Smoking: physician advice helps smokers quit

Clinical bottom line (level 1a)

  1. Smokers who receive advice from physicians are more likely to stop smoking (NNT = 38 at 6 months) .
  2. Smokers who receive an intensive session of advice compared with a session of minimal advice are more likely to quit (NNT = 34 at 6 months) .
Silagy and Stead: Cochrane Library 2001; 2 : -
Expires May 2004

The study

Systematic review of all randomised trials of
  • Patients: smoker
  • Intervention: advice from a medical practitioner (Minimal intervention: single consultation of < 20 minutes with up to one follow-up session and a leaflet. More than this was considered to be intensive.)
  • Outcome: stopped smoking at 6 months

Articles found in all languages using Cochrane Tobacco Addiction Group trials register and Cochrane Controlled Trials Register, and Medline, to October 2000 (search terms: detailed in text )

Selection criteria: by 2 independent reviewers with a third reviewer resolving disagreements: see above and below
Appraisal criteria: by 2 independent reviewers with a third reviewer resolving disagreements using method of allocation, blinding, outcome measure
Articles excluded if:
  • follow-up < 6 months
  • pregnant women
  • studies comparing nicotine replacement therapy with or without advice
  • smoking advice given as part of multifactorial lifestyle counselling
34 RCTs found involving over 28000 smokers

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
quit smoking: brief advice v. control 6 months 241/5870
(4.1%)		 1.69
(1.45 to 1.98) 		38
(27 to 57)
quit smoking: intensive advice 6 months 145/2288
(6.3%)		 2.11
(1.74 to 2.54) 		16
(12 to 24)
quit smoking: intensive advice v. minimal advice 6 months 305/4036
(7.6%)		 1.44
(1.24 to 1.66) 		34
(23 to 61)

  • The effects of using aids, or amount of follow-up provided on quit rates was unclear.

Citation

  1. Silagy C, and Stead LF: physician advice for smoking cessation. Cochrane Library 2001; 2 : -
Search Terms: smoking and cessation in Cochrane Library
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient smoker
Intervention or Exposure physician advice
Outcome quit smoking