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Apoyo conductual adicional como complemento a la farmacoterapia para el abandono del hábito de fumar

Appendices

Appendix 1. Register Search

Search used in the Cochrane Register of Studies.

  1. NRT:TI,AB,KW   

  2. (nicotine NEAR (replacement OR patch* OR transdermal OR gum OR lozenge* OR sublingual OR inhaler* OR inhalator* OR oral OR nasal OR spray)):TI,AB,KW     

  3. (bupropion OR zyban OR wellbutrin):TI,AB,KW,MH,EMT  

  4. (varenicline OR champix OR chantix):TI,AB,KW,MH,EMT   

  5. combined modality therapy:MH,KW    

  6. ((behavio?r therapy) AND (drug therapy)):KW,MH,EMT,TI,AB   

  7. ((counsel*) AND (*drug therapy)):KW,MH,EMT,TI,AB   

  8. #1 OR #2 OR #3 OR #4 OR #5      

  9. #6 OR #7 OR #8   

  10. #9 AND INREGISTER

Study flow diagram for 2019 update
Figures and Tables -
Figure 1

Study flow diagram for 2019 update

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Effect of increasing behavioural support. Abstinence at longest follow‐up.Subgroups by type of pharmacotherapy
Figures and Tables -
Figure 3

Effect of increasing behavioural support. Abstinence at longest follow‐up.

Subgroups by type of pharmacotherapy

Meta‐regression results (the fitted meta‐regression trend is shown as the solid line)
Figures and Tables -
Figure 4

Meta‐regression results (the fitted meta‐regression trend is shown as the solid line)

Funnel plot of comparison: 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, outcome: 1.1 Subgroups by type of pharmacotherapy.
Figures and Tables -
Figure 5

Funnel plot of comparison: 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, outcome: 1.1 Subgroups by type of pharmacotherapy.

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 1 Subgroups by type of pharmacotherapy.
Figures and Tables -
Analysis 1.1

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 1 Subgroups by type of pharmacotherapy.

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 2 Subgroups by contrast in number of contacts between intervention & control.
Figures and Tables -
Analysis 1.2

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 2 Subgroups by contrast in number of contacts between intervention & control.

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 3 Subgroups by duration of contact in control condition (not prespecified).
Figures and Tables -
Analysis 1.3

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 3 Subgroups by duration of contact in control condition (not prespecified).

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 4 Subgroup by modality of intervention contact (not prespecified).
Figures and Tables -
Analysis 1.4

Comparison 1 Effect of increasing behavioural support. Abstinence at longest follow‐up, Outcome 4 Subgroup by modality of intervention contact (not prespecified).

Comparison 2 Effect of increasing behavioural support: Sensitivity analyses, Outcome 1 Sensitivity analysis including intermediate intensity conditions. Adjunct behavioural support versus pharmacotherapy alone.
Figures and Tables -
Analysis 2.1

Comparison 2 Effect of increasing behavioural support: Sensitivity analyses, Outcome 1 Sensitivity analysis including intermediate intensity conditions. Adjunct behavioural support versus pharmacotherapy alone.

Comparison 2 Effect of increasing behavioural support: Sensitivity analyses, Outcome 2 By outcome definition.
Figures and Tables -
Analysis 2.2

Comparison 2 Effect of increasing behavioural support: Sensitivity analyses, Outcome 2 By outcome definition.

Comparison 3 Studies matched for contact time. Abstinence at longest follow‐up point, Outcome 1 Abstinence at longest follow‐up.
Figures and Tables -
Analysis 3.1

Comparison 3 Studies matched for contact time. Abstinence at longest follow‐up point, Outcome 1 Abstinence at longest follow‐up.

