“Sick of Smoking”: evaluation of a targeted minimal smoking cessation intervention in general practice

Wilson, David H.; Wakefield, Melanie; Id, Steven; Rohrsheim, Richard; Esterman, Adrian; Graham, Neil M.H.

doi:10.5694/j.1326-5377.1990.tb125351.x

Cited by 77 publications

(36 citation statements)

References 27 publications

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“…It included information about health and social consequences of tobacco smoking, as well as of cessation, answers to the most often asked questions in relation to the negative effects of smoking cessation,3 19 and advice to stop. A special training session was organised for the physicians included in the strategy A, independent of another training session for the physicians in strategy B.…”

Section: Methodsmentioning

confidence: 99%

Smoking cessation at the workplace. Results of a randomised controlled intervention study

Lang

2000

Journal of Epidemiology &Amp; Community Health

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Objectives-To compare the eVects of a worksite intervention by the occupational physician oVering simple advice of smoking cessation with a more active strategy of advice including a "quit date" and extra support. Population-Employees of an electrical and gas company seen at the annual visit by their occupational physicians. Criteria end points-Smoking point prevalence defined as the percentage of smokers who were non-smokers at one year. Secondary criteria were the percentage of smokers who stopped smoking for more than six months and the diVerence in prevalence of smoking in both groups. Methods-Randomised controlled trial. The unit of randomisation was the work site physician and a random sample of the employees of whom he or she was in charge. The length of the follow up was one year. Each of 30 work site physicians included in the study 100 to 150 employees. Results-Among 504 subjects classified as smokers at baseline receiving simple advice (group A) and 591 the more active programme (group B), 68 (13.5%) in group A and 109 (18.4%) were nonsmokers one year later (p=0.03; p=0.01 taking the occupational physician as the statistical unit and using a nonparametric test). Twenty three subjects (4.6%) in group A and 36 (6.1%) in group B (p=0.26) declared abstinence of six months or more. Among non-smokers at baseline, 3.4% in both groups were smokers after one year follow up. The prevalence of smokers did not diVer significantly at baseline (32.9% and 32.4%, p=0.75). After the intervention the prevalence of smoking was 30.8% in group A and 28.7% in group B (p=0.19). An increase of the mean symptoms score for depression in those who quit was observed during this period. Despite the major impact of smoking, responsible for a significant proportion of several leading causes of mortality, such as cardiovascular diseases, lung cancer and chronic bronchitis, 1 the priority of smoking cessation has not yet ranked as high in medical activities as one might expect. Asking patients whether they smoke and advising them to quit is not common practice among physicians 2 despite the evidence of eYcacy of this practice.3-7 For example, less than 50% of smokers stated that their physicians had ever advised them to stop or reduce smoking.2 5 Physicians' practices have only slightly changed in recent years with respect to tobacco counselling. 8 More attention has been paid to the pharmacological help to nicotine dependent smokers than to the potential benefits of simple advice by health personal given to a large number of smokers who may quit or consider quitting after such a simple advice. Indeed, the great majority of smokers report they have quitted without any formal programme to help them. 9 Even if the success rates that can be expected by these mass strategies are much lower than those obtained among volunteers, the large numbers of potential quitters makes the mass strategy interesting from the population and public health point of view.In France, among the worksite physician responsibilities is an annual mandator...

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Section: Methodsmentioning

confidence: 99%

Smoking cessation at the workplace. Results of a randomised controlled intervention study

Lang

2000

Journal of Epidemiology &Amp; Community Health

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“…The descriptions of patients are shown in Tables 1 and 2. Thirteen studies in this review characterized patients as those visiting their physician for no specific presenting condition (Demers et al, 1990;Jamrozik, Vessey, and Fowler, 1984;Janz et al, 1987;McDowell, Mothersill, Rosser, and Hartman, 1985;Molyneaux et al, 2003;Pieterse et al, 2001;Richmond, Austin, and Webster, 1986;Russell, Wilson, Taylor, and Baker, 1979;Russell, Merriman, Stapleton, and Taylor, 1983;Sanders et al, 1989;Slama et al, 1990;Stewart and Prosser, 1982;Wilson et al, 1990). Patients who presented with or were recovering from untoward cardiac events (e.g., acute myocardial infarction, myocardial infarction survivors, or coronary problems) participated in four studies (Bolman, de Vries, and van Breukelen, 2002;Burt et al, 1974;Quist-Paulsen and Gallefoss, 2003;Taylor, Houston-Miller, Killeen, and DeBusk, 1990).…”

Section: Subjectsmentioning

confidence: 97%

“…Brief advice intervention vs. usual care. Demers 1990Jamrozik 1984Jamrozik 1984Jamrozik 1984Janz 1987Pieterse 2001RCBTS 1990Russell 1979Russell 1979Russell 1979Russell 1983Sanders 1989Sanders 1989Severson 1998Slama 1990Stewart 1982Stewart 1982Vetter 1990Wilson 1990 Total (95% CI) Tot al events Heterogeneity: Tau² = 0.13; Chi² = 42.72, df = 18 (P = 0.0009); I² = 58% Test for overall effect: Z = 4.53 (P < 0.00001) 1996RCBTS 1990RCBTS 1990RCBTS 1990Richmond 1986Severson 1998Slama 1990 To nnesen 1996…”

