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Nursing interventions for smoking cessation

  1. Virginia Hill Rice1,*,
  2. Jamie Hartmann-Boyce2,
  3. Lindsay F Stead2

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 12 AUG 2013

Assessed as up-to-date: 27 JUN 2013

DOI: 10.1002/14651858.CD001188.pub4


How to Cite

Rice VH, Hartmann-Boyce J, Stead LF. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub4.

Author Information

  1. 1

    Wayne State University, College of Nursing, Detroit, Michigan, USA

  2. 2

    University of Oxford, Department of Primary Care Health Sciences, Oxford, UK

*Virginia Hill Rice, College of Nursing, Wayne State University, 5557 Cass Avenue, Detroit, Michigan, 48202, USA. vrice@wayne.edu. vrice@cms.cc.wayne.edu.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 12 AUG 2013

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Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

 
Summary of findings for the main comparison. Nursing interventions for smoking cessation

Nursing interventions for smoking cessation

Patient or population: adult smokers
Settings: any
Intervention: cessation interventions delivered by nurses

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlNursing interventions

Smoking cessation at longest follow up (high and low intensity)
Follow-up: 6+ months
115 per 10001144 per 1000
(134 to 156)
RR 1.26
(1.17 to 1.36)
17629
(35 studies)
⊕⊕⊕⊝
moderate2,3
Pooled results from the below two subgroups

Smoking cessation at longest follow-up - High intensity intervention
Follow-up: 6+ months
137 per 10001172 per 1000
(160 to 186)
RR 1.26
(1.17 to 1.36)
13613
(28 studies)
⊕⊕⊕⊝
moderate2,3
High intensity = initial contact > 10 minutes, additional materials (e.g. manuals) and/or strategies other than simple leaflets, additional follow-up visits

Smoking cessation at longest follow-up - Low intensity intervention
Follow-up: 6+ months
51 per 1000164 per 1000
(50 to 82)
RR 1.27
(0.99 to 1.62)
4016
(7 studies)
⊕⊕⊕⊝
moderate2,4
Low intensity = advice provided (with or without a leaflet) during single consultation lasting 10 minutes or less with up to one follow-up visit

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Control group quit rate based on average across all included studies
2 Sensitivity analyses excluding studies at high or unclear risk of bias did not significantly alter the effect size
3 Unexplained statistical heterogeneity present
4 Total number of events < 300, confidence intervals include a significant effect and no effect

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

Tobacco-related deaths and disabilities are on the increase worldwide because of continued use of tobacco (mainly cigarettes). Tobacco use has reached epidemic proportions in many developing countries, while steady use continues in industrialized nations like the United States (The Tobacco Atlas 2012; CDC 2012). The following two factors may help to reduce the prevalence of cigarette smoking. According to the Centers for Disease Control, 68.8% of adult smokers in the USA want to quit and millions have attempted to quit (CDC 2011), with 70% of smokers visiting a healthcare professional each year (AHRQ 2008). Nurses, representing the largest number of healthcare providers worldwide, are involved in the majority of these visits and therefore, have the potential for a profound effect on the reduction of tobacco use (Youdan 2005).

Systematic reviews (e.g. Stead 2013) have confirmed the effectiveness of advice from physicians to stop smoking. The Agency for Health Care Research and Quality Clinical Practice Guideline (AHRQ 2008) lists nurses as one of the many providers from whom advice to stop smoking could increase quit rates, but identifies the effectiveness of advice to quit smoking given by clinicians other than physicians (including nurses) as an area requiring further research. The American Nurses Association (ANA 2012) wrote that nurses have tremendous potential to implement smoking cessation interventions effectively and advance tobacco use reduction goals proposed by Healthy People 2010, and noted that nurses must be equipped to assist with smoking cessation, prevent tobacco use, and promote strategies to decrease exposure to second-hand smoke. The American Nurses Association/American Nurses Foundation promotes the mission of Tobacco-Free Nurses to the nation’s registered nurses through its constituent associations, members, and organizational affiliates (ANA 2012).

A review of nursing's specific role in smoking cessation is essential if the profession is to endorse the International Council of Nurses (ICN) call to encourage nurses to "...integrate tobacco use prevention and cessation ... as part of their regular nursing practice" (ICN 2012).

The aim of this review is to examine and summarize randomized clinical trials where nurses provided smoking cessation interventions. The review therefore focuses on the nurse as the intervention provider, rather than on a particular type of intervention. Smoking cessation interventions targeting pregnant women are not included here, because of the particular circumstances and motivations among this population. Interventions for pregnant smokers have been reviewed elsewhere (Lumley 2009; Coleman 2012).

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

The primary objective of this review was to determine the effectiveness of nursing-delivered interventions on smoking behaviour in adults. A priori study hypotheses were that nursing-delivered smoking cessation interventions:
(i) are more effective than no intervention;
(ii) are more effective if the intervention is more intensive;
(iii) differ in effectiveness with health state and setting of the participants;
(iv) are more effective if they include follow-ups;
(v) are more effective if they include aids that demonstrate the pathophysiological effect of smoking.

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Inclusion criteria for studies were:
(i) they had to have at least two treatment groups;
(ii) allocation to treatment groups must have been stated to be 'random'.
Studies that used historical controls were excluded.

 

Types of participants

Participants were adult smokers, 18 years and older, of either gender and recruited in any type of healthcare or other setting. The only exceptions were studies that had exclusively recruited pregnant women. Trials in which 'recent quitters' were classified as smokers were included, but sensitivity analyses were performed to determine whether they differed from trials that excluded such individuals.

 

Types of interventions

Nursing intervention was defined as the provision of advice, counselling, and/or strategies to help people quit smoking. The review includes cessation studies that compared usual care with an intervention, brief advice with a more intensive smoking cessation intervention or different types of interventions. Studies of smoking cessation interventions as a part of multifactorial lifestyle counselling or rehabilitation were included only if it was possible to discern the specific nature and timing of the intervention, and to extract data on the outcomes for those who were smokers at baseline. Advice was defined as verbal instructions from the nurse to 'stop smoking' whether or not information was provided about the harmful effects of smoking. Interventions were grouped into low and high intensity for comparison. Low intensity was defined as trials where advice was provided (with or without a leaflet) during a single consultation lasting 10 minutes or less with up to one follow-up visit. High intensity was defined as trials where the initial contact lasted more than 10 minutes, there were additional materials (e.g. manuals) and/or strategies other than simple leaflets, and usually participants had more than one follow-up contact. Studies where participants were randomized to receive advice versus advice plus some form of nicotine replacement therapy (NRT) were excluded, since these were primarily comparisons of the effectiveness of NRT rather than nursing interventions. These are covered in a separate review (Stead 2012).

 

Types of outcome measures

The principal outcome was smoking cessation rather than a reduction in withdrawal symptoms or a reduction in the number of cigarettes smoked. Trials had to report follow-up of at least six months for inclusion in the review. We excluded trials which did not include data on smoking cessation rates. We used the strictest available criteria to define abstinence in each study, e.g. sustained cessation rather than point prevalence. Where biochemical validation was used, only participants meeting the biochemical criteria for cessation were regarded as abstainers. Participants lost to follow-up were regarded as continuing smokers (in intention-to-treat analyses).

 

Search methods for identification of studies

We searched the Tobacco Addiction Review Group Specialized Register for trials (most recent search June 2013). This Register includes trials located from systematic searches of MEDLINE, EMBASE and PsycINFO and handsearching of specialist journals, conference proceedings, and reference lists of previous trials and overviews. At the time of the search the Register included the results of searches of the Cochrane Central Register of Controlled trials (CENTRAL), 2013, Issue 6 ; MEDLINE (via OVID) to update 20130607; EMBASE (via OVID) to week 201324; PsycINFO (via OVID) to update 20130610. See the Tobbaco Addiction Group module in The Cochrane Library for full search strategies and list of other resources searched. We checked all trials with 'nurse*' or 'nursing' or 'health visitor' in the title, abstract, or keywords for relevance. See Appendix 1 for the search strategy. We also searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on OVID for 'nursing' and 'smoking cessation' from 1983 to June 2013.

 

Data collection and analysis

 

Selection of studies

One review author screened titles and abstracts. Where there was uncertainty, we requested the full text. Two review authors checked the full text of articles flagged for inclusion, with discrepancies resolved via discussion or by referral to a third review author.

 

Data extraction and management

The authors extracted data from the published reports independently. Disagreements were resolved by referral to a third person. For each trial, the following data were extracted: (i) author(s) and year; (ii) country of origin, study setting, and design; (iii) number and characteristics of participants and definition of 'smoker'; (iv) description of the intervention and designation of its intensity (high or low); and (v) outcomes and biochemical validation.

 

Assessment of risk of bias in included studies

We used the Cochrane 'Risk of bias' tool to assess bias in four domains:

  • random sequence generation (a potential source of selection bias);
  • allocation concealment (also a potential source of selection bias);
  • incomplete outcome data (attrition bias);
  • other biases.

We did not judge the trials on the basis of blinding, as we tested behavioural interventions where blinding of participants and providers is not possible.

We judged each included study to be at high, unclear, or low risk of bias in each of the above domains according to the guidelines in the Cochrane Handbook.

 

Measures of treatment effect

We use the risk ratio (RR) for summarizing individual trial outcomes and for the estimate of the pooled effect. Where we judged a group of studies to be sufficiently clinically and statistically homogeneous we used the Mantel-Haenszel fixed-effect method (Greenland 1985) to calculate a weighted average of the risk ratios of the individual trials, with 95% confidence intervals.

 

Dealing with missing data

In trials where the details of the methodology were unclear or where the results were expressed in a form that did not allow for extraction of key data, we approached the original investigators for additional information. We treated participants lost to follow-up as continuing smokers. We excluded from totals only those participants who died before follow-up or were known to have moved to an untraceable address.

 

Assessment of heterogeneity

To assess statistical heterogeneity between trials we used the I² statistic (Higgins 2003). This measures the percentage of total variation across studies due to heterogeneity rather than to chance. Values of I² over 75% indicate a considerable level of heterogeneity (Chapter 8, Cochrane Handbook).

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
 

Description of studies

 

Included studies

Forty-nine trials met the inclusion criteria, of which seven were new for this update (Duffy 2006; Aveyard 2007; Jiang 2007; Wood 2008; Meysman 2010; Cossette 2011; Chan 2012). Longer-term follow-up was reported for two trials (Hilberink 2005; Hanssen 2007) and the data they contributed to the meta-analysis were updated. Trials were of nursing interventions for smoking cessation for adults who used tobacco (primarily cigarettes), published between 1987 and 2012. One trial (Sanders 1989a; Sanders 1989b) had two parts with randomization at each stage, so is treated here as two separate studies, making a total of 50 studies in the Characteristics of included studies table. Thirty-five studies contributed to the primary meta-analysis that compared a nursing intervention to a usual care or minimal intervention control. Eleven studies included a comparison between two nursing interventions, involving different components or different numbers of contacts. Six studies did not contribute to a meta-analysis and their results are described separately. Sample sizes of studies contributing to a meta-analysis ranged from 25 to 2700 but were typically between 150 and 500.