Summary of findings for the main comparison. Behavioural interventions as adjuncts to pharmacotherapy for smoking cessation

Behavioural interventions as adjuncts to pharmacotherapy for smoking cessation

Patient or population: People using smoking cessation pharmacotherapy
Settings: Healthcare and community settings
Intervention: Behavioural interventions as adjuncts to pharmacotherapy

Outcomes

Illustrative absolute effects* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed successful quitters without intervention

Estimated quitters with intervention

Pharmacotherapy

(with variable level of behavioural support)

Additional behavioural support

(in addition to pharmacotherapy)

Smoking cessation at longest follow‐up
Follow‐up: 6 ‐ 24 months

Study population1

RR 1.15
(1.08 to 1.22)

23,331
(65 studies)

⊕⊕⊕⊕
high2,3

Effect very stable over time: updates of this analysis (15 new studies added 2015; 18 new studies added 2019) have had minimal impact on the effect estimate. Little evidence of differences in effect based on amount of support or type of pharmacotherapy provided.

171 per 1000

197 per 1000
(185 to 209)

The estimated rate of quitting with behavioural intervention (and its 95% confidence interval) is based on the assumed quit rate in the control 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.

1Based on the control group crude average

2Sensitivity analysis removing studies at high risk of bias yielded results consistent with those from the overall analysis. A funnel plot was inconclusive but suggested there may have been slightly more small studies with large effect sizes than with small effect sizes. However, asymmetry was not clear and we did not downgrade on this basis; given the large number of included studies and the degree of homogeneity between them, it is unlikely that smaller unpublished studies showing no effect, if they existed, would significantly alter our results.

Figures and Tables -
Summary of findings for the main comparison. Behavioural interventions as adjuncts to pharmacotherapy for smoking cessation
Table 1. Summary of control and intervention characteristics

Intervention

Control

Study ID

Pharmacotherapy

Modality

(included face‐to‐face/

telephone only)

Number of contacts

Total duration (minutes)

Number of contacts

Total duration (minutes)

Comments

Ahluwalia 2006

NRT

Face‐to‐face

6

120

6

120

Aimer 2017

NRT

Face‐to‐face

4

Unclear

Unclear

Unclear

Alterman 2001

NRT

Face‐to‐face

16

4290

1

30

Multiple arms ‐ highest vs lowest intensity

Aveyard 2007

NRT

Face‐to‐face

7

140

4

80

Bailey 2013

NRT

Face‐to‐face

19

950

10

500

Baker 2015

NRT

Face‐to‐face

17

1050

17

290

Bastian 2012

NRT

Telephone

5

100

5

100

Begh 2015

NRT

Face‐to‐face

7

112

7

112

Berndt 2014

NRT

Face‐to‐face

7

285

7

105

Bloom 2017

NRT

Face‐to‐face

20

400

20

880

Exercise sessions/time excluded

Bock 2014

NRT

Face‐to‐face

3

Unclear

1

Unclear

Boyle 2007

Choice

Face‐to‐face

9

Unclear

0

0

Bricker 2014

NRT

Telephone

5

90

5

90

Brody 2017

NRT & Bupropion

Face‐to‐face

22

970

12

720

Brown 2013

NRT

Face‐to‐face

Unclear

Unclear

Unclear

Unclear

Busch 2017

NRT

Face‐to‐face

6

220

6

87.5

Bushnell 1997

NRT

Face‐to‐face

8

480

4

240

Calabro 2012

NRT

Face‐to‐face

2

120

1

5

Intervention also had "access to 5 web‐based booster sessions"

