Background
Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully.
Objectives
The aims of ...this review were to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups.
Search methods
We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018.
Selection criteria
We included randomised trials of smoking cessation with follow‐up of at least six months, where at least one arm tested print‐based materials providing self‐help compared with minimal print‐based self‐help (such as a short leaflet) or a lower‐intensity control. We defined 'self‐help' as structured programming for smokers trying to quit without intensive contact with a therapist.
Data collection and analysis
We extracted data in accordance with standard methodological procedures set out by Cochrane. The main outcome measure was abstinence from smoking after at least six months' follow‐up in people smoking at baseline. We used the most rigorous definition of abstinence in each study and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a random‐effects model.
Main results
We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.
Thirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).
Thirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.
Five studies evaluated self‐help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes.
Authors' conclusions
Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded. Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.
Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
The primary objectives are to summarise the evidence from Cochrane Reviews that assessed the effect of ...behavioural interventions designed to support smoking cessation attempts, and address the following two questions:
How do modes of delivery, person delivering the intervention, and the behavioural and motivational components of behavioural interventions for smoking cessation compare with each other in achieving abstinence at follow‐up of six months or longer?
Do the effects of behavioural interventions vary by other characteristics, including population, setting, and length of intervention?
The secondary objective of this review is to summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost‐effectiveness, in the form of a brief economic commentary.
Aims
To investigate the comparative and combined effectiveness of four types of components of behavioural interventions for cigarette smoking cessation: behavioural (e.g. counselling), motivational ...(e.g. focus on reasons to quit), delivery mode (e.g. phone) and provider (e.g. nurse).
Design
Systematic review and component network meta‐analysis of randomised controlled trials identified from Cochrane reviews. Interventions included behavioural interventions for smoking cessation (including all non‐pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self‐help materials), compared with another behavioural intervention or no support. Building on a 2021 review (CD013229), we conducted three analyses, investigating: comparative effectiveness of the components, whether models that allowed interactions between components gave different results to models assuming additivity, and predicted effect estimates for combined effects of components that had showed promise but where there were few trials.
Setting
Community and health‐care settings.
Participants
Adults who smoke tobacco.
Measurements
Smoking cessation at ≥6 months, preferring sustained, biochemically validated outcomes where available.
Findings
Three hundred and twelve trials (250 563 participants) were included. Fifty were at high risk of bias using Cochrane risk of bias tool, V1 (ROB1); excluding these studies did not change findings. Head‐to‐head comparisons of components suggested that support via text message (SMS) compared with telephone (OR 1.48, 95% CrI 1.13–1.94) or print materials (OR 1.44, 95% CrI 1.14–1.83) was more effective, and individual delivery was less effective than delivery as part of a group (OR 0.78, 95% CrI 0.64–0.95). There was no conclusive evidence of synergistic or antagonistic interactions when combining components that were commonly used together. Adding multiple components that are commonly used in behavioural counselling suggested clinically relevant and statistically conclusive evidence of benefit. Components with the largest effects that could be combined, but rarely have been, were estimated to increase the odds of quitting between two and threefold. For example, financial incentives delivered via SMS, with tailoring and a focus on how to quit, had an estimated OR of 2.94 (95% CrI 1.91–4.52).
Conclusions
Among the components of behavioural support for smoking cessation, behavioural counselling and guaranteed financial incentives are associated with the greatest success. Incorporating additional components associated with effectiveness may further increase benefit, with delivery via text message showing particular promise.
Objectives
To evaluate effectiveness and acceptability of a novel intervention, based on self‐regulation theory, for weight loss.
Design
A two‐arm parallel group design was employed.
Methods
Adult ...participants with a BMI ≥ 30 kg/m2 and the aim to lose weight were recruited and randomized to either a control or intervention group. Both groups were asked to weigh themselves daily for eight weeks. The intervention group was encouraged to use a weight tracking app, and complete daily and weekly questionnaires to prompt action planning, reflection, and evaluation of actions. Participants chose daily actions from a menu of 53 behaviours. The primary outcome was weight change after 8 weeks, assessed using linear mixed effects models. At follow‐up, 20 intervention group participants were interviewed regarding their experiences in the trial.
Results
100 participants were recruited, and 98% were followed up at 8 weeks. Mean weight loss was −4.18 kg (SD = 3.84) in the intervention compared to −1.01 kg (SD = 2.67) in the control group; the adjusted difference was −3.20 kg (95% CI −4.49, −1.92). Participants rated the intervention’s usefulness as 8.25 (SD = 2.04) on a scale from 1 to 10. Adherence was a significant independent predictor of weight loss success (−1.54 kg per one SD, 95% CI −2.16, −0.93), but not a mediator of the intervention effect. Participants reported that the intervention enabled them to experiment with and identify effective weight loss actions.
Conclusions
Guiding participants through the self‐regulation process was feasible, acceptable to participants, and led to significantly greater short‐term weight loss than unguided self‐weighing.
Competitions for smoking cessation Fanshawe, Thomas R; Hartmann‐Boyce, Jamie; Perera, Rafael ...