Seventeen trials took place in the USA, ten in the UK, four in Canada, and two each in Australia, China, Denmark, Japan, The Netherlands, Norway and Spain. One trial was reported from Belgium, South Korea and Sweden. One multicenter study was conducted in multiple European countries.

Twenty trials intervened with hospitalized participants (Taylor 1990; Rigotti 1994; DeBusk 1994; Allen 1996; Carlsson 1997; Miller 1997; Lewis 1998; Feeney 2001; Bolman 2002; Hajek 2002, Quist-Paulsen 2003; Froelicher 2004; Hasuo 2004; Chouinard 2005; Hennrikus 2005; Nagle 2005; Hanssen 2007; Wood 2008; Meysman 2010; Cossette 2011). One trial (Rice 1994) recruited hospitalized participants, but with follow-up after discharge. Twenty-four studies recruited from primary care or outpatient clinics (Janz 1987; Sanders 1989a/Sanders 1989b; Risser 1990; Vetter 1990; Nebot 1992; Hollis 1993; OXCHECK 1994; Family Heart 1994; Tonnesen 1996; Campbell 1998; Lancaster 1999; Steptoe 1999; Canga 2000; Aveyard 2003; Ratner 2004; Tonnesen 2006; Kim 2005; Hilberink 2005; Duffy 2006; Sanz-Pozo 2006; Aveyard 2007; Jiang 2007; Wood 2008; Chan 2012). In some trials, the recruitment took place during a clinic visit whilst in others the invitation to enrol was made by letter. One study (Terazawa 2001) recruited employees during a workplace health check, two enrolled community-based adults motivated to make a quit attempt (Davies 1992; Alterman 2001), one recruited mothers taking their child to a pediatric clinic (Curry 2003) and one recruited people being visited by a home healthcare nurse (Borrelli 2005).

Fifteen of the studies focused on adults with diagnosed cardiovascular health problems (Taylor 1990; DeBusk 1994; Family Heart 1994; Rice 1994; Rigotti 1994; Allen 1996; Carlsson 1997; Miller 1997; Campbell 1998; Feeney 2001; Bolman 2002; Hajek 2002; Jiang 2007; Cossette 2011; Chan 2012 (subgroup with cardiovascular disease)); two studies were with participants with respiratory diseases (Tonnesen 1996; Tonnesen 2006) and one with participants with diabetes (Canga 2000). One study recruited participants either with diagnosed cardiovascular health problems or judged to be at high risk of developing heart disease (Wood 2008). Two studies recruited surgical patients: Ratner 2004 recruited people attending a surgical pre-admission clinic and Meysman 2010 recruited people admitted to surgical wards. One study recruited head and neck cancer patients at four medical centres (Duffy 2006).

All studies included adults 18 years and older who used some form of tobacco. Allen 1996, Curry 2003 and Froelicher 2004 studied women only, and Terazawa 2001 men only. The definition of tobacco use varied and in some cases included recent quitters.

Seven of the studies examined a smoking cessation intervention as a component of multiple risk factor reduction interventions in adults with cardiovascular disease (DeBusk 1994; Allen 1996; Carlsson 1997; Campbell 1998; Hanssen 2007; Jiang 2007; Wood 2008). In four studies, the smoking cessation component was clearly defined, of high intensity, and independently measurable (DeBusk 1994; Allen 1996; Carlsson 1997; Jiang 2007), whereas in the remaining three the smoking component was less clearly specified (Campbell 1998; Hanssen 2007; Wood 2008).

Thirty-five studies with a total of over 17,000 participants contributed to the main comparison of nursing intervention versus control. We classified 28 as high intensity on the basis of the planned intervention, although in some cases implementation may have been incomplete. In seven, we classified the intervention as low intensity (Janz 1987; Vetter 1990; Davies 1992; Nebot 1992; Tonnesen 1996; Aveyard 2003; Nagle 2005). All of these were conducted in outpatient, primary care or community settings. One further study (Hajek 2002) may be considered as a comparison between a low intensity intervention and usual care. Participants in the usual care control group received systematic brief advice and self-help materials from the same nurses who provided the intervention. Unlike the other trials in the low intensity subgroup, this trial was conducted amongst inpatients with cardiovascular disease. Since the control group received a form of nursing intervention, we primarily classified the trial as a comparison of two intensities of nursing intervention. But since other studies had usual care groups that may have received advice from other healthcare professionals, we also report the sensitivity of the main analysis results to including it there as a low intensity nursing intervention compared to usual care control.

Hajek 2002 and ten other studies contributed to a second group comparing two interventions involving a nursing intervention. Three of these tested additional components as part of a session: demonstration of carbon monoxide (CO) levels to increase motivation to quit (Sanders 1989b); CO and spirometry feedback (Risser 1990); and CO feedback plus additional materials and an offer to find a support buddy (Hajek 2002). Five involved additional counselling sessions from a nurse (Alterman 2001; Feeney 2001; Tonnesen 2006; Aveyard 2007; Jiang 2007). One other study compared two interventions with a usual-care control (Miller 1997). The minimal intervention condition included a counselling session and one telephone call after discharge from hospital. In the intensive condition, participants received three additional telephone calls, and those who relapsed were offered further face-to-face meetings, and nicotine replacement therapy if needed. We classified both interventions as intensive in the main meta-analysis, but compared the intensive and minimal conditions in a separate analysis of the effect of additional follow-up. Chouinard 2005 also assessed the effect of additional telephone support as an adjunct to an inpatient counselling session, so is pooled in a subgroup with Miller 1997. We included in the same subgroup a study that tested additional telephone follow-up as a relapse prevention intervention for people who had inpatient counselling (Hasuo 2004).

Five studies (Family Heart 1994; OXCHECK 1994; Campbell 1998; Steptoe 1999; Wood 2008) were not included in any meta-analysis and do not have results displayed graphically because their designs did not allow appropriate outcome data to be extracted. The first part of a two-stage intervention study is also included here (Sanders 1989a); the second part (Sanders 1989b) is included in one of the meta-analyses. These six studies are discussed separately in the results.

We determined whether the nurses delivering the intervention were providing it alongside clinical duties that were not smoking-related, were working in health promotion roles, or were employed specifically as project nurses. Of the high intensity intervention studies, 12 used nurses for whom the intervention was a core component of their role (Hollis 1993; DeBusk 1994; Allen 1996; Carlsson 1997; Terazawa 2001; Quist-Paulsen 2003; Froelicher 2004; Duffy 2006; Aveyard 2007; Meysman 2010; Cossette 2011; Chan 2012). In nine studies the intervention was delivered by a nurse specifically employed by the project (Taylor 1990; Rice 1994; Rigotti 1994; Miller 1997; Lewis 1998; Canga 2000; Hennrikus 2005; Hanssen 2007; Jiang 2007). In four of these, the same nurse provided all the interventions (Rigotti 1994; Lewis 1998; Canga 2000; Jiang 2007). One study (Kim 2005) employed retired nurses who were trained to provide a brief intervention using the '5 As' framework. In only four studies were intensive interventions intended to be delivered by nurses for whom it was not a core task (Lancaster 1999; Bolman 2002; Curry 2003; Sanz-Pozo 2006). Most of the low intensity interventions were delivered by primary care or outpatient clinic nurses. One low-intensity inpatient intervention was delivered by a clinical nurse specialist (Nagle 2005).

Follow-up periods for reinforcement and outcome measurements varied across studies, with a tendency for limited reinforcement and shorter follow-up periods in the older studies. All trials had some contact with participants in the first three months of follow-up for restatement of the intervention and/or point prevalence data collection. Five of the studies had less than one year final outcome data collection (Janz 1987; Vetter 1990; Davies 1992; Lewis 1998; Canga 2000). The rest had follow-up at one year or beyond. Outcome used for the meta-analysis was the longest follow-up (six months and beyond), with the exception of Hanssen 2007 in which 12-month data were used in preference over 18-month data. The outcome in this study was point prevalence abstinence and the 18-month data were judged to be too conservative due to a rise in abstinent participants in the control group. There was no evidence from a subgroup analysis that the differences in length of follow-up explained any of the heterogeneity in study results.

A brief description of the main components of each intervention is provided in the 'Characteristics of included studies' table.

 

Excluded studies

Fifty-four studies that we had identified as potentially relevant based on title and abstract were excluded upon screening the full text. These are listed in the Characteristics of excluded studies table along with the reason for exclusion for each. The most common reasons for exclusion were: study design (not a randomized clinical trial); less than six months follow-up; multicomponent studies with insufficient detail on smoking intervention/outcome; and studies in which the impact of the nursing intervention was confounded by additional pharmacological or behavioural treatment that was not provided to the control arm.

 

Risk of bias in included studies

As seen in Figure 1, the majority of studies were judged to be at low or unclear risk of selection bias (random sequence generation and allocation concealment) and attrition bias (loss to follow-up).

 FigureFigure 1. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

 

Allocation

Twenty-four studies provided details of a method of random sequence generation judged to be at low risk of bias, and a further 20 studies did not report how the sequence was generated and were hence rated as unclear in this domain. Five studies were judged to be at high risk based on their reported methods of random sequence generation: Bolman 2002 was a cluster-randomized study in which some hospitals picked their allocation; in Curry 2003 participants drew a coloured ball from a bag; Davies 1992 allocated based on order of attendance; Hollis 1993 randomized participants based on health record number; and Sanders 1989a/Sanders 1989b randomized participants based on day of attendance. In addition to these five studies, three further studies in which providers rather than participants were randomized were judged to be at high risk of selection bias: Hilberink 2005 reported that self selection at practice level may have affected the results; in Janz 1987 allocation was determined by clinic session; and in Nebot 1992 the providers were also responsible for allocating participants, rendering allocation concealment impossible. A sensitivity analysis including only the results of studies judged to be at low risk of selection bias did not alter the main conclusions.

 

Incomplete outcome data

Twenty-seven studies that reported minimal to moderate loss to follow-up and accounted for all participants in their reporting were judged to be at low risk of attrition bias. A further 19 studies did not provide sufficient detail with which to judge likelihood of attrition bias and hence were rated as 'unclear' in this domain. Four studies were judged to be at high risk of attrition bias: in Feeney 2001, 79% of usual-care participants were not followed up; OXCHECK 1994 stated that their methods of accounting for missing participants may have overestimated the effect; in Sanders 1989a/Sanders 1989b only a subsample of participants from the control group was followed up; and in Steptoe 1999 overall drop-out rates were high and varied between intervention and control groups.

 

Other potential sources of bias

Definitions of abstinence ranged from single point prevalence to sustained abstinence (multiple point prevalence with self report of no slips or relapses). In one study (Miller 1997) we used validated abstinence at one year rather than continuous self-reported abstinence because only the former outcome was reported for disease diagnosis subgroups. Validation of smoking behaviour using biochemical analysis of body fluids (e.g. cotinine or thiocyanate) was reported in 15 (47%) of the 31 studies in the primary meta-analysis. Expired CO was used for validation in another six (24%) of the trials. One study tested CO levels only amongst people followed up in person (Curry 2003). Five others used some validation but did not report rates based on biochemical validation of every self-reported quitter (Nebot 1992; Rice 1994; Miller 1997; Froelicher 2004; Borrelli 2005). Six studies (23%) did not use any biochemical validation and relied on self-reported smoking cessation at a single follow-up (Janz 1987; Allen 1996; Carlsson 1997; Bolman 2002; Hilberink 2005; Hanssen 2007), though two of these warned participants that samples might be requested for testing (i.e. 'bogus pipeline'). Where both self-reported and validated quitting were reported, the level of misreporting or failure to provide a sample is typically similar across intervention and control groups. One study, however, reported differential validation failure rates so that the significant differences based on self report were not found for validated abstinence (Hennrikus 2005); this study was judged to be at high risk of other bias.

