Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7257.355 (Published 05 August 2000) Cite this as: BMJ 2000;321:355All rapid responses
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Sirs,
As an ex-smoker, and an advocate for greater attention to the
efficacy of smoking cessation efforts, I welcome the Cochrane review. I
was surprised, however, that the review did not consider experience with
residential 12 step programs. I am a serious nicotine addict, and was
only able to 'quit' following a 5 day residential treatment program,
modeled on residential alcoholic treatment programs conducted by the Caron
Foundation Wernersville, Pennsylvania ( www.caron.org)
I am pleased, and quite surprised, to say that I remain nicotine free
now 10.5 months after treatment -- the longest I have remained nicotine
free since the age of 18 (I am now 50). At current count, 10 of the 14 of
us who went through the program remain nicotine free.
I do hope that your research begins to explore the efficacy of this
and similar programs, since wider awareness among physcians may amplify
the success of their personal intervention with smoking patients.
Competing interests: No competing interests
Editor
Lancaster et al reported1 that advice from GPs and structured
interventions from nurses are effective in helping people stop smoking.
However, they did not mention the potential contribution of other primary
health care team members.
Pharmacists and their staff are well placed to support people wanting
to stop smoking. They can provide advice over-the-counter, or, for those
pharmacies with consultation facilities, in a more formal clinic setting.
Many people entering a pharmacy for help with stopping smoking will be
considering purchasing nicotine replacement therapy (NRT) as part of a
serious quit attempt. Suitably trained pharmacy personnel can increase
the effectiveness of NRT by offering brief counselling at the point of
sale.
We have demonstrated the efficacy2 and cost effectiveness3 of such an
approach. We commissioned a two-hour smoking cessation training package,
based on the stage of change model, for community pharmacists and their
staff, and evaluated its effect in a randomised controlled trial.
Pharmacy customers who were starting a new attempt to stop smoking
were recruited, and followed up after one, four and nine months. We
assumed that non-respondents were continuing smokers. One month point
prevalence of abstinence was claimed by 30% of intervention customers and
24% of controls (p=0.12); four months' continuous abstinence was claimed
by 16% of intervention customers and 11% of controls (p=0.094); and nine
months' continuous abstinence was claimed by 12% of intervention customers
and 7% of controls (p=0.089). These trends in outcome were not affected
by potential confounders or by clustering at the pharmacy level. The
intervention was also associated with increased and more highly rated
counselling.
Pharmacy personnel working on their own have the potential to make a
significant contribution to smoking cessation. Much more could be
achieved through a co-ordinated approach to intervention, utilising all
members of the primary care team.4
1. Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of
interventions to help people stop smoking: findings from the Cochrane
Library. BMJ; 2000321:355-8.
2. Sinclair HK, Bond CM, Lennox AS, Silcock J, Winfield AJ: Training
pharmacists and pharmacy assistants in the stage-of-change model of
smoking cessation: A randomised controlled trial in Scotland. Tobacco
Control. 1998;7:253-261.
3. Sinclair HK, Silcock J, Bond CM, Lennox AS, Winfield AJ. The cost-
effectiveness of intensive pharmaceutical intervention in assisting people
to stop smoking. International Journal of Pharmacy Practice 1999;7:107-
12.
4. Lichtenstein E, Hollis JF, Severson HH, Stevens VJ, Vogt TM, Glasgow
RE, Andrews JA. Tobacco cessation interventions in health care settings:
rationale, model, outcomes. Addictive Behaviors 1996;21(6):709-20.
Hazel Sinclair
Research Fellow
Department of General Practice and Primary Care,
University of Aberdeen
h.sinclair@abdn.ac.uk
A Scott Lennox
Clinical Research Fellow (GP)
Department of General Practice and Primary Care,
University of Aberdeen
Competing interests: No competing interests
Applicability of review?
The review by Tim Lancaster et. al. talks about the effectiveness of
various interventions in the cessation of smoking. After reading the
review, I questions it's applicability as it fails to mention the
characteristics of the populations (such as age, sex, socio-economic
group)which were studied in the reviews incorporated into this study.
As a future clinician it is important for me to be able to tailor
therapy to particular groups of patients, so that the right patients
receives the right treatment.
Competing interests: No competing interests