Cochrane database of systematic reviews,
02/2019, Letnik:
2019, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background
Competitions might encourage people to undertake and/or reinforce behaviour change, including smoking cessation. Competitions involve individuals or groups having the opportunity to win a ...prize following successful cessation, either through direct competition or by entry into a lottery or raffle.
Objectives
To determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.
Search methods
This review has merged two previous Cochrane reviews. Here we include studies testing competitions from the reviews ‘Competitions and incentives for smoking cessation' and ‘Quit & Win interventions for smoking cessation'. We updated the evidence by searching the Cochrane Tobacco Addiction Group Specialized Register in June 2018.
Selection criteria
We considered randomized controlled trials (RCTs), allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post‐intervention measures in which participants were assigned to interventions by the investigators. Participants were smokers, of any age and gender, in any setting. Eligible interventions were contests, competitions, lotteries, and raffles, to reward cessation and continuous abstinence in smoking cessation programmes.
Data collection and analysis
For this update, data from new studies were extracted independently by two review authors. The primary outcome measure was abstinence from smoking at least six months from the start of the intervention. We performed meta‐analyses to pool study effects where suitable data were available and where the effect of the competition component could be separated from that of other intervention components, and report other findings narratively.
Main results
Twenty studies met our inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (N = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (N = 10,580). Five of these used Quit & Win contests (N = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomized or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (risk ratio (RR) 1.16, 95% confidence interval (CI) 0.77 to 1.74, N = 3201, I2 = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates.
The three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.
Reported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention.
Using the GRADE system we rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated.
Authors' conclusions
At present, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions. This is due to a lack of well‐designed comparative studies. Smoking cessation competitions have not been shown to enhance long‐term cessation rates. The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs. It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions. Future studies should be designed to compensate for the substantial biases in the current evidence base.
Background
Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS‐CoV‐2 through the stimulation of inflammation, functional ...immunologic deficit and a pro‐thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism.
Methods
Observational studies in COVID‐19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models.
Results
Eight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID‐19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43‐3.86) and 3.52 (1.32‐9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72‐18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years).
Conclusions
Excess adiposity is a risk factor for severe disease and mortality in people with SARS‐CoV‐2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS‐CoV‐2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures.
Systematic review registration: PROSPERO 2020: CRD42020179783.
Background and Aims
The Cochrane Tobacco Addiction Group (TAG) conducts systematic reviews of the evidence for tobacco cessation and prevention interventions. In 2016 TAG conducted a ...priority‐setting, stakeholder engagement project to identify where further research is needed in the areas of tobacco control and smoking cessation.
Design
The project comprised two surveys and a workshop. A range of stakeholders participated, including members of the public (smokers and ex‐smokers), clinicians, researchers, research funders, health‐care commissioners and public health organizations. The first survey phase identified unanswered research questions in the field of tobacco control. The second phase asked participants to rank these, with overall rankings calculated by combining scores across participants. The workshop allowed attendees to discuss prioritization of topics and questions in more depth. Workshop discussions were transcribed and analysed thematically, and a final voting activity at the close of the workshop allowed participants to choose topics to prioritize and to de‐prioritize.
Findings
A total of 304 stakeholders (researchers, health professionals, smokers and ex‐smokers, guideline developers, research funders and policymakers, representing 28 countries) identified 183 unanswered research questions. These were categorized into 15 research categories. A total of 175 participants prioritized categories and questions in the second survey phase, with ‘electronic cigarettes’; ‘addressing inequalities’; and ‘mental health and other substance abuse’ prioritized as the top three categories. Forty‐three stakeholders attended the workshop and discussed reasons for and against category prioritization. Prioritized research categories largely mirrored those in the survey stage, although ‘treatment delivery’ also emerged as a key category. Five cross‐cutting themes emerged: efficacy; relative efficacy; cost effectiveness; addressing inequalities; and different types of evidence.
Conclusions
There are many unanswered questions in the field of tobacco control. Stakeholders highlighted electronic cigarettes, addressing inequalities and mental health and other substance abuse as key areas for further research, and efficacy, relative efficacy, cost‐effectiveness and use of non‐randomized studies as important themes cutting across research areas. Future prioritization work would benefit from targeting non‐US and non‐UK stakeholders explicitly and from examining where priorities may differ based on stakeholder group.
Antidepressants for smoking cessation Hughes, John R; Stead, Lindsay F; Hartmann‐Boyce, Jamie ...
Cochrane database of systematic reviews,
01/2014, Letnik:
2016, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Background
There are at least three reasons to believe antidepressants might help in smoking cessation. Firstly, nicotine withdrawal may produce depressive symptoms or precipitate a major depressive ...episode and antidepressants may relieve these. Secondly, nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. Finally, some antidepressants may have a specific effect on neural pathways (e.g. inhibiting monoamine oxidase) or receptors (e.g. blockade of nicotinic‐cholinergic receptors) underlying nicotine addiction.
Objectives
The aim of this review is to assess the effect and safety of antidepressant medications to aid long‐term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); selegiline; sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine.
