Smoking: physician advice and nicotine replacements help people quit

Clinical bottom line (level 1a)

  1. Patients motivated to stop smoking (myocardial infarction, high-risk for heart disease, pregnant) are more likely to do it with physician encouragement.
  2. Patients are more likely to stop if encouraged to quit during routine consultation with physicians (NNT = 53 at unknown) .
  3. Nicotine gum and nicotine patches help smokers stop.
Law and Tang: Archives of Internal Medicine 1995; 155: 1933-1941
Expires March 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: smokers
  • Intervention: smoking cessation interventions
  • Outcome: stopped smoking

Articles found in English using Medline and Index Medicus, ? (search terms: ) and searching citations in retrieved articles and review, and contacting experts.

Selection criteria: not given
Appraisal criteria: not given
Articles excluded if:
  • usually if less than 6 months follow-up


52 trials on advice and encouragement involving 44498 patients; 61 trials on behaviour modification therapy (including aversion therapy, sensory deprivation and hypnosis) involving 58716 patients; 54 trials on treatments to reduce withdrawal symptoms (nicotine replacement, clonidine and tranquillisers) involving 16453 patients; 8 trial on acupuncture, involing 2759 patients; and 8 trials on gradual versus sudden cessation involving 630 patients were found.
Studies were combined using a random effects model.

The evidence

Outcome Time to outcome ARR
(95% CI)		NNT
(95% CI)
stopped following myocardial infarction unknown 35.6%
(23.3% to 47.8%)		 3
(2 to 4)
stopped following physician advice to stop if high levels of heart disease risk factors unknown 20.5%
(10.2% to 30.9%)		 5
(3 to 10)
stopped if self-referred using nicotine patch unknown 13%
(10% to 16%)		 8
(6 to 10)
stopped if self-referred using 2-mg nicotine gum unknown 11%
(7% to 15%)		 9
(7 to 14)
stopped during pregancy following physician advice or self-help manuals unknown 7.6%
(4.3% to 10.8%)		 13
(9 to 23)
stopped with additional encouragement unknown 5%
(1% to 8%)		 20
(13 to 100)
stopped using nicotine patch unknown 4%
(2% to 6%)		 25
(17 to 50)
stopped using 2mg nicotine gum unknown 3%
(2% to 5%)		 30
(20 to 50)
stopped when advised by a physician during routine consultation unknown 1.9%
(0.1% to 2.8%)		 53
(36 to 1000)
behaviour modification therapy unknown 1.8%
(0.0% to 3.5%)		 56
(29 to infinity)

  • The effects of using nurses in health promotion clinics, clonidine, aversion with rapid or satiation smoking, and hypnosis is unclear.
  • Supportive group sessions, aversion with silver acetate gum or spray, sensory deprivation, tranquilizers, and acupuncture were not clearly effective.

Comments

  1. By limiting the search to Medline and the English language, important articles may have been missed.
  2. Sensitivity is needed when aproaching smokers in consultation - around half found comments intrusive and irritating

Citation

  1. Law M, and Tang JL: an analysis of the effectivenss of interventions intended to help people stop smoking. Archives of Internal Medicine 1995; 155: 1933-1941
Contributor: Bob Phillips and Chris Ball, November 1999
Reviewer: Santiago Alvarez Montero

Clinical Question.
Patient smokers
Intervention or Exposure counselling, nicotine patches, nicotine gum, acupuncture, hypnosis
Outcome cessation of smoking, stopping smoking