Almost all the trials used convenience rather than randomly selected samples. Only one of the studies (Vetter 1990) did not let participants know initially that they were going to be part of a smoking cessation study. In most of the research, the basis for sample size was not specified a priori, nor was a retrospective power analysis conducted. Most studies did not report 'refusal to participate' rates.

 

Effects of interventions

See:  Summary of findings for the main comparison Nursing interventions for smoking cessation

 

Effects of intervention versus control/usual care

Smokers offered advice by a nursing professional had an increased likelihood of quitting compared to smokers without intervention, with evidence of only moderate statistical heterogeneity between the results of the 35 studies contributing to this comparison (I² = 50%). Heterogeneity was marginally more apparent in the subgroup of 28 high-intensity trials (I² = 54%). There was one trial with a significant negative effect for treatment (Rice 1994) and two with particularly large positive effects (Canga 2000; Terazawa 2001). Pooling all 35 studies using a fixed-effect model gave a risk ratio (RR) of 1.29 with a 95% confidence interval (CI) 1.20 to 1.39 at the longest follow-up (Figure 2,  Analysis 1.1). Because of the heterogeneity we tested the sensitivity to pooling the studies using a random-effects model. This did not materially alter the estimated effect size or greatly widen the confidence intervals (RR 1.32, 95% CI 1.17 to 1.49). A sensitivity analysis excluding the three outlying trials widened the CIs but did not alter the point estimate whilst greatly reducing statistical heterogeneity not attributable to chance in the high intensity subgroup (I² = 7%).

 FigureFigure 2. Trials of nursing intervention versus control grouped by intensity of intervention. Outcome: Smoking cessation at longest follow-up.

We also tested the sensitivity of these results to excluding studies that did not validate all reports of abstinence, limiting the analysis to studies judged to be at low risk of selection bias and excluding studies with less than 12 months follow-up. None of these altered the estimates to any great extent, although confidence intervals became wider due to the smaller number of studies. Excluding one study (Bolman 2002) for which we were not able to enter the numbers of quitters directly did not alter the results.

Some participants in Taylor 1990 had been encouraged to use nicotine replacement therapy (NRT). Exclusion of these people did not alter the significant effect of the intervention in this study. In Miller 1997 more people in the intervention conditions than the control used NRT (44% of intensive and 39% of minimal intervention versus 29% of control). People who were prescribed NRT had lower quit rates than those who were not, but the relative differences in quit rates between the usual-care and intervention groups were similar for the subgroups that did and did not use NRT. However, because of the different rates of use of NRT, it is probable that the increased use of NRT contributed to the effects of the nursing intervention. Use of NRT was also encouraged as part of the Canga 2000 intervention, with 17% of the intervention group accepting a prescription, and as part of the Duffy 2006 intervention, although at six months similar percentages in the intervention and control group had used NRT over the course of the study.

 

Effect of intervention intensity

We detected no evidence from our indirect comparison between subgroups that the trials we classified as using higher intensity interventions had larger treatment effects. In this update of the review the point estimate for the pooled effect of the seven lower-intensity trials is effectively the same as for the 28 of higher intensity, although for the low-intensity group the confidence interval does not exclude 1 (high-intensity subgroup RR 1.26, 95% CI 1.17 to 1.36; low-intensity subgroup RR 1.27, 95% CI 0.99 to 1.62). In a sensitivity analysis we included Hajek 2002, a study for which we were uncertain over the classification of the control group (as noted above in the Description of studies section), in the low-intensity subgroup. Including this study in the low-intensity subgroup further reduces the point estimate and there was no evidence of a treatment effect (RR 1.09, 95% CI 0.92 to 1.29). Compared to the other trials in the low-intensity subgroup, the Hajek trial was conducted amongst hospitalized participants with cardiovascular disease and the overall quit rates were high. The large number of events gave this trial a high weight in the meta-analysis.

The distinction between low- and high-intensity subgroups was based on our categorization of the intended intervention. Low levels of implementation were particularly noted in the trial reports for Lancaster 1999, Bolman 2002 and Curry 2003, so we tested the effect of moving them from the high- to the low-intensity subgroup. This reduced the point estimate of effect in the low-intensity subgroup and increased it in the high-intensity one. If these three studies and Hajek 2002 are included in the low-intensity subgroup, the pooled estimate of effect is small and non-significant (RR 1.09, 95% CI 0.96 to 1.25,  Analysis 4.1). We also assessed the sensitivity of the results to using additional participants in the control group for Aveyard 2003 (see Characteristics of included studies for details). This reduced the size of the effect in the low-intensity subgroup but did not alter our conclusions.

 

Effects of differing health states and client settings

Trials in hospitals recruited participants with health problems, but some trials specifically recruited those with cardiovascular disease, and amongst these, some interventions addressed multiple risks whilst most only addressed smoking. Trials in primary care generally did not select participants with a particular health problem. We combined setting and disease diagnosis in one set of subgroups ( Analysis 2.1).
Five trials that included a smoking cessation intervention from a nurse as part of cardiac rehabilitation showed a significant pooled effect on smoking (RR 1.35, 95% CI 1.14 to 1.59). Four of these (Allen 1996; Carlsson 1997; Hanssen 2007; Jiang 2007) did not use biochemical validation of quitting, and in the fifth (DeBusk 1994) we were unable to confirm the proportion of drop-outs with the study authors.
There was moderate heterogeneity (I² = 50%) amongst seven trials in hospitalized smokers with cardiovascular disease, due to the strong intervention effect in one of the seven trials (Taylor 1990). The estimated RR was 1.29 (95% CI 1.14 to 1.45) and the effect remained significant if Taylor 1990 was excluded or if a random-effects model was used. A sensitivity analysis of the effect of including Hajek 2002 in this category increased the heterogeneity (I² = 60%), and the pooled effect was just significant whether a fixed-effect or a random-effects model was used ( Analysis 5.1). Excluding Taylor 1990 again removed heterogeneity but the pooled effect was then small and not significant (RR 1.1, 95% CI 0.99 to 1.26, analysis not shown).
Amongst the six trials in non-cardiac hospitalized smokers the risk ratio was small and the confidence interval did not exclude no effect (RR 1.09, 95% CI 0.94 to 1.28). We included in this subgroup one trial that began the intervention in a pre-admission clinic for elective surgery patients (Ratner 2004).
Heterogeneity was high (I² = 94%) between two trials of interventions delivered to non-hospitalized adults with cardiovascular disease,(Rice 1994; Chan 2012;). Subgroup analysis in Rice 1994, however, suggested that smokers who had experienced cardiovascular bypass surgery were more likely to quit, and these participants were over-represented in the control group who received advice to quit but no structured intervention.
Pooling 15 trials of cessation interventions for other non-hospitalized adults showed an increase in the success rates (RR 1.81, 95% CI 1.48 to 2.22). A sensitivity analysis testing the effect of excluding those trials (Janz 1987; Vetter 1990; Curry 2003; Hilberink 2005) where a combination of a nursing intervention and advice from a physician was used did not substantially alter this.

 

Higher versus lower intensity interventions

 

Effects of physiological feedback

Two trials (Sanders 1989b; Risser 1990) that evaluated the effect of physiological feedback as an adjunct to a nursing intervention failed to detect an effect at maximum follow-up ( Analysis 3.1.1).

 

Effects of other components at a single contact

One trial in hospitalized smokers with cardiovascular disease (Hajek 2002) failed to detect a significant benefit of additional support from a nurse giving additional written materials, a written quiz, an offer of a support buddy, and carbon monoxide measurement compared to controls receiving brief advice and a self-help booklet (RR 0.91, 95% CI 0.73 to 1.13,  Analysis 3.1.2).

 

Effects of additional telephone support

There was weak evidence from pooling three trials that additional telephone support increased cessation, as the lower limit of the confidence interval was at the boundary of no effect (RR 1.25, 95% CI 1.00 to 1.56;  Analysis 3.2.1).

 

Effects of additional face-to-face sessions

One trial of additional support from an alcohol and drug assessment unit nurse for people admitted to a coronary care unit (Feeney 2001) showed a very significant benefit for the intervention. The cessation rate among the controls, however, was very low (1/97), and there were a large number of drop-outs, particularly from the control group. This could have underestimated the control group quit rate. In another trial (Alterman 2001), offering four nurse sessions rather than one as an adjunct to nicotine patch showed no benefit, with the control group having a significantly higher quit rate (RR 0.43, 95% CI 0.21 to 0.89,  Analysis 3.2.3). No explanation was offered for the lower than expected quit rates in the intervention group.

 

Effects of additional face-to-face sessions and telephone support

Pooled results from three trials did not show an effect of providing additional clinic sessions and telephone support to participants (RR 0.92, 95% CI 0.65 to 1.31,  Analysis 3.2.4).

 

Results of studies not included in the meta-analysis

We identified six studies (Sanders 1989a; Family Heart 1994; OXCHECK 1994; Campbell 1998; Steptoe 1999; Wood 2008) in which nurses intervened with primary care patients. All except Sanders 1989a addressed multiple cardiovascular risk factors, and all except Campbell 1998 and Wood 2008 targeted healthy people. Campbell 1998 recruited participants with coronary heart disease. Wood 2008 recruited general practice patients deemed to be at high risk of cardiovascular disease, and also recruited hospitalized participants with established coronary heart disease. Although they met the main inclusion criteria, in five of the trials the design did not allow for data extraction for meta-analysis in a comparable format to other studies. In the other (Sanders 1989a) only a random sample of the control group was followed up. We therefore discuss these trials separately.

Sanders 1989a, in which smokers visiting their family doctor were asked to make an appointment for cardiovascular health screening, reported that only 25.9% of the patients made and kept such an appointment. The percentage that had quit at one month and at one year and reported last smoking before the one-month follow-up was higher both in the attenders (4.7%) and the non-attenders (3.3%) than in the usual-care controls (0.9%). This suggests that the invitation to make an appointment for health screening could have been an anti-smoking intervention in itself, and that the additional effect of the structured nursing intervention was small.

We do not have comparable data for OXCHECK 1994, which used similar health checks, because the households had been randomized to be offered the health check in different years. The authors compared the proportions of smokers in the intervention group who claimed to have stopped smoking in the previous year to patients attending for their one-year follow-up, and to controls attending for their first health check. They found no difference in the proportions that reported stopping smoking in the previous year.