Cook 2016

NRT

Face‐to‐face

11

130

0

0

Multifactorial ‐ highest vs lowest intensity

Cropsey 2015

NRT

Face‐to‐face

4

100

1

Unclear

Ellerbeck 2009

Choice

Face‐to‐face

6

Unclear

0

0

Multiple arms ‐ highest vs lowest intensity

Ferguson 2012

NRT

Telephone

6

Unclear

Unclear

Unclear

Fiore 2004

NRT

Face‐to‐face

5

Unclear

0

0

Multiple arms ‐ highest vs lowest intensity

Gariti 2009

Choice

Face‐to‐face

10

125

4

30

Gifford 2011

Bupropion

Face‐to‐face

20

Unclear

1

60

Ginsberg 1992

NRT

Face‐to‐face

5

Unclear

2

Unclear

Hall 1985

NRT

Face‐to‐face

14

1050

4

Unclear

Hall 1987

NRT

Face‐to‐face

14

1050

5

300

Hall 1994

NRT

Face‐to‐face

10

1200

5

450

Hall 1998

Nortriptyline

Face‐to‐face

10

1200

5

450

Hall 2002

Bupropion/Nortriptyline

Face‐to‐face

5

450

4

30

Hall 2009

NRT & Bupropion

Face‐to‐face

11

330

5

Unclear

Multifactorial study design

Hasan 2014

NRT

Face‐to‐face

7

195

6

105

Hollis 2007

NRT

Telephone

4

100

1

15

Multiple arms ‐ highest vs lowest intensity

Huber 2003

NRT

Face‐to‐face

5

450

5

225

Humfleet 2013

NRT

Face‐to‐face

6

300

1

'Brief'

Multiple arms ‐ highest vs lowest intensity

Jorenby 1995

NRT

Face‐to‐face

8

480

0

0

Multiple arms ‐ highest vs lowest intensity

Kahler 2015

NRT

Face‐to‐face

6

210

6

210

Killen 2008

NRT & Bupropion

Face‐to‐face

10

300

10

200

Kim 2015

NRT

Face‐to‐face

8

320

8

80

LaChance 2015

NRT

Face‐to‐face

7

420

7

420

Lando 1997

NRT

Face‐to‐face

4

48

0

0

Multiple arms ‐ highest vs lowest intensity

Lifrak 1997

NRT

Face‐to‐face

20

736.5

4

82.5

Lloyd‐Richardson 2009

NRT

Face‐to‐face

5

Unclear

2

Unclear

MacLeod 2003

NRT

Telephone

5

60

0

0

Macpherson 2010a

NRT

Face‐to‐face

8

480

8

480

Matthews 2018

NRT

Face‐to‐face

6

540

6

540

McCarthy 2008

Bupropion

Face‐to‐face

13

Unclear

13

Unclear

Control received 80 minutes less contact than intervention

NCT00879177

NRT & Varenicline

Face‐to‐face

9

Unclear

5

Unclear

Ockene 1991

NRT

Face‐to‐face

5

45

2

15

O'Cleirigh 2018

NRT

Face‐to‐face

10

600

5

100

Okuyemi 2013

NRT

Face‐to‐face

6

105

1

12.5

Otero 2006

NRT

Face‐to‐face

4

240

1

20

Multiple arms ‐ highest vs lowest intensity

Patten 2017

NRT

Face‐to‐face

36

1080

36

1080

Intervention group: "exercise counselling delivered while the participant was engaged in exercise" ‐ have left this time in as also counselling

Prapavessis 2016

NRT

Face‐to‐face

64

1985

59

1860

Multiple arms ‐ highest vs lowest intensity

Reid 1999

NRT

Face‐to‐face

6

Unclear

3

45

Rohsenow 2014

NRT

Face‐to‐face

3

65

3

35

Rovina 2009

Bupropion

Face‐to‐face

9

540

1

15

Multiple arms ‐ highest vs lowest intensity

Schlam 2016

NRT

Face‐to‐face

12

320

4

200

Multifactorial study design

Schmitz 2007a

Bupropion

Face‐to‐face

7

420

7

420

Simon 2003

NRT

Face‐to‐face

6

195

1

10

Smith 2001

NRT

Face‐to‐face

6

90

0

0

Multiple arms ‐ highest vs lowest intensity

Smith 2013a

NRT

Telephone

4

67

4

60

Exact duration of contact not recorded, but averages given, intervention: 67.0 (± 25.8), control: 60.1 (± 23.9)

Smith 2014

Varenicline

Face‐to‐face

5

Unclear

5

Unclear

Comparing culturally‐tailored with standard counselling ‐ duration of sessions not stated

Solomon 2000

NRT

Telephone

See note

See note

0

0

Control = "access to quitline"; intervention = "up to 12 calls" ‐ averaged 7 calls at 9 minutes each

Solomon 2005

NRT

Telephone

8.2

80

0

0

Intervention numbers based on average number/duration of calls

Stanton 2015

NRT

Face‐to‐face

7

Unclear

3

Unclear

Stein 2006

NRT

Face‐to‐face

3

65

2

5

Control offered "up to 2 visits", intervention only offered 3rd visit if ready to quit