Search methods
We searched the Cochrane Tobacco Addiction Group Specialised Register which includes reports of trials indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO, and other reviews and meeting s, in July 2013.
Selection criteria
We considered randomized trials comparing antidepressant medications to placebo or an alternative pharmacotherapy for smoking cessation. We also included trials comparing different doses, using pharmacotherapy to prevent relapse or re‐initiate smoking cessation or to help smokers reduce cigarette consumption. We excluded trials with less than six months follow‐up.
Data collection and analysis
We extracted data and assessed risk of bias using standard methodological procedures expected by the Cochrane Collaboration.
The main outcome measure was abstinence from smoking after at least six months follow‐up in patients smoking at baseline, expressed as a risk ratio (RR). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta‐analysis using a fixed‐effect model.
Main results
Twenty‐four new trials were identified since the 2009 update, bringing the total number of included trials to 90. There were 65 trials of bupropion and ten trials of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long‐term cessation (44 trials, N = 13,728, risk ratio RR 1.62, 95% confidence interval CI 1.49 to 1.76). There was moderate quality evidence, limited by a relatively small number of trials and participants, that nortriptyline also significantly increased long‐term cessation when used as the sole pharmacotherapy (six trials, N = 975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 trials, N = 3487, RR 1.19, 95% CI 0.94 to 1.51) or nortriptyline (4 trials, N = 1644, RR 1.21, 95% CI 0.94 to 1.55) to nicotine replacement therapy (NRT) provides an additional long‐term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline appear to be equally effective and of similar efficacy to NRT (bupropion versus nortriptyline 3 trials, N = 417, RR 1.30, 95% CI 0.93 to 1.82; bupropion versus NRT 8 trials, N = 4096, RR 0.96, 95% CI 0.85 to 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four trials comparing bupropion to varenicline showed significantly lower quitting with bupropion than with varenicline (N = 1810, RR 0.68, 95% CI 0.56 to 0.83). Meta‐analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the confidence interval only narrowly missed statistical significance (33 trials, N = 9631, RR 1.30, 95% CI 1.00 to 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is unclear. Nortriptyline has the potential for serious side‐effects, but none have been seen in the few small trials for smoking cessation.
There was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1.22, N = 1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, N = 466, RR 0.70, 95% CI 0.64 to 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1.79, N = 827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, N = 147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John's wort (hypericum) (2 trials, N = 261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, N = 120, RR 0.70, 95% CI 0.24 to 2.07).
Authors' conclusions
The antidepressants bupropion and nortriptyline aid long‐term smoking cessation. Adverse events with either medication appear to rarely be serious or lead to stopping medication. Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement. Evidence also suggests that bupropion is less effective than varenicline, but further research is needed to confirm this finding. Evidence suggests that neither selective serotonin reuptake inhibitors (e.g. fluoxetine) nor monoamine oxidase inhibitors aid cessation.
Objective
To describe the development of the Oxford Food and Activity Behaviors (OxFAB) taxonomy and questionnaire to explore the cognitive and behavioral strategies used by individuals during weight ...management attempts.
Methods
The taxonomy was constructed through a qualitative analysis of existing resources and a review of existing behavior change taxonomies and theories. The taxonomy was translated into a questionnaire to identify strategies used by individuals. Think‐aloud interviews were conducted to test the face/concept validity of the questionnaire, and test–retest reliability was assessed in a sample of 138 participants.
Results
The OxFAB taxonomy consists of 117 strategies grouped into 23 domains. Compared to taxonomies used to describe interventions, around half of the domains and strategies identified are unique to the OxFAB taxonomy. The OxFAB questionnaire consists of 117 questions, one for each strategy from the taxonomy. Test–retest resulted in a mean PABAK score of 0.61 (SD 0.15). Questions were revised where appropriate.
Conclusions
The OxFAB taxonomy and questionnaire provide a conceptual framework to identify the cognitive and behavioral strategies used by individuals during attempts at weight control.
Food production is a major contributor to environmental damage. More environmentally sustainable foods could incur higher costs for consumers. In this review, we explore whether consumers are willing ...to pay (WTP) more for foods with environmental sustainability labels ('ecolabels'). Six electronic databases were searched for experiments on consumers' willingness to pay for ecolabelled food. Monetary values were converted to Purchasing Power Parity dollars and adjusted for country-specific inflation. Studies were meta-analysed and effect sizes with confidence intervals were calculated for the whole sample and for pre-specified subgroups defined as meat-dairy, seafood, and fruits-vegetables-nuts. Meta-regressions tested the role of label attributes and demographic characteristics on participants' WTP. Forty-three discrete choice experiments (DCEs) with 41,777 participants were eligible for inclusion. Thirty-five DCEs (n = 35,725) had usable data for the meta-analysis. Participants were willing to pay a premium of 3.79 PPP$/kg (95%CI 2.7, 4.89,
≤ 0.001) for ecolabelled foods. WTP was higher for organic labels compared to other labels. Women and people with lower levels of education expressed higher WTP. Ecolabels may increase consumers' willingness to pay more for environmentally sustainable products and could be part of a strategy to encourage a transition to more sustainable diets.
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