The Family Heart 1994 study offered nurse-led cardiovascular screening for men aged 40 to 59 and for their partners, with smoking cessation as one of the recommended lifestyle changes. Cigarette smokers were invited to attend up to three further visits. Smoking prevalence was lower amongst those who returned for the one-year follow up than amongst the control group screened at one year. This difference was reduced if non-returners were assumed to have continued to smoke, and if CO-validated quitting was used. In that case there was a reduction of only about one percentage point, with weak evidence of a true reduction.

Campbell 1998 invited people with a diagnosis of coronary heart disease to nurse-run clinics promoting medical and lifestyle aspects of secondary prevention. There was no significant effect on smoking cessation. At one year the decline in smoking prevalence was greater in the control group than in the intervention group. Four-year follow-up did not alter the effect of a lack of benefit.

Steptoe 1999 recruited people at increased risk of coronary heart disease for a multi-component intervention. The quit rate amongst smokers followed up after one year was not significantly higher in the intervention group (9.4%, 95% CI -9.6 to 28.3), and there was greater loss to follow-up of smokers in the intervention group.

Wood 2008 recruited people with established or increased risk of coronary heart disease for a multicomponent lifestyle intervention, coordinated by nurses. The authors report results separately for those participants recruited in hospital and those recruited in general practice. For coronary patients recruited in hospital who had smoked within one month at baseline, abstinence at one year favoured the intervention group (58% versus 47%), but the difference was not significant (P = 0.06). For participants at high risk of coronary heart disease recruited in general practice the prevalence of smoking fell from baseline but did not differ between conditions.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
 

Summary of main results

The results of this meta-analysis support a modest but positive effect for smoking cessation intervention by nurses, but with caution about the effects that can be expected if interventions are very brief or cannot be consistently delivered (see  Summary of findings for the main comparison). A structured smoking cessation intervention delivered by a nurse was more effective than usual care on smoking abstinence at six months or longer from the start of treatment. The direction of effect was consistent in different intensities of intervention, in different settings, and in smokers with and without tobacco-related illnesses. In a subgroup of low-intensity studies the confidence interval did not exclude no effect, but the point estimate was effectively the same as that in the larger group of high-intensity studies. There was also some evidence of statistical heterogeneity, although this was attributable to a very small number of outlying studies. In the one study (Rice 1994) that showed a statistically significantly higher quit rate in a control group, participants had been advised to quit and the control group included a significantly larger proportion of people who had had coronary artery bypass graft surgery. A multivariate analysis of one-year follow-up data in this study revealed that a quitter was significantly more likely to be less than 48 years, male, to have had individualized versus group or no cessation instruction, and to have had a high degree of perceived threat relative to their health state.

 

Overall completeness and applicability of evidence

Overall, these meta-analysis findings need to be interpreted carefully in light of the methodological limitations of both the review and the clinical trials. In terms of the review, it is possible that there was a publication selection bias due to using only tabulated data derived from published works (Stewart 1993). Data from the unpublished and/or missed studies could have shown more or less favourable results, though a funnel plot for the main comparison did not suggest the presence of reporting bias. Secondly, the results of a meta-analysis (based on the findings of many small trials) should be viewed with caution even when the combined effect is statistically significant (LeLorier 1997). In this analysis one study (Miller 1997) contributes 21% of the weight to the primary analysis, while the next largest contributes 11% of the weight. Finding statistical heterogeneity between the relative incidence of cessation in different studies limits any assumption that interventions in any clinical setting and with any type of participant are equally effective.

A difference among the studies that may have contributed to the differences in outcome was baseline cigarette use. There was an inverse relationship between number of cigarettes smoked per day and success in quitting; the more addicted the individuals, the more difficult it was for them to quit. Studies that recruited a higher proportion of lighter smokers or that included recent quitters could have achieved better results. Interestingly, the studies in the meta-analysis that reported the highest cigarette use rates had the weakest effect for the intervention (Davies 1992; Rice 1994). Although some trials included recent quitters in their recruitment, there was no evidence that these trials had different results.

The findings of this review, and in particular the estimated size of the treatment effect, have remained remarkably stable since its initial publication. In 1999. fifteen studies contributed to the main analysis, with a pooled risk ratio of 1.30 (95% CI 1.16 to 1.44). Further studies have more than doubled the number of participants and thus narrowed the CIs but have had little impact on the point estimate

 

Effectiveness by intervention characteristics and population

The effect estimates are similar for high- and low-intensity smoking cessation interventions by nurses, as was found in a review of physicians' advice (Stead 2013). Presumably, the more components added to the intervention the more intensive the intervention; however, assessing the contribution of factors such as total contact time, number of contacts, and content of the intervention was difficult. Our distinction between high and low intensity based on the length of initial contact and number of planned follow-ups may not have accurately distinguished among the key elements that could have contributed to greater efficacy. We found that the nature of the smoking cessation interventions differed from advice alone, to more intensive interventions with multiple components, and that the description of what constituted 'advice only' varied. In most trials, advice was given with an emphasis on 'stopping smoking' because of some existing health problem. To make most interventions more intensive, verbal advice was supplemented with a variety of counselling messages, including benefits and barriers to cessation (e.g. Taylor 1990) and effective coping strategies (e.g. Allen 1996). Manuals and printed self-help materials were also added to many interventions along with repeated follow-up (Hollis 1993; Miller 1997). In some studies, the proposed intervention was not delivered consistently to all participants. In recent updates the evidence for the benefit of a low-intensity intervention has become weaker than that for a more intensive intervention, and the estimated effect is sensitive to the inclusion of one additional study (Hajek 2002) and to the classification of intensity of three studies. Almost all the intensive interventions were delivered by either dedicated project staff or nurses with a health promotion role. Most studies in which the intensive intervention was intended to be delivered by a nurse with other roles reported problems in delivering the intervention consistently. None showed a statistically significant benefit for the intervention. We found no studies of brief opportunistic advice that were directly analogous to the low-intensity interventions used in physician advice trials (Stead 2013).

In two studies in the low-intensity category (Janz 1987; Vetter 1990), advice from a physician was also part of the intervention and this almost certainly contributed to the overall effect. The most highly weighted study in the high-intensity subgroup (Miller 1997) produced only relatively modest results. This was due in part to the effect of the minimal treatment condition that had just one follow-up telephone call. However, using just the high-intensity condition in the analysis did not materially alter the pooled estimate.

One study (Miller 1997) provided data on the effect of the same intervention in smokers with different types of illness and showed a greater effect in cardiovascular patients. In these individuals the intervention increased the 12-month quit rate from 24% to 31%, which just reached statistical significance. In other types of patients, the rates were increased from 18.5% to 21%, an effect that did not reach statistical significance. In this study participants were eligible if they had smoked any tobacco in the month prior to hospitalization, but were excluded if they had no intention of quitting (although they were also excluded if they wanted to quit on their own). These criteria may have contributed to the relatively high quit rates achieved. Also, a higher proportion of participants in the intensive treatment arm than in the minimal or usual care intervention arms were prescribed nicotine replacement therapy (NRT). However, the intervention was also effective in those not prescribed NRT. Those given NRT were heavier smokers (with higher levels of addiction) who achieved lower cessation rates than those who did not use NRT.

This suggests that nursing professionals may have an important 'window of opportunity' to intervene with patients in the hospital setting, or at least to introduce the notion of not resuming tobacco use on hospital discharge. The size of the effect may be dependent on the reason for hospitalization. The additional telephone support, with the possibility of another counselling session for people who relapsed after discharge, seemed to contribute to more favourable outcomes in the intensive intervention used by Miller 1997, although pooled results from three studies testing the addition of telephone counselling and further face-to-face contact did not detect an effect. A separate Cochrane review of the efficacy of interventions for hospitalized patients has been recently updated (Rigotti 2012), and this supports the efficacy of interventions for this patient group, but only when the interventions included post-discharge support for at least one month.

Providing additional physiological feedback in the form of spirometry and demonstrated carbon monoxide level as an adjunct to nursing intervention did not appear to have an effect. Three studies in primary care or outpatient settings used this approach (Sanders 1989b; Risser 1990; Hollis 1993). It was also used as part of the enhanced intervention in a study with hospitalized patients (Hajek 2002).

The identification of an effect for a nurse-mediated intervention in smokers who were not hospitalized is based on 15 studies. The largest study (Hollis 1993) increased the quit rate from 2% in those who received only advice from a physician to 4% when a nurse delivered one of three additional interventions, including a video, written materials, and a follow-up telephone call. Control group quit rates were less than 10% in almost all these studies, and more typically between 4% and 8%. The risk ratio in this group of studies (1.8) was a little higher than in some subgroups, but because of the low background quit rate the proportion of participants likely to become long-term quitters as a result of a nursing intervention in these settings is likely to be small. However, because of the large number of people who could be reached by nursing, the effect would be important.

The evidence is not strong for an effect of nurse counselling about smoking cessation when it is provided as part of a health check. It may be unrealistic to expect a benefit from this type of intervention. Two studies that invited smokers to make an appointment with a nurse for counselling (Lancaster 1999; Aveyard 2003) also had relatively poor results. In both cases the uptake of the intervention was reported to be poor, with participants reluctant to schedule visits.

Combined efforts of many types of healthcare professionals are likely to be required. The US Public Health Service clinical practice guideline 'Treating Tobacco Use and Dependence' (AHRQ 2008) used logistic regression to estimate efficacy for interventions delivered by different types of providers. Their analysis did not distinguish among the non-physician medical healthcare providers, so that dentists, health counsellors, and pharmacists were included with nurses. The guideline concluded that these providers were effective (Table 15, OR 1.7, 95% CI 1.3 to 2.1). They also concluded that interventions by multiple clinician types were more effective (Table 16, OR 2.5, 95% CI 1.9 to 23.4). Although it was recognized that there could be confounding between the number of providers and the overall intensity of the intervention, the findings confirmed that a nursing intervention that reinforces or complements advice from physicians and/or other healthcare providers is likely to be an important component in helping smokers to quit.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

 

Implications for practice

The results of this review indicate the potential benefits of interventions given by nurses to their patients. The challenge remains to incorporate smoking cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice to quit along with reinforcement and follow-up. Nicotine replacement therapy has been shown to improve quit rates when used in conjunction with counselling for behavioural change and should be considered an important adjunct, but not a replacement for nursing interventions (Stead 2012). The evidence suggests that brief interventions from nurses who combine smoking cessation work with other duties are less effective than longer interventions with multiple contacts, delivered by nurses with a role in health promotion or cardiac rehabilitation.

 
Implications for research

Further studies of nursing interventions are warranted, with more careful consideration of sample size, participant selection, refusals, drop-outs, long-term follow-up, and biochemical verification. Additionally, controlled studies are needed that carefully examine the effects of 'brief advice by nursing' as this type of professional counselling may more accurately reflect the current standard of care. Work is now required to systematize interventions so that more rigorous comparisons can be made between studies. None of the trials reviewed was a replication study; this is a very important method to strengthen the science, and should be encouraged.

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

Nicky Cullum and Tim Coleman for their helpful peer review comments on the original version of this review. Hitomi Kobayasha, a doctoral student, for assistance with Japanese translation of a study.