Strong 2009

Bupropion

Face‐to‐face

12

1440

12

1440

Swan 2003

Bupropion

Telephone

4

Unclear

1

7.5

Multiple arms ‐ highest vs lowest intensity

Swan 2010

Varenicline

Telephone

5

67

0

0

Tonnesen 2006

NRT

Face‐to‐face

12

270

10

150

Van Rossem 2017

Varenicline

Face‐to‐face

10

120

1

20

Duration of sessions not stipulated, but maximum amounts recorded in paper. Intervention: 120, control: 20

Vander Weg 2016

Choice

Telephone

6

150

0

0

Intervention sessions listed as 20 to 30 minutes ‐ control was referral to a quitline, but there were no mandated sessions, so contact listed as 0

Vidrine 2016 (CBT)

NRT

Face‐to‐face

8

960

4

40

Vidrine study intervention 2 (control split)

Vidrine 2016 (MBAT)

NRT

Face‐to‐face

8

960

4

40

Vidrine study intervention 1 (control split)

Wagner 2016

NRT

Face‐to‐face

12

Unclear

12

Unclear

Sessions' duration not reported

Warner 2016

NRT

Face‐to‐face

1

5

1

5

Webb Hooper 2017

NRT

Face‐to‐face

9

945

9

945

Exact duration not listed, but approximate range given

Wewers 2017

NRT

Face‐to‐face

7

210

6

180

Compared 2 interventions, less intensive counted as control

Wiggers 2006

NRT

Face‐to‐face

3

Unclear

1

Unclear

Williams 2010

NRT

Face‐to‐face

24

1080

9

180

Wu 2009

NRT

Face‐to‐face

4

240

4

240

Yalcin 2014

Choice

Face‐to‐face

14

730

9

150

Figures and Tables -
Table 1. Summary of control and intervention characteristics
Comparison 1. Effect of increasing behavioural support. Abstinence at longest follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Subgroups by type of pharmacotherapy Show forest plot

65

23331

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.08, 1.22]

1.1 NRT

49

16541

Risk Ratio (M‐H, Random, 95% CI)

1.12 [1.04, 1.21]

1.2 Bupropion

5

2298

Risk Ratio (M‐H, Random, 95% CI)

1.27 [1.10, 1.46]

1.3 Nortriptyline

2

172

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.60, 1.63]

1.4 Varenicline

2

1111

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.87, 1.27]

1.5 NRT & bupropion

3

719

Risk Ratio (M‐H, Random, 95% CI)

1.24 [1.00, 1.54]

1.6 Choice of pharmacotherapy

5

2490

Risk Ratio (M‐H, Random, 95% CI)

1.30 [1.00, 1.68]

2 Subgroups by contrast in number of contacts between intervention & control Show forest plot

63

21997

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.08, 1.22]

2.1 4 to 8 or > 8 contacts versus no contact

8

4018

Risk Ratio (M‐H, Random, 95% CI)

1.20 [1.02, 1.43]

2.2 More than 8 contacts versus 1 to 3 contacts

4

1063

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.70, 1.57]

2.3 4 to 8 contacts versus 1 to 3 contacts

18

9579

Risk Ratio (M‐H, Random, 95% CI)

1.10 [1.01, 1.19]

2.4 More than 8 contacts versus 4 to 8 contacts

12

1737

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.98, 1.33]

2.5 Intervention & control in same contact category

21

5600

Risk Ratio (M‐H, Random, 95% CI)

1.32 [1.16, 1.50]

3 Subgroups by duration of contact in control condition (not prespecified) Show forest plot

62

21695

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.08, 1.22]

3.1 No contact for control

8

4018

Risk Ratio (M‐H, Random, 95% CI)

1.20 [1.02, 1.43]

3.2 'Brief intervention' for control

22

10565

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.99, 1.21]

3.3 'Dose response', over 30 minutes contact for control

32

7112

Risk Ratio (M‐H, Random, 95% CI)

