from adding self-help materials to face to face advice, or to nicotine replacement therapy. There was evidence from eight trials using materials which were tailored for the characteristics of individual smokers that such personalised materials were more effective than standard materials (odds ratio 1.41, 95% confidence interval 1.14 to 1.75). Adding follow-up telephone calls from counsellors also appeared to increase quitting (odds ratio 1.62, 95% confidence interval 1.33 to 1.97). One trial of offering access to a hotline also showed an effect. REVIEWER'S CONCLUSIONS: Self-help materials may provide a small increase in quitting compared to no intervention. There is no evidence that they have an additional benefit over other minimal interventions such as advice from a health care professional, or nicotine replacement therapy. There is evidence that materials tailored for individual smokers are more effective.

Behavior Therapy↗

PubMed2000

Nursing interventions for smoking cessation.

BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: To determine the effectiveness of nursing delivered smoking cessation interventions. SEARCH STRATEGY: The Cochrane Tobacco Addiction Group register was searched for studies of interventions using nurses or health visitors and an additional search made on CINAHL. SELECTION CRITERIA: Randomised trials with follow-up of at least 6 months. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently. MAIN RESULTS: Fifteen studies comparing nursing intervention to a control or usual care found intervention to significantly increase the odds of quitting (Peto Odds Ratio 1.43, 95% CI 1.24-1.66). There was heterogeneity between the study results, but pooling using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was limited evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non hospitalised patients also showed evidence of efficacy. Three studies of nurse counseling on smoking cessation during a screening health check, not included in the main meta-analysis, suggested that under these conditions nursing intervention was likely to have less effect. REVIEWER'S CONCLUSIONS: The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that interventions can be effective. The challenge will be to incorporate smoking cessation intervention as part of standard practice so that all patients are given an opportunity to be queried about their tobacco use and to be given advice to quit along with reinforcement and follow-up.

Counseling↗

PubMed2000

Individual behavioural counselling for smoking cessation.

BACKGROUND: Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. OBJECTIVES: The objective of the review is to determine the effects of individual counselling. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies with counsel* in any field. Date of the most recent search: October 1998. SELECTION CRITERIA: Randomised or quasi-randomised trials with at least one treatment arm consisting of face to face individual counselling from a health care worker not involved in routine clinical care. The outcome was smoking cessation at follow-up at least six months after the start of counselling. DATA COLLECTION AND ANALYSIS: Both reviewers extracted data. The intervention and population, method of randomisation and completeness of follow-up were recorded. MAIN RESULTS: We identified eleven trials. Ten compared individual counselling to a minimal intervention, two compared two intensities of counselling, and one compared individual counselling to group therapy. Individual counselling was more effective than control. The odds ratio for successful smoking cessation was 1.55 (95% confidence interval 1.27 to 1.90). There was no evidence that more intensive counselling was more effective than brief counselling (odds ratio 1.17, 95% confidence interval 0.59 to 2.34). There was no evidence of a difference in effect between individual counselling and group therapy (odds ratio 1.33, 95% confidence interval 0.83 to 2.13). REVIEWER'S CONCLUSIONS: Smoking cessation counselling can assist smokers to quit.

Behavior Therapy↗

PubMed2000

Interventions for preventing tobacco sales to minors.

BACKGROUND: Laws restricting sales of tobacco products to minors exist in many countries, but young people may still purchase cigarettes easily. OBJECTIVES: The review assesses the effects of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction group trials register and Medline. Date of the most recent searches: July 1999. SELECTION CRITERIA: We included controlled trials and uncontrolled studies with pre- and post intervention assessment of interventions to change retailers' behaviour. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), changes in young people's smoking behaviour, and perceived ease of access to tobacco products. DATA COLLECTION AND ANALYSIS: Studies were prescreened for relevance by one person and assessed for inclusion by two people independently. Data from included studies were extracted by one person and checked by a second. Study designs and types of intervention were heterogeneous so results were synthesised narratively, with greater weight given to controlled studies. MAIN RESULTS: We identified 27 studies of which 13 were controlled. Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access or prevalence of smoking. REVIEWER'S CONCLUSIONS: Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.

Adolescent↗