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
Download statistical data

 
Comparison 1. All nursing intervention vs control trials, grouped by intensity of intervention

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Smoking cessation at longest follow-up3517604Risk Ratio (M-H, Fixed, 95% CI)1.29 [1.20, 1.39]

    1.1 High intensity intervention
2813588Risk Ratio (M-H, Fixed, 95% CI)1.29 [1.20, 1.40]

    1.2 Low intensity intervention
74016Risk Ratio (M-H, Fixed, 95% CI)1.27 [0.99, 1.62]

 
Comparison 2. All nursing intervention vs control trials, grouped by setting and population

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Smoking cessation at longest follow-up34Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Smoking intervention as part of multifactorial intervention in patients with cardiovascular disease
5553Risk Ratio (M-H, Fixed, 95% CI)1.35 [1.14, 1.59]

    1.2 Smoking intervention alone in hospitalized smokers with a cardiovascular disease
72278Risk Ratio (M-H, Fixed, 95% CI)1.29 [1.14, 1.45]

    1.3 Smoking intervention alone in other hospitalized smokers
64759Risk Ratio (M-H, Fixed, 95% CI)1.09 [0.94, 1.28]

    1.4 Smoking intervention alone in non-hospitalized smokers with a cardiovascular disease
22090Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.73, 1.34]

    1.5 Smoking intervention alone in other non-hospitalized smokers
157799Risk Ratio (M-H, Fixed, 95% CI)1.81 [1.48, 2.22]

 
Comparison 3. Effect of additional strategies: Higher versus lower intensity

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Additional components at single contact. Smoking cessation at longest follow-up3Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    1.1 Demonstration of CO levels
1751Risk Ratio (M-H, Fixed, 95% CI)1.06 [0.55, 2.02]

    1.2 Demonstration of spirometry and CO measurement
190Risk Ratio (M-H, Fixed, 95% CI)0.33 [0.10, 1.15]

    1.3 Additional support including CO reading, materials
1505Risk Ratio (M-H, Fixed, 95% CI)0.91 [0.73, 1.13]

 2 Additional contacts. Smoking cessation at longest follow-up8Risk Ratio (M-H, Fixed, 95% CI)Subtotals only

    2.1 Additional telephone support
31220Risk Ratio (M-H, Fixed, 95% CI)1.25 [1.00, 1.56]

    2.2 Self-help manual, additional telephone support
1189Risk Ratio (M-H, Fixed, 95% CI)32.68 [4.55, 234.56]

    2.3 Three additional sessions
1157Risk Ratio (M-H, Fixed, 95% CI)0.43 [0.21, 0.89]

    2.4 Additional face-to-face and telephone support
31335Risk Ratio (M-H, Fixed, 95% CI)0.92 [0.65, 1.31]

 
Comparison 4. Sensitivity analysis by intensity, including Hajek 2002, with Lancaster, Bolman, Curry as low intensity

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Smoking cessation at longest follow-up3417615Risk Ratio (M-H, Fixed, 95% CI)1.24 [1.15, 1.33]

    1.1 High intensity intervention
2311559Risk Ratio (M-H, Fixed, 95% CI)1.30 [1.20, 1.42]

    1.2 Low intensity intervention
116056Risk Ratio (M-H, Fixed, 95% CI)1.09 [0.96, 1.25]

 
Comparison 5. Sensitivity analysis by setting and population, including Hajek 2002

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Smoking cessation at longest follow-up9Risk Ratio (M-H, Random, 95% CI)Subtotals only

    1.1 Smoking intervention alone in hospitalized smokers with a cardiovascular disease
94127Risk Ratio (M-H, Random, 95% CI)1.20 [1.02, 1.42]

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
 

Appendix 1. Register search strategy

Run using Cochrane Register of Studies (CRS) software

#1 (nurse* or nursing):TI,AB,XKY,MH,EMT,KY
#2 (health visitor*):TI,AB,XKY,MH,EMT,KY
#3 #1 OR #2

XKY, MH, EMT, KY are keyword fields. XKY field includes indexing terms added for the use of the tobacco addiction group.

 

Appendix 2. Glossary of terms


TermDefinition

AbstinenceA period of being quit, i.e. stopping the use of cigarettes or other tobacco products, May be defined in various ways; see also:
point prevalence abstinence; prolonged abstinence; continuous/sustained abstinence

Biochemical verificationAlso called 'biochemical validation' or 'biochemical confirmation':
A procedure for checking a tobacco user's report that he or she has not smoked or used tobacco. It can be measured by testing levels of nicotine or cotinine or other chemicals in blood, urine, or saliva, or by measuring levels of carbon monoxide in exhaled breath or in blood.

BupropionA pharmaceutical drug originally developed as an antidepressant, but now also licensed for smoking cessation; trade names Zyban, Wellbutrin (when prescribed as an antidepressant)

Carbon monoxide (CO)A colourless, odourless highly poisonous gas found in tobacco smoke and in the lungs of people who have recently smoked, or (in smaller amounts) in people who have been exposed to tobacco smoke. May be used for biochemical verification of abstinence.

CessationAlso called 'quitting'
The goal of treatment to help people achieve abstinence from smoking or other tobacco use, also used to describe the process of changing the behaviour

Continuous abstinenceAlso called 'sustained abstinence'
A measure of cessation often used in clinical trials involving avoidance of all tobacco use since the quit day until the time the assessment is made. The definition occasionally allows for lapses. This is the most rigorous measure of abstinence

'Cold Turkey'Quitting abruptly, and/or quitting without behavioural or pharmaceutical support.

CravingA very intense urge or desire [to smoke].
See: Shiffman et al 'Recommendations for the assessment of tobacco craving and withdrawal in smoking cessation trials'
Nicotine & Tobacco Research 2004: 6(4): 599-614

DopamineA neurotransmitter in the brain which regulates mood, attention, pleasure, reward, motivation and movement

EfficacyAlso called 'treatment effect' or 'effect size':
The difference in outcome between the experimental and control groups

Harm reductionStrategies to reduce harm caused by continued tobacco/nicotine use, such as reducing the number of cigarettes smoked, or switching to different brands or products, e.g. potentially reduced exposure products (PREPs), smokeless tobacco.

Lapse/slipTerms sometimes used for a return to tobacco use after a period of abstinence. A lapse or slip might be defined as a puff or two on a cigarette. This may proceed to relapse, or abstinence may be regained. Some definitions of continuous, sustained or prolonged abstinence require complete abstinence, but some allow for a limited number or duration of slips. People who lapse are very likely to relapse, but some treatments may have their effect by helping people recover from a lapse.

nAChR[neural nicotinic acetylcholine receptors]: Areas in the brain which are thought to respond to nicotine, forming the basis of nicotine addiction by stimulating the overflow of dopamine

NicotineAn alkaloid derived from tobacco, responsible for the psychoactive and addictive effects of smoking.

Nicotine Replacement Therapy (NRT)A smoking cessation treatment in which nicotine from tobacco is replaced for a limited period by pharmaceutical nicotine. This reduces the craving and withdrawal experienced during the initial period of abstinence while users are learning to be tobacco-free The nicotine dose can be taken through the skin, using patches, by inhaling a spray, or by mouth using gum or lozenges.

OutcomeOften used to describe the result being measured in trials that is of relevance to the review. For example smoking cessation is the outcome used in reviews of ways to help smokers quit. The exact outcome in terms of the definition of abstinence and the length of time that has elapsed since the quit attempt was made may vary from trial to trial.

PharmacotherapyA treatment using pharmaceutical drugs, e.g. NRT, bupropion

Point prevalence abstinence (PPA)A measure of cessation based on behaviour at a particular point in time, or during a relatively brief specified period, e.g. 24 hours, 7 days. It may include a mixture of recent and long-term quitters. cf. prolonged abstinence, continuous abstinence

Prolonged abstinenceA measure of cessation which typically allows a 'grace period' following the quit date (usually of about two weeks), to allow for slips/lapses during the first few days when the effect of treatment may still be emerging.
See: Hughes et al 'Measures of abstinence in clinical trials: issues and recommendations'; Nicotine & Tobacco Research, 2003: 5 (1); 13-25

RelapseA return to regular smoking after a period of abstinence

Secondhand smokeAlso called passive smoking or environmental tobacco smoke [ETS]
A mixture of smoke exhaled by smokers and smoke released from smouldering cigarettes, cigars, pipes, bidis, etc. The smoke mixture contains gases and particulates, including nicotine, carcinogens and toxins.

Self-efficacyThe belief that one will be able to change one's behaviour, e.g. to quit smoking

SPC [Summary of Product Characteristics]Advice from the manufacturers of a drug, agreed with the relevant licensing authority, to enable health professionals to prescribe and use the treatment safely and effectively.

TaperingA gradual decrease in dose at the end of treatment, as an alternative to abruptly stopping treatment

TarThe toxic chemicals found in cigarettes. In solid form, it is the brown, tacky residue visible in a cigarette filter and deposited in the lungs of smokers.

TitrationA technique of dosing at low levels at the beginning of treatment, and gradually increasing to full dose over a few days, to allow the body to get used to the drug. It is designed to limit side effects.

WithdrawalA variety of behavioural, affective, cognitive and physiological symptoms, usually transient, which occur after use of an addictive drug is reduced or stopped.
See: Shiffman et al 'Recommendations for the assessment of tobacco craving and withdrawal in smoking cessation trials'
Nicotine & Tobacco Research 2004: 6(4): 599-614



 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

Last assessed as up-to-date: 27 June 2013.


DateEventDescription

14 June 2013New citation required but conclusions have not changedConclusions unchanged.

14 June 2013New search has been performedSearches updated. Seven new included studies, and new data (longer follow-up) added for two already included studies.



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

Protocol first published: Issue 3, 1998
Review first published: Issue 3, 1999


DateEventDescription

22 June 2011AmendedAdditional table converted to appendix to correct pdf format

29 October 2008AmendedConverted to new review format.

21 October 2007New citation required and minor changesUpdated for issue 1 2008 with 12 new studies included; no major changes to results. The conclusions did not change.

14 September 2003New citation required and conclusions have changedUpdated for issue 1 2004 with 7 new studies. Conclusions now give more emphasis to possible differences between high and low intensity interventions. 

14 October 2001New citation required and minor changesUpdated for issue 3 2001 with 3 new studies. The conclusions did not change substantially. 



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

VHR extracted data and wrote the review. LS conducted searches, extracted data and assisted in drafting the review. Both authors contribute to review updates. JHB contributed to the 2013 update, extracting data and assisting in updating the text.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms

V.H. Rice was the principal investigator in one of the studies included in this review.

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Index terms
 

Internal sources

  • Wayne State University College of Nursing, Adult Health & Administration, USA.
  • Department of Primary Health Care, Oxford University, UK.

