NEW ORLEANS – Behavioral interventions aimed at smoking cessation showed modest, albeit statistically significant efficacy in a new meta-analysis of 51 randomized controlled trials totaling nearly 27,000 smokers, Salvatore Mottillo reported at the annual meeting of the American College of Cardiology.
The behavioral interventions were of four types: brief physician-given advice to quit, typically a one-on-one intervention lasting 30 seconds to a couple of minutes; individual counseling by a therapist or physician in a more in-depth session of at least 20 minutes; group counseling; or proactive telephone counseling in which a nurse or therapist makes multiple phone calls to follow up on the patient's smoking status.
All 51 studies used biochemically validated patient self-reported smoking abstinence at 6 and/or 12 months as an end point.
Control subjects were individuals who felt motivated to quit smoking but received no assistance. Their success rate was about 10%. All four types of behavioral intervention boosted the success rate to about 15%–17%, with no significant difference among them, according to Mr. Mottillo.
“What's interesting is clearly there's not one intervention that stands out as being more effective than the others. It seems as though minimal clinical intervention–that's the brief advice provided by a physician–may be as effective as these more resource-intensive interventions which require a lot more time and a lot more money. The government spends a lot of money on telephone hotlines to help patients quit smoking; that might not be any more helpful than a physician telling someone to quit,” said Mr. Mottillo, an undergraduate student at McGill University, Montreal, in an interview.
He and his coinvestigators have applied to the Canadian Institutes for Health Research for funding of a head-to-head comparative trial testing that hypothesis, he added.
Nicotine patches and other pharmacotherapies appear to be slightly more effective than are behavioral interventions. In a separate meta-analysis, Mr. Mottillo's coinvestigators found that motivated patients given pharmacotherapeutic help were roughly twice as likely to quit smoking as controls. However, there has not been a randomized trial comparing behavioral and pharmacologic interventions, Mr. Mottillo noted.