Stopping Smoking?

Diana Sanders, of the London School of Hygiene and Tropical Medicine, published a review of smoking cessation interventions in 1992. The review was commissioned by the Health Education Authority to examine the effectiveness of interventions aimed at encouraging people to stop smoking while they are patients in the health service. Interventions in both primary care and secondary care settings were included.

The document includes an overview of the research, a critique of the evidence for effectiveness of interventions, recommendations and a detailed bibliography with abstracts of key papers.

Inclusion criteria

Published literature on smoking cessation interventions from the 1970s to 1991 were sought from clearly identified sources. Articles included in the review had to meet at least one of the following criteria:-

a minimum of 100 subjects in each study group.
randomisation of the intervention.
follow up for a minimum of one year.
validation of smoking status in some or all of the study group.
an intervention used as part of, or in addition to routine care.

Over 100 references were identified and 68 abstracts are listed. No formal meta-analysis is included.

Primary care

In primary care the evidence from many trials demonstrated that even brief, one-off advice from the GP to stop smoking in the context of a general consultation is effective in helping a small but statistically and clinically significant number of people to stop smoking, and remain non-smokers for at least a year. Success rates can be boosted by:

offering smokers health education and self-help booklets
emphasising to smokers the short-term benefits of stopping smoking rather than dwelling on long-term dangers
negotiating a date to stop smoking
warning smokers that they will be asked about their progress on subsequent visits
the use of nicotine replacement therapy in selected individuals (see Bandolier 9 for a review of nicotine replacement)

Whilst GPs may be most effective in offering brief advice, practice and community nurses, or counsellors, can offer more intensive intervention and support.

Supporting the supporters

Although brief advice and support to stop smoking may achieve long-term cessation rates of 5%, this still means that for every "success" primary care staff will offer many episodes of smoking cessation advice with little response. Thus encouragement and support of the primary care team is needed to motivate them to invest time and energy in helping smokers stop.

General medical outpatients

In the general medical outpatient setting the small number of trials indicate that advice to stop smoking is as effective as that provided by GPs. For smokers who have diseases caused by smoking, pregnant smokers, and patients who have suffered from myocardial infarction, brief advice with follow-up in the form of letters or follow-up clinics increases the cessation rate.

This comprehensive report, which would be valuable to anyone planning a smoking cessation service, indicates that health professionals can help a significant number of individuals stop smoking, and that higher cessation rates can be achieved by increasing the intensity and level of support offered to smokers. Motivating health professionals to offer consistent help to smokers and supporting them in their efforts to encourage smokers to stop is a priority.

Dr Selena Gray
Clinical Advisor, Regional R&D Directorate, Bristol.

Diana Sanders. "Smoking Cessation Interventions: Is Patient Education Effective?" 1992 ISSN: 0962-6115.

Copies of the report (£10) are available from the Health Promotion Sciences Unit, London School of Hygiene and Tropical Medicine, Tel 0171 927 2404.

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