 

External sources

  • American Heart Association, USA.
  • NHS Research & Development Programme, UK.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. References to ongoing studies
  22. Additional references
  23. References to other published versions of this review
Allen 1996 {published data only}
Alterman 2001 {published data only}
Aveyard 2003 {published data only}
Aveyard 2007 {published data only}
  • Aveyard P, Brown K, Saunders C, Alexander A, Johnstone E, Munafo MR, et al. Weekly versus basic smoking cessation support in primary care: a randomised controlled trial. Thorax 2007;62(10):898-903.
Bolman 2002 {published data only}
Borrelli 2005 {published data only}
  • Borrelli B, Hayes RB, Dunsiger S, Fava JL. Risk perception and smoking behavior in medically ill smokers: a prospective study. Addiction 2010;105(6):1100-8.
  • Borrelli B, Lee C, Novak S. Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses. Preventive Medicine 2008;46(4):358-63.
  • Borrelli B, Novak S, Hecht J, Emmons K, Papandonatos G, Abrams D. Home health care nurses as a new channel for smoking cessation treatment: outcomes from project CARES (Community-nurse Assisted Research and Education on Smoking). Preventive Medicine 2005;41(5-6):815-21.
  • Hayes RB, Dunsiger S, Borrelli B. The influence of quality of life and depressed mood on smoking cessation among medically ill smokers. Journal of Behavioral Medicine 2010;33(3):209-18.
Campbell 1998 {published data only}
  • Campbell NC, Ritchie LD, Thain J, Deans HG, Rawles JM, Squair JL. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart 1998;80(5):447-52.
  • Campbell NC, Thain J, Deans HG, Ritchie LD, Rawles JM, Squair JL. Secondary prevention clinics for coronary heart disease: randomised trial of effect on health. BMJ 1998;316(7142):1434-7.
  • Murchie P, Campbell NC, Ritchie LD, Simpson JA, Thain J. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. BMJ 2003;326(7380):84.
Canga 2000 {published data only}
  • Canga N, De Irala J, Vara E, Duaso MJ, Ferrer A, Martinez-Gonzalez MA. Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings. Diabetes Care 2000;23(10):1455-60.
Carlsson 1997 {published data only}
Chan 2012 {published data only}
  • Chan SS, Leung DY, Lau C, Wong V, Lam T. Cost-effectiveness analysis of a low intensity nurse-led stage-matched smoking cessation intervention to cardiac patients in Hong Kong. Circulation 2010;122(2):E87.
  • Chan SS, Leung DY, Wong DC, Lau CP, Wong VT, Lam TH. A randomized controlled trial of stage-matched intervention for smoking cessation in cardiac out-patients. Addiction 2012;107:829-37.
  • Chan SSC, Lam TH, Lau C-P. The effectiveness of a nurse-delivered smoking cessation intervention for cardiac patients: a randomised controlled trial. Nicotine & Tobacco Research 2005;7:692.
Chouinard 2005 {published data only}
  • Chouinard MC, Robichaud-Ekstrand S. The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease. Nursing Research 2005;54(4):243-54.
  • Chouinard MC, .Robichaud-Ekstrand S. Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease. European Journal of Cardiovascular Prevention & Rehabilitation 2007;14:51-8.
Cossette 2011 {published data only}
  • Cossette S, Frasure-Smith N, Robert M, Chouinard MC, Juneau M, Guertin MC, et al. A pilot randomized trial of a smoking cessation nursing intervention in cardiac patients after hospital discharge. Canadian Journal of Cardiovascular Nursing 2012;22(4):16-26.
  • Cossette S, Frasure-Smith N, Robert M, Chouinard MC, Juneau M, Guertin MC, et al. A pre-assessment for nursing intervention to support tobacco cessation in patients hospitalized for cardiac problems: a pilot study (So-Live). [Évaluation préliminaire d'une intervention infirmière de soutien à la cessation tabagique chez des patients hospitalisés pour un problème cardiaque: étude pilote (So-Live)]. Recherche en soins infirmiers 2011;105:60-75.
Curry 2003 {published data only}
  • Curry SJ, Ludman EJ, Graham E, Stout J, Grothaus L, Lozano P. Pediatric-based smoking cessation intervention for low-income women: a randomized trial. Archives of Pediatric and Adolescent Medicine 2003;157(3):295-302.
Davies 1992 {published data only}
  • Davies BL, Matte-Lewis L, O'Connor AM, Dulberg CS, Drake ER. Evaluation of the "Time to Quit" self-help smoking cessation program. Canadian Journal of Public Health 1992;83(1):19-23.
DeBusk 1994 {published data only}
  • DeBusk RF, Miller NH, Superko HR, Dennis CA, Thomas RJ, Lew HT, et al. A case-management system for coronary risk factor modification after acute myocardial infarction. Annals of Internal Medicine 1994;120(9):721-9.
Duffy 2006 {published data only}
  • Duffy SA, Ronis DL, Valenstein M, Lambert MT, Fowler KE, Gregory L, et al. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology, Biomarkers & Prevention 2006;15:2203-08.
  • Duffy SA, Scheumann AL, Fowler KE, Darling-Fisher C, Terrell JE. Perceived difficulty quitting predicts enrollment in a smoking-cessation program for patients with head and neck cancer. Oncology Nursing Forum 2010;37(3):349-56.
Family Heart 1994 {published data only}
  • Family Heart Study Group. Randomised controlled trial evaluating cardiovascular screening and intervention in general practice: principal results of British family heart study. BMJ 1994;308:313-20.
  • Wood DA, Kinmonth A-L, Davies G, Thompson SG, Pyke SDM, Cramb R, et al. British family heart study: its design and method, and prevalence of cardiovascular risk factors. British Journal of General Practice 1994;44:62-7.
Feeney 2001 {published data only}
Froelicher 2004 {published data only}
  • Froelicher ES, Christopherson DJ. Women's Initiative for Nonsmoking (WINS) I: Design and methods. Heart & Lung 2000;29(6):429-37.
  • Froelicher ES, Christopherson DJ, Miller NH, Martin K. Women's initiative for nonsmoking (WINS) IV: description of 277 women smokers hospitalized with cardiovascular disease. Heart & Lung 2002;31:3-14.
  • Froelicher ES, Li WW, Mahrer-Imhof R, Christopherson D, Stewart AL. Women's Initiative for Non-Smoking (WINS) VI: Reliability and validity of health and psychosocial measures in women smokers with cardiovascular disease. Heart & Lung 2004;33(3):162-75.
  • Froelicher ES, Miller NH, Christopherson DJ, Martin K, Parker KM, Amonetti M, et al. High rates of sustained smoking cessation in women hospitalized with cardiovascular disease: the Women's Initiative for Nonsmoking (WINS). Circulation 2004;109(5):587-93.
  • Mahrer-Imhof R, Froelicher ES, Li WW, Parker KM, Benowitz N. Women's Initiative for Nonsmoking (WINS)V: under-use of nicotine replacement therapy. Heart & Lung 2002;31:368-73.
  • Martin K, Froelicher ES, Miller NH. Women's Initiative for Nonsmoking (WINS) II: The intervention. Heart & Lung 2000;29(6):438-45.
Hajek 2002 {published data only}
  • Hajek P, Taylor TZ, Mills P. Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial. BMJ 2002;324(7329):87-9.
Hanssen 2007 {published data only}
  • Hanssen TA, Nordrehaug JE, Eide GE, Hanestad BR. Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial. Journal of Clinical Nursing 2009;18:1334-45.
  • Hanssen TA, Nordrehaug JE, Eide GE, Hanestad BR. Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. European Journal of Cardiovascular Prevention and Rehabilitation 2007;14(3):429-37.
Hasuo 2004 {published data only}
  • Hasuo S, Tanaka H, Oshima A. [Efficacy of a smoking relapse prevention program by postdischarge telephone contacts: a randomized trial] (Japanese). Nippon Koshu Eisei Zasshi [Japanese Journal of Public Health] 2004;51(6):403-12.
Hennrikus 2005 {published data only}
  • Hennrikus D, Lando HA, McCarty MC, Vessey JT. The effectiveness of a systems approach to smoking cessation in hospital inpatients. Society for Research on Nicotine and Tobacco 7th Annual Meeting March 23-23 Seattle Washington. 2001:47.
  • Hennrikus DJ, Lando HA, McCarty MC, Klevan D, Holtan N, Huebsch JA, et al. The TEAM project: the effectiveness of smoking cessation interventions with hospital patients. Preventive Medicine 2005;40:249-58.
Hilberink 2005 {published data only}
  • Hilberink SR, Jacobs JE, Bottema BJ, De Vries H, Grol RP. Smoking cessation in patients with COPD in daily general practice (SMOCC): six months' results. Preventive Medicine 2005;41:822-7.
  • Hilberink SR, Jacobs JE, Breteler MHM, De Vries H, Grol RPTM. General practice counseling for patients with chronic obstructive pulmonary disease to quit smoking: Impact after 1 year of two complex interventions. Patient Education and Counseling 2011;83:120-4.
Hollis 1993 {published data only}
  • Hollis JF, Lichtenstein E, Mount K, Vogt TM, Stevens VJ. Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians. Preventive Medicine 1991;20:497-507.
  • Hollis JF, Lichtenstein E, Vogt TM, Stevens VJ, Biglan A. Nurse-assisted counseling for smokers in primary care. Annals of Internal Medicine 1993;118:521-5.
Janz 1987 {published data only}
  • Janz NK, Becker MH, Kirscht JP, Eraker SA, Billi JE, Woolliscroft JO. Evaluation of a minimal-contact smoking cessation intervention in an outpatient setting. American Journal of Public Health 1987;77:805-9.
Jiang 2007 {published data only}
Kim 2005 {published data only}
  • Kim JR, Lee MS, Hwang JY, Lee JD. Efficacy of a smoking cessation intervention using the AHCPR guideline tailored for Koreans: a randomized controlled trial. Health Promotion International 2005;20:51-9.
Lancaster 1999 {published data only}
  • Lancaster T, Dobbie W, Vos K, Yudkin P, Murphy M, Fowler G. Randomised trial of nurse-assisted strategies for smoking cessation in primary care. British Journal of General Practice 1999;49(440):191-4.
Lewis 1998 {published data only}
  • Lewis SF, Piasecki TM, Fiore MC, Anderson JE, Baker TB. Transdermal nicotine replacement for hospitalized patients: A randomized clinical trial. Preventive Medicine 1998;27:296-303.
Meysman 2010 {published data only}
  • Meysman M, Boudrez H, Nackaerts K, Dieriks B, Indemans R, Vermeire P. Smoking cessation rates after a nurse-led inpatient smoking cessation intervention. Journal of Smoking Cessation 2010;5(1):69-76.
Miller 1997 {published data only}
  • Miller NH, Smith PM, DeBusk RF, Sobel DS, Taylor CB. Smoking cessation in hospitalized patients - Results of a randomized trial. Archives of Internal Medicine 1997;157:409-15.
  • Miller NH, Smith PM, Taylor CB, Sobel D, DeBusk RF. Smoking cessation in hospitalized patients - results of a randomized trial. Circulation 1995;92(8):SS179 (abstract 855).
  • Taylor CB, Miller NH, Herman S, Smith PM, Sobel D, Fisher L, et al. A nurse-managed smoking cessation program for hospitalized smokers. American Journal of Public Health 1996;86(11):1557-60.
Nagle 2005 {published data only}
  • Hensley MJ, Nagle AL, Schofield MJ, Koschel A. Efficacy of a brief nurse provided nicotine management intervention for hospitalised smokers. Respirology 2002;7:A12.
  • Nagle AL, Hensley MJ, Schofield MJ, Koschel AJ. A randomised controlled trial to evaluate the efficacy of a nurse-provided intervention for hospitalised smokers. Australian and New Zealand Journal of Public Health 2005;29(3):285-91.
Nebot 1992 {published data only}
  • Nebot M, Cabezas C. Does nurse counseling or offer of nicotine gum improve the effectiveness of physician smoking-cessation advice?. Family Practice Research Journal 1992;12:263-70.
OXCHECK 1994 {published data only}
  • Imperial Cancer Research Fund OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care: Results of the OXCHECK study after one year. BMJ 1994;308(6924):308-12.
  • Imperial Cancer Research Fund OXCHECK Study Group. Effectiveness of health checks conducted by nurses in primary care: final results of the OXCHECK study. BMJ 1995;310(6987):1099-104.
Quist-Paulsen 2003 {published data only}
  • Brown DW. Nurse-led intervention increases smoking cessation among people with coronary heart disease. Evidence Based Healthcare 2004;8:128-30.
  • Quist-Paulsen P, Bakke PS, Gallefoss F. Does smoking cessation improve quality of life in patients with coronary heart disease?. Scandinavian Cardiovascular Journal 2006;40(1):11-16.
  • Quist-Paulsen P, Bakke PS, Gallefoss F. Predictors of smoking cessation in patients admitted for acute coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 2005;12(5):472-7.
  • Quist-Paulsen P, Gallefoss F. Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ 2003;327(7426):1254-7.
  • Quist-Paulsen P, Lydersen S, Bakke PS, Gallefoss F. Cost effectiveness of a smoking cessation program in patients admitted for coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 2006;13(2):274-80.
Ratner 2004 {published data only}
Rice 1994 {published data only}
  • Rice VH, Fox DH, Lepczyk M, Sieggreen M, Mullin M, Jarosz P, et al. A comparison of nursing interventions for smoking cessation in adults with cardiovascular health problems. Heart and Lung 1994;23(6):473-86.
Rigotti 1994 {published data only}
  • Rigotti NA, McKool KM, Shiffman S. Predictors of smoking cessation after coronary artery bypass graft surgery. Results of a randomized trial with 5-year follow-up. Annals of Internal Medicine 1994;120:287-93.
Risser 1990 {published data only}
  • Risser NL, Belcher DW. Adding spirometry, carbon monoxide, and pulmonary symptom results to smoking cessation counseling: a randomized trial. Journal of General Internal Medicine 1990;5(1):16-22.
Sanders 1989a {published data only}
  • Sanders D, Fowler G, Mant D, Fuller A, Jones L, Marzillier J. Randomized controlled trial of anti-smoking advice by nurses in general practice. Journal of the Royal College of General Practitioners 1989;39(324):273-6.
Sanders 1989b {published data only}
  • Sanders D, Fowler G, Mant D, Fuller A, Jones L, Marzillier J. Randomized controlled trial of anti-smoking advice by nurses in general practice. Journal of the Royal College of General Practitioners 1989;39(324):273-6.
Sanz-Pozo 2006 {published data only}
  • Sanz Pozo B, Miguel Diaz J, Aragon Blanco M, Gonzalez Gonzalez AI, Cortes Catalan M, Vazquez I. [Effectiveness of non-pharmacological primary care methods for giving up tobacco dependency] (Spanish) [Efectividad de los métodos no farmacológicos para la deshabituación tabáquica en atención primaria]. Atencion Primaria 2003;32(6):366-70.
  • Sanz-Pozo B, Miguel-Diaz J, Aragon-Blanco M, Garcia-Caballo M, Gomez-Suarez E, Fernandez-Dominguez JF. Effectiveness of a programme of intensive tobacco counselling by nursing professionals (Spanish) [Efectividad de un programa de consejo antitabaco intensivo realizado por profesionales de enfermería]. Atencion Primaria 2006;37:266-72.
Steptoe 1999 {published data only}
  • Steptoe A, Doherty S, Rink E, Kerry S, Kendrick T, Hilton S. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. BMJ 1999;319:943-7.