Section: Meta-analysismentioning

confidence: 97%

“…Physicians constituted the largest group of health professionals to provide a smoking cessation intervention in 16 studies (Demers et al, 1990;Haug, Fugelli, Aaro, and Foss, 1994;Hilberink et al, 2005;Jamrozik, Vessey, and Fowler, 1984;McDowell, Mothersill, Rosser, and Hartman, 1985;Morgan et al, 1996;Pieterse et al, 2001; Richmond, Austin, and Webster, 1986; Rose and Hamilton, 1978;Russell, Wilson, Taylor, and Baker, 1979;Russell, Merriman, Stapleton, and Taylor, 1983;Slama et al, 1990;Stewart and Prosser, 1982;Wilson et al, 1990). Nurses were the intervention providers in eight studies (Groner, Ahijevych, Grossman, and Rich, 2000;Quist-Paulsen and Gallefoss, 2003;Sanders et al, 1989;Taylor, Houston-Miller, Killeen, and DeBusk, 1990;Tonnesen et al, 1996;Vetter and Ford, 1990;Yilmaz, Karacan, Yoney, and Yilmaz, 2006).…”

Section: Health Professionalsmentioning

confidence: 98%

“…Six studies used cluster randomization and allocated either the health professional (Haug, Fugelli, Aaro, and Foss, 1994;Wilson et al, 1990) professional practice (Hilberink et al, 2005;Morgan et al, 1996;Severson et al, 1998) or geographical province (de Vries, Bakker, Mullen, and van Breukelen, 2006) to intervention or usual care. Two studies used cluster allocation with methods not consistent with randomization.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Advice as a smoking cessation strategy: A systematic review and implications for physical therapists

Bodner

Dean

2009

Physiotherapy Theory and Practice

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Although identified as a clinical priority, smoking cessation has been addressed minimally in the literature in the context of physical therapy practice. Smoking cessation advice delivered by a health professional can help smokers quit. The salient components of such advice however warranted elucidation to enable physical therapists to integrate this clinical competence into their practices. Therefore, we conducted a systematic review to elucidate the effectiveness of advice by a health professional and its components to optimize smoking cessation instituted in the context of physical therapy practice. Thirty source articles were identified. A random-effects model meta-analysis was used to assess the effectiveness of the advice parameters. Risk ratios (RRs) were used to estimate pooled treatment effects. RRs for brief, intermediate, and intensive advice were 1.74 (95% CI=1.37, 2.22), 1.71 (95% CI=1.39, 2.09), and 1.60 (95% CI=1.13, 2.27), respectively. Self-help materials, follow-up, and interventions based on psychological or motivational frameworks were particularly effective components of intermediate and intensive advice interventions. Advice can be readily integrated into physical therapy practice and used to initiate or support ongoing smoking cessation in clients irrespective of reason for referral. Incorporating smoking cessation as a physical therapy goal is consistent with the contemporary definition of the profession and the mandates of physical therapy professional associations to promote health and wellness, including smoking cessation for both primary health benefit and to minimize secondary effects (e.g., delayed healing and recovery, and medical and surgical complications). Thus, advice is an evidence-based strategy to effect smoking cessation that can be exploited in physical therapy practice. Further research to refine how best to assess smokers and, in turn, individualize brief smoking cessation advice could augment positive smoking cessation outcomes.

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An Analysis of the Effectiveness of Interventions Intended to Help People Stop Smoking

Law¹

1995

Arch Intern Med

384

153

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In a systematic review of the efficacy of interventions intended to help people stop smoking, data have been analyzed from 188 randomized controlled trials. Following personal advice and encouragement to stop smoking given by physicians during a single routine consultation, an estimated 2% (95% confidence limits, 1%, 3%; P < .001) of all smokers stopped smoking and did not relapse up to 1 year as a direct consequence of the advice. The effect is modest but cost-effective: the cost of saving a life is about $1500. Supplementary interventions (follow-up letters or visits, demonstration of spirometry, etc) have an additional effect--variable in extent. Advice and encouragement are particularly effective for smokers at special risk--pregnant women (efficacy; 8%) and patients with ischemic heart disease. Behavior modification techniques (relaxation, rewards and punishment, avoiding "trigger" situations, etc), in group or individual sessions led by a psychologist, have an effect that is statistically significant (P = .05) but no greater than simple advice by a physician (2%); yet, these techniques are several times more expensive. The effect of hypnosis is unproved (no trials have used biochemical markers). Nicotine replacement therapy is effective in an estimated 13% of smokers who seek help in cessation; the effect is greater in those who are nicotine-dependent. Other pharmacological treatments are not of proven efficacy, and acupuncture is ineffective. Sudden cessation or gradual reduction in smoking are similar in their efficacy on average. Physicians should take time to advise all their patients who smoke to quit. Smokers who are intent on stopping should be given additional support and encouraged to use nicotine replacement therapy.

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“Sick of Smoking”: evaluation of a targeted minimal smoking cessation intervention in general practice

Cited by 77 publications

References 27 publications

Smoking cessation at the workplace. Results of a randomised controlled intervention study

Smoking cessation at the workplace. Results of a randomised controlled intervention study

Advice as a smoking cessation strategy: A systematic review and implications for physical therapists

An Analysis of the Effectiveness of Interventions Intended to Help People Stop Smoking

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