1.19 [1.08, 1.32]

4 Subgroup by modality of intervention contact (not prespecified) Show forest plot

65

23331

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.08, 1.22]

4.1 Intervention delivered by telephone

8

6670

Risk Ratio (M‐H, Random, 95% CI)

1.25 [1.15, 1.37]

4.2 Intervention included face‐to‐face contact

57

16661

Risk Ratio (M‐H, Random, 95% CI)

1.11 [1.03, 1.19]

Figures and Tables -
Comparison 1. Effect of increasing behavioural support. Abstinence at longest follow‐up
Comparison 2. Effect of increasing behavioural support: Sensitivity analyses

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sensitivity analysis including intermediate intensity conditions. Adjunct behavioural support versus pharmacotherapy alone Show forest plot

65

27425

Risk Ratio (M‐H, Random, 95% CI)

1.13 [1.07, 1.20]

1.1 NRT

49

18666

Risk Ratio (M‐H, Random, 95% CI)

1.10 [1.03, 1.19]

1.2 Bupropion

5

2298

Risk Ratio (M‐H, Random, 95% CI)

1.27 [1.10, 1.46]

1.3 Nortriptyline

2

172

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.60, 1.63]

1.4 Varenicline

2

1513

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.90, 1.26]

1.5 NRT & bupropion

3

719

Risk Ratio (M‐H, Random, 95% CI)

1.24 [1.00, 1.54]

1.6 Choice of pharmacotherapy

5

4057

Risk Ratio (M‐H, Random, 95% CI)

1.23 [1.00, 1.51]

2 By outcome definition Show forest plot

65

23389

Risk Ratio (M‐H, Random, 95% CI)

1.15 [1.08, 1.22]

2.1 12 months validation PP outcomes only

21

6036

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.90, 1.17]

2.2 12 months validated sustained outcomes

11

3604

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.93, 1.30]

2.3 < 12 months, but validated

19

5581

Risk Ratio (M‐H, Random, 95% CI)

1.25 [1.12, 1.39]

2.4 No validation at all

13

7933

Risk Ratio (M‐H, Random, 95% CI)

1.18 [1.08, 1.30]

2.5 > 12 months validation PP outcomes only

1

235

Risk Ratio (M‐H, Random, 95% CI)

1.34 [0.59, 3.01]

Figures and Tables -
Comparison 2. Effect of increasing behavioural support: Sensitivity analyses
Comparison 3. Studies matched for contact time. Abstinence at longest follow‐up point

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Abstinence at longest follow‐up Show forest plot

15

4138

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.84, 1.25]

1.1 Family support versus usual care telephone counselling

1

471

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.72, 1.45]

1.2 Face‐to‐face, tests attentional training v placebo training

1

119

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.48, 2.50]

1.3 ACT versus CBT telephone counselling

1

121

Risk Ratio (M‐H, Random, 95% CI)

1.35 [0.74, 2.46]

1.4 Positive psychotherapy versus usual care (face‐to‐face)

1

77

Risk Ratio (M‐H, Random, 95% CI)

8.78 [0.49, 157.62]

1.5 Couples treatment versus individual treatment (face‐to‐face)

1

49

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.37, 1.43]

1.6 Behavioural activation versus standard treatment (face‐to‐face)

1

68

Risk Ratio (M‐H, Random, 95% CI)

4.72 [0.24, 94.85]

1.7 Culturally tailored versus standard (face‐to‐face)

4

929

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.68, 1.92]

1.8 Exercise counselling versus health education (face‐to‐face)

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.23, 1.89]

1.9 Adherence counselling versus standard care (telephone)

1

987

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.83, 1.15]

1.10 MIndfulness versus CBT (face‐to‐face)

1

309

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.48, 1.45]

1.11 Quitline facilitation session versus brief advice (telephone)

1

600

Risk Ratio (M‐H, Random, 95% CI)

1.57 [0.62, 4.00]

1.12 Motivational interviewing versus health education

1

378

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.33, 0.94]

Figures and Tables -
Comparison 3. Studies matched for contact time. Abstinence at longest follow‐up point