Taylor 1990 {published data only}
  • Taylor CB, Houston-Miller N, Killen JD, DeBusk RF. Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Annals of Internal Medicine 1990;113(2):118-23.
Terazawa 2001 {published data only}
  • Terazawa T, Mamiya T, Masui S, Nakamura M. The effect of smoking cessation counseling at health checkup (Japanese). Sangyo Eiseigaku Zasshi 2001;43(6):207-13.
Tonnesen 1996 {published data only}
  • Tonnesen P, Mikkelsen K, Markholst C, Ibsen A, Bendixen M, Pedersen L, et al. Nurse-conducted smoking cessation with minimal intervention in a lung clinic: a randomized controlled study. European Respiratory Journal 1996;9(11):2351-5.
Tonnesen 2006 {published data only}
Vetter 1990 {published data only}
Wood 2008 {published data only}
  • Wood D, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet 2008;371(9629):1999-2012.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. References to ongoing studies
  22. Additional references
  23. References to other published versions of this review
Aertsen-Van Der Kuip 2006 {published data only}
  • Aertsen-Van Der Kuip M, Besselink RM, van der Vlugt MJ, Peters E, Fouwels AJ, Wollersheim Hal. Successful motivational interviewing for smoking cessation in a secondary cardiovascular prevention clinic. European Heart Journal 2006;27(Suppl 1):165.
Andrews 2007 {published data only}
Avanzini 2011 {published data only}
  • Avanzini F, Di GP, Amodeo R, Baldo S, Bergna ML, Busi G, et al. Effectiveness of a nurse-led educational intervention for patients admitted for acute coronary syndrome. [Italian]. [Efficacia di un intervento educativo infermieristico in pazienti ricoverati per una sindrome coronarica acuta]. Assistenza Infermieristica e Ricerca:Air 2011;30:16-23.
Bredie 2011 {published data only}
  • Bredie SJ, Fouwels AJ, Wollersheim H, Schippers GM. Effectiveness of nurse based motivational interviewing for smoking cessation in high risk cardiovascular outpatients: A randomized trial. European Journal of Cardiovascular Nursing 2011;10(3):174-9.
Browning 2000 {published data only}
  • Browning KK, Ahijevych KL, Ross P Jr, Wewers ME. Implementing the Agency for Health Care Policy and Research's Smoking Cessation Guideline in a lung cancer surgery clinic. Oncology Nursing Forum 2000;27(8):1248-54.
Brunner-Frandsen 2012 {published data only}
  • Brunner Frandsen N, Sorensen M, Hyldahl TK, Henriksen RM, Bak S. Smoking cessation intervention after ischemic stroke or transient ischemic attack. A randomized controlled pilot trial. Nicotine & Tobacco Research 2012;14(4):443-7.
  • Brunner-Frandsen NS, Bak S. Smoking cessation intervention after stroke or transient ischemic attack. A randomised controlled trial. Cerebrovascular Diseases 2010;29(Suppl 2):323.
Cabezas 2011 {published data only}
  • Cabezas C, Advani M, Puente D, Rodriguez T, Martin C. Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study). Addiction 2011;106:1696-706.
  • Cabezas C, Martin C, Granollers S, Morera C, Ballve JL, Zarza E, et al. Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial. BMC Public Health 2009;9:48.
  • Puente D, Cabezas C, Rodriguez-Blanco T, Fernandez-Alonso C, Cebrian T, Torrecilla M, et al. The role of gender in a smoking cessation intervention: a cluster randomized clinical trial. BMC Public Health 2011;11:369.
Carlsson 1998 {published data only}
  • Carlsson R. Serum cholesterol, lifestyle, working capacity and quality of life in patients with coronary artery disease. Experiences from a hospital-based secondary prevention programme. Scandinavian Cardiovascular Journal Supplement 1998;50:1-20.
Caslin 2006 {published data only}
  • Caslin EK, Newhouse R, Zissimos J, Murray P, Thompson KM, Ashen D, et al. Smoking Cessation Intervention and Nurse Initiation (SCINI) Trial. 13th World Conference on Tobacco & Health. 2006.
  • Thompson KM, Caslin EK, Murray P, Zissimos J, Newhouse R, Yung R. Barriers to implementing nurse initiated inpatient smoking cessation [Abstract].. Proceedings of the American Thoracic Society 2006: A294. 2006.
Chan 2005 {published data only}
  • Chan SS, Lam TH, Salili F, Leung GM, Wong DC, Botelho RJ, et al. A randomized controlled trial of an individualized motivational intervention on smoking cessation for parents of sick children: a pilot study. Applied Nursing Research 2005;18:178-81.
Chan 2008 {published data only}
  • Chan SS, Leung GM, Wong DC, Lam TH. Helping Chinese fathers quit smoking through educating their nonsmoking spouses: a randomized controlled trial. American Journal of Health Promotion 2008;23(1):31-4.
  • Chan SSC, Wong DCN, Lam T-H. Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial . BMC Pediatrics 2013;13:50.
Efraimsson 2008 {published data only}
Fletcher 1987 {published data only}
French 2007 {published data only}
Fritz 2008 {published data only}
  • Fritz DJ, Hardin SB, Gore PA Jr, Bram D. A computerized smoking cessation intervention for high school smokers. Pediatric Nursing 2008;34:13-7.
Galvin 2001 {published data only}
  • Galvin K, Webb C, Hillier V. Assessing the impact of a nurse-led health education intervention for people with peripheral vascular disease who smoke: the use of physiological markers, nicotine dependence and withdrawal. International Journal of Nursing Studies 2001;38(1):91-105.
Gies 2008 {published data only}
Griebel 1998 {published data only}
  • Griebel B, Wewers ME, Baker CA. The effectiveness of a nurse-managed minimal smoking-cessation intervention among hospitalized patients with cancer. Oncology Nursing Forum 1998;25(5):897-902.
Haddock 1997 {published data only}
  • Haddock J, Burrows C. The role of the nurse in health promotion: an evaluation of a smoking cessation programme in surgical pre-admission clinics. Journal of Advanced Nursing 1997;26(6):1098-110.
Hall 2007 {published data only}
  • Hall S, Reid E, Ukoumunne OC, Weinman J, Marteau TM. Brief smoking cessation advice from practice nurses during routine cervical smear tests appointments: a cluster randomised controlled trial assessing feasibility, acceptability and potential effectiveness. British Journal of Cancer 2007;96:1057-61.
Heath 2012 {published data only}
  • Heath J,  Inglett S,  Young S,  Joshua TV,  Sakievich N,  Hawkins J, et al. The impact of the Georgia Health Sciences University nursing faculty practice on tobacco cessation rates. Nursing Clinics of North America 2012;47(1):1-12.
Hjalmarson 2007 {published data only}
  • Hjalmarson A, Boethius G. The effectiveness of brief advice and extended smoking cessation counseling programs when implemented routinely in hospitals. Preventive Medicine 2007;45(2-3):202-7.
Jansink 2013 {published data only}
  • Jansink R, Braspenning J, Keizer E, Van de Weijden T, Elwyn G, Grol R. No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: A cluster randomized trial. Scandinavian Journal of Primary Health Care 2013;31:119-27.
  • Jansink R, Braspenning J, Van der Weijden T, Niessen L, Elwyn G, Grol R. Nurse-led motivational interviewing to change the lifestyle of patients with type 2 diabetes (MILD-project): protocol for a cluster, randomized, controlled trial on implementing lifestyle recommendations. BMC Health Services Research 2009;9:19.
Jelley 1995 {published data only}
  • Jelley MJ, Prochazka AV. A smoking cessation intervention in family planning clinics. Journal of Women's Health 1995;4:555-67.
Johnson 1999 {published data only}
  • Johnson JL, Budz B, Mackay M, Miller C. Evaluation of a nurse-delivered smoking cessation intervention for hospitalized patients with cardiac disease. Heart and Lung 1999;28(1):55-64.
Johnson 2000 {published data only}
  • Johnson JL, Ratner PA, Bottorff JL, Hall W, Dahinten S. Preventing smoking relapse in postpartum women. Nursing Research 2000;49(1):44-52.
  • Ratner PA, Johnson JL, Bottorff JL, Dahinten S, Hall W. Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women. Addictive Behaviors 2000;25(1):81-92.
Katz 2012 {published data only}
Kendrick 1995 {published data only}
  • Kendrick JS, Zahniser SC, Miller N, Salas N, Stine J, Gargiullo PM, et al. Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project. American Journal of Public Health 1995;85(2):217-22.
Koelewijn-van Loon 2009 {published data only}
  • Koelewijn-van Loon MS, Van der Weijden T, Van Steenkiste B, Ronda G, Winkens B, Severens JL, et al. Involving patients in cardiovascular risk management with nurse-led clinics: a cluster randomized controlled trial. Canadian Medical Association Journal 2009;181(12):E267-74.
Kotz 2009 {published data only}
  • Kotz D, Huibers MJH, West RJ, Wesseling G, Van Schayck OCP. What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD?. Patient Education and Counseling 2009;76(1):16-24.
  • Kotz D, Wesseling G, Huibers MJ, Van Schayck OC. Efficacy of confrontational counselling for smoking cessation in smokers with previously undiagnosed mild to moderate airflow limitation: study protocol of a randomized controlled trial. BMC Public Health 2007;7:332.
  • Kotz D, Wesseling G, Huibers MJ, van Schayck OC. Efficacy of confronting smokers with airflow limitation for smoking cessation.[see comment]. European Respiratory Journal 2009;33(4):754-62.
Lakerveld 2010 {published data only}
  • Lakerveld J, Bot SDM, Chinapaw MJM, Kostense PJ, Nijpels G. An individual lifestyle intervention program is not more effective in changing diabetes risk and lifestyle behaviors than providing health brochures: The Hoorn Prevention Study. Diabetologia 2010;53:S82.
Lifrak 1997 {published data only}
  • Lifrak P, Gariti P, Alterman AI, McKay J, Volpicelli J, Sparkman T, et al. Results of two levels of adjunctive treatment used with the nicotine patch. American Journal of Addiction 1997;6(2):93-8.
McHugh 2001 {published data only}
  • McHugh F, Lindsay GM, Hanlon P, Hutton I, Brown MR, Morrison C, et al. Nurse led shared care for patients on the waiting list for coronary artery bypass surgery: a randomised controlled trial. Heart 2001;86(3):317-23.
Meulepas 2007 {published data only}
  • Meulepas MA, Jacobs JE, Smeenk FW, Smeele I, Lucas AE, Bottema BJal. Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases. Scandinavian Journal of Primary Health Care 2007;25(3):186-92.
O'Connor 1992 {published data only}
  • O'Connor AM, Davies BL, Dulberg CS, Buhler PL, Nadon C, McBride BH, et al. Effectiveness of a pregnancy smoking cessation program. Journal of Obstetric, Gynecologic, and Neonatal Nursing 1992;21(5):385-92.
Persson 2006 {published data only}
  • Persson LG, Hjalmarson A. Smoking cessation in patients with diabetes mellitus: results from a controlled study of an intervention programme in primary healthcare in Sweden. Scandinavian Journal of Primary Health Care 2006;24(2):75-80.
Planer 2011 {published data only}
  • Planer D, Lev I, Elitzur Y, Sharon N, Ouzan E, Pugatsch T, et al. Bupropion for smoking cessation in patients with acute coronary syndrome. Archives of Internal Medicine 2011;171(12):1055-60.
Pozen 1977 {published data only}
Reeve 2000 {published data only}
  • Reeve K, Calabro K, Adams-McNeill J. Tobacco cessation intervention in a nurse practitioner managed clinic. Journal of the American Academy of Nurse Practitioners 2000;12(5):163-9.
Reid 2003 {published data only}
  • Reid R, Pipe A, Higginson L, Johnson K, D'Angelo MS, Cooke D, et al. Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease. Journal of Cardiopulmonary Rehabilitation 2003;23:176-82.
Rigotti 1997 {published data only}
  • Rigotti NA, Arnsten JH, McKool KM, Wood-Reid KM, Pasternak RC, Singer DE. Efficacy of a smoking cessation program for hospital patients. Archives of Internal Medicine 1997;157:2653-60.
Smith 2009 {published data only}
  • Smith PM, Burgess E. Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial. Canadian Medical Association Journal 2009;180(13):1297-303.
Stanislaw 1994 {published data only}
  • Stanislaw AE, Wewers ME. A smoking cessation intervention with hospitalized surgical cancer patients: a pilot study. Cancer Nursing 1994;17(2):81-6.
Sun 2000 {published data only}
  • Sun C. Roles of psychological nursing played in the course of auricle point applying to help individuals giving up smoking (Chinese). Shanxi Nursing Journal 2000;14(2):69-70.
Targhetta 2011 {published data only}
  • Targhetta R, Bernhard L, Sorokaty JM, Balmes JL, Nalpas B, Perney P. Intervention study to improve smoking cessation during hospitalization. Public Health 2011;125:457-63.
Van Elderen 1994 {published data only}
  • Van Elderen-van Kemenade T, Maes S, Van den Broek Y. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. British Journal of Clinical Psychology 1994;33(3):367-78.
    Direct Link:
Van Zuilen 2011 {published data only}
  • Van Zuilen AD, Blankestijn PJ, Van Buren M, Ten Dam MA, Kaasjager KA, Ligtenberg G, et al. Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised study. Netherlands Journal of Medicine 2011;69(11):517-26.
  • Van Zuilen AD, Bots ML, Dulger A, Van Der Tweel I, Van Buren M, Ten Dam MAGJ, et al. Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease. Kidney International 2012;82(6):710-7.
Wadland 1999 {published data only}
Wadland 2001 {published data only}
Wewers 1994 {published data only}
  • Wewers ME, Bowen JM, Stanislaw AE, Desimone VB. A nurse-delivered smoking cessation intervention among hospitalized postoperative patients--influence of a smoking-related diagnosis: a pilot study. Heart and Lung 1994;23(2):151-6.
Wewers 2009 {published data only}
  • Wewers ME, Ferketich AK, Harness J, Paskett ED. Effectiveness of a nurse-managed, lay-led tobacco cessation intervention among Ohio Appalachian women. Cancer Epidemiology, Biomarkers and Prevention 2009;18(12):3451-8.
Wilson 2008 {published data only}
  • Wilson JS, Elborn JS, Fitzsimons D, McCrum-Gardner E. Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation. International Journal of Nursing Studies 2011;48(7):856-62.
  • Wilson JS, Fitzsimons D, Bradbury I, Stuart EJ. Does additional support by nurses enhance the effect of a brief smoking cessation intervention in people with moderate to severe chronic obstructive pulmonary disease? A randomised controlled trial. International Journal of Nursing Studies 2008;45(4):508-17.
Woollard 1995 {published data only}
  • Woollard J, Beilin LJ, Lord T, Puddey I, MacAdam D, Rouse I. A controlled trial of nurse counselling of life-style change for hypertensives treated in general practice -preliminary results. Clinical and Experimental Pharmacology and Physiology 1995;22(6-7):466-8.
Zakrisson 2011 {published data only}
  • Zakrisson AB,  Engfeldt P,  Hägglund D,  Odencrants S,  Hasselgren M,  Arne M, et al. Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Primary Care Respiratory Journal 2011;20(4):427-33.

