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European Heart Journal Advance Access originally published online on December 24, 2008
European Heart Journal 2009 30(6):718-730; doi:10.1093/eurheartj/ehn552
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials

Salvatore Mottillo1,2, Kristian B. Filion1,3,4, Patrick Bélisle4, Lawrence Joseph3,4, André Gervais5, Jennifer O'Loughlin6, Gilles Paradis3, Robert Pihl7, Louise Pilote3,4,8, Stephane Rinfret9, Michèle Tremblay10 and Mark J. Eisenberg1,3,*

1 Division of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite A-118, Montreal, Quebec, Canada H3T 1E2
2 Faculté de Médecine, Université de Montréal, Montréal, Canada
3 Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
4 Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Canada
5 Agence de la santé et des services sociaux, Direction de santé publique, Montréal, Canada
6 Département de Médecine Sociale et Préventive, Centre de Recherche du Centre, Hospitalier de l’Université de Montréal et Université de Montréal, Montréal, Canada
7 Department of Psychology, McGill University, Montréal, Canada
8 Division of Internal Medicine, McGill University Health Centre, Montréal, Canada
9 Division de Cardiologie, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
10 Développement des individus et des communautés, Institut national de santé publique, Montréal, Canada

Received 24 January 2008; revised 20 October 2008; accepted 19 November 2008; online publish-ahead-of-print 24 December 2008.

* Corresponding author. Tel: +1 514 340 8222 Ext. 3564, Fax: +1 514 340 7564, Email: mark.eisenberg{at}mcgill.ca

Aims: Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling.

Methods and results: We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84–2.78], individual counselling (OR 1.49, 95% CrI 1.08–2.07), group counselling (OR 1.76, 95% CrI 1.11–2.93), and telephone counselling (OR 1.58, 95% CrI 1.15–2.29).

Conclusion: Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

Key Words: Smoking cessation • Smoking abstinence • Minimal clinical intervention • Meta-analysis • Bayesian • Behavioural intervention • Counselling • Individual counselling • Group counselling • Telephone counselling


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