References to ongoing studies

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. References to ongoing studies
  22. Additional references
  23. References to other published versions of this review
Berndt 2012 {published data only}
  • Berndt N, Bolman C, Lechner L, Mudde A, Verheugt FWA, De Vries H. Effectiveness of two intensive treatment methods for smoking cessation and relapse prevention in patients with coronary heart disease: study protocol and baseline description. BMC Cardiovascular Disorders 2012;12:33.
Duffy 2012 {published data only}
  • Duffy SA, Ronis DL, Richardson C, Waltje AH, Ewing LA, Noonan D, et al. Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers. BMC Public Health 2012;12:335.
Smit 2010 {published data only}
  • Smit ES, De Vries H, Hoving C. The PAS study: a randomized controlled trial evaluating the effectiveness of a web-based multiple tailored smoking cessation programme and tailored counselling by practice nurses. Contemporary Clinical Trials 2010;31(3):251-8.
Zwar 2010 {published data only}
  • Zwar N, Richmond R, Halcomb E, Furler J, Smith J, Hermiz O, et al. Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC Family Practice 2010;11:59.

Additional references

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. References to ongoing studies
  22. Additional references
  23. References to other published versions of this review
AHRQ 2008
  • Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, 2008.
ANA 2012
  • American Nurses Association. Tobacco Free Nurses. http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/TobaccoFree.html (accessed 24 July 2013).
CDC 2011
  • Centers for Disease Control and Prevention. Quitting Smoking Among Adults—United States, 2001–2010. Morbidity and Mortality Weekly Report 2011;60(44):1513-9.
CDC 2012
  • Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(44):889-94.
Cochrane Handbook
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Coleman 2012
Greenland 1985
Higgins 2003
ICN 2012
  • International Council of Nurses. Tobacco use and health: ICN position. http://www.icn.ch/publications/position-statements/ (accessed 24 July 2013).
LeLorier 1997
  • LeLorier J, Gregoire G, Benhaddad A, Lapierre J, Derderian F. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. New England Journal of Medicine 1997;337(8):536-42.
Lumley 2009
Rigotti 2012
Stead 2012
  • Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD000146.pub4]
Stead 2013
  • Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. [DOI: 10.1002/14651858.CD000165.pub4]
Stewart 1993
The Tobacco Atlas 2012
  • Eriksen M, Mackay J, Ross H. The Tobacco Atlas. (www.TobaccoAtlas.org). 4th Edition. Atlanta, GA: American Cancer Society; New York, NY: World Lung Foundation, 2012.
Youdan 2005
  • Youdan B, Queally B. Nurses' role in promoting and supporting smoking cessation. Nursing Times 2005;101(10):26.

References to other published versions of this review

  1. Top of page
  2. Abstract
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. References to ongoing studies
  22. Additional references
  23. References to other published versions of this review
Rice 1999a
  • Rice VH, Stead LF. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 1999, Issue 3. [DOI: 10.1002/14651858.CD001188]
Rice 1999b
Rice 2001
Rice 2004
Rice 2008