Incentivos para el abandono del hábito de fumar
Información
- DOI:
- https://doi.org/10.1002/14651858.CD004307.pub5Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 18 mayo 2015see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Tabaquismo
- Copyright:
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- Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
KC (guarantor of the review) extracted data, conducted the analyses and wrote the review.
JH‐B checked data extraction and contributed to the writing of the review
RP checked the statistical analysis and commented on the review.
Sources of support
Internal sources
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Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
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JHB is funded by the National Institute of Health Research School for Primary Care Research (NIHR SPCR), UK.
External sources
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NHS Research and Development Fund, UK.
Declarations of interest
KC: None known
JH‐B: None known
RP: None known.
Acknowledgements
We are profoundly grateful to Scott Halpern, Theresa Marteau and Justin White for exceptional support and co‐operation in supplying data and information for use in this review. We would also like to thank Sheila Alessi, Carla Berg, Suzanne Colby, Sandra Gallagher, Xavier Giné, Suzy Bird Gulliver, Tomoko Hiragaya, Leonard Jason, Susan McMahon, Steven Ondersma, Erin Rotherham‐Fuller, Damaris Rohsenow, Steven Shoptaw, David Tappin, Tracy Tevyaw, Andrea Troxel, and Kevin Volpp for additional data or clarification. Thanks also to Frances Kellie from the Cochrane Pregnancy and Childbirth Group for collaborative support with the inclusion of the pregnancy trials.
Version history
| Published | Title | Stage | Authors | Version |
| 2019 Jul 17 | Incentives for smoking cessation | Review | Caitlin Notley, Sarah Gentry, Jonathan Livingstone‐Banks, Linda Bauld, Rafael Perera, Jamie Hartmann‐Boyce | |
| 2015 May 18 | Incentives for smoking cessation | Review | Kate Cahill, Jamie Hartmann‐Boyce, Rafael Perera | |
| 2011 Apr 13 | Competitions and incentives for smoking cessation | Review | Kate Cahill, Rafael Perera | |
| 2008 Jul 16 | Competitions and incentives for smoking cessation | Review | Kate Cahill, Rafael Perera | |
| 2005 Apr 20 | Competitions and incentives for smoking cessation | Review | K Hey, Rafael Perera, Kate Cahill | |
| 2003 Apr 22 | Competitions and incentives for smoking cessation | Protocol | Kate Hey, Rafael Perera | |
Differences between protocol and review
For this 2015 update, we have separated out the competitions trials from the incentives trials, and now present the findings as two separate updates. This one is for incentives and contingency management interventions only. We took this decision because competition‐based programmes are now a rarely‐used intervention, while incentives and contingency management programmes are increasingly being developed and deployed, so that the research agenda continues to grow and change in this area.
For this 2015 update, we have pooled the meta‐analysis findings, rather than displaying them as descriptive forest plots only.
For this 2015 update, we now include interventions in pregnant women, whom we had excluded in earlier versions of the review.
For this 2015 update, we have dropped the secondary outcome of recruitment, as this is now fully covered in a recent Cochrane review (Belisario 2012).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Female; Humans; Male; Pregnancy;
PICO
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 2 Smoking cessation: mixed populations, outcome: 2.1 Smoking cessation in mixed populations.
Forest plot of comparison: 3 Smoking cessation: pregnancy, outcome: 3.1 Pregnancy trials at longest follow‐up (adjusted OR).
| Study | Denominator | Abstinence | Time point | Biological criterion | Quit rate | Stat sig? | Other outcomes | Comment |
| Alessi 2014 | 24 (CM) 21 (control) | 7‐day PPA | 24 weeks | CO < 6 ppm cotinine < 30 ng/ml | 12.5% (I) 23.8% (C) | No | % reduction in cpd; self efficacy | Raw data supplied by the author |
| Crowley 1995 | 36/49 randomised | 24 hr PPA | 6 months | CCO < 10ppm | N = 5/36 | Chi² N.S. | Mean CO values (reduction) | Groupings were collapsed at follow‐up; of 49 at baseline, 9 dropped out, 4 had moved or died. |
| De Paul 1994 | 281 (I) | PPA | 24 months | CO < 9ppm | 13.2% (I) | N.S. | PP, ITT and continuous quit rates reported at all time points | Comparison confined to I and SH groups in this review |
| Drummond 2014 | 50 (UC/LA) 50 (CM x 2) | 7 days PPA | 6 months | cotinine, eCO | UC/LA 1/50 CM 3/50 | N.S. | CO values, Fagerstrom score, N of visits wanting to quit, trying to quit, reporting cessation, eCO‐confirmed quitting | Groupings collapsed, as lung age alone or conbined with CM produced no quitters |
| Gallagher 2007 | 60 (CR) | PPA | 36 wks | CO ≤ 10 ppm | 7% (CR) | N.S. | CO‐validated rates higher, i.e. 37% (CR), 8% (Cont). | CR+NRT group not used in our comparison. |
| Giné 2010 | 781 (CARES) 603 (Cards) 616 (Control) | PPA | 12 months | NicCheck strip (urinary cotinine) = 0 | 11% (CARES) 9.3% (Cards) 8.9% (Cont) | @ 0.05 | 6m PPA: CARES 9.7%, Cards 10%, Control 8.3%. Cost effectiveness: USD 700 per quitter | 12m assessment was 'sprung' on pts |
| Glasgow 1993 | 344 (I) | 7 days | 2 years | CO ≤ 9ppm | 14.2% (I) | N.S. | Incentives had a sig. effect (P < 0.03) on less educated subjects (18.6% vs 8.8% @ 2yr 'probably chance'). | 27% of all abstinent claims could not be biochemically verified |
| Halpern (A) 2015 | 498 (Ind R) 519 (Coll R) 582 (Ind D) 471 (Com D) 468 (UC) | sustained | 12 months | Cotinine < 10 ng/ml anabasine/anabitine < 3 ng/ml | 7.4% (Ind R) 8.7% (Coll R) 3.6% (Ind D) 6.2% (Com D) 3.4% (UC) | vs UC: 0.007 0.001 0.94 0.052 | Sustained verified abstinence @ 14 days, 30 days, 6m; Self‐reported abstinence at 12m; per protocol analyses; Uptake rates of assigned intervention | No differences between individual and group interventions, so both reward arms versus both deposit arms combined for analysis |
| Hennrikus 2002 | 407 | 7 days PP | 24 months | Saliva from 149 random sample of quitters @ 24m. | 19.4% | Not stated | Cohort prevalence and cessation rates (PP and continuous) | Programme registrants' outcomes not available |
| Ledgerwood 2014 | ECM: 36 TCM: 28 SC (Control): 17 | PPA | 6 months | Urinary cotinine ≤ 100 ng/mL CO ≤ 6 ppm | 4/64 (TCM+ECM) 1/17 | N.S. | Prize money won; 81% CM pts earned prizes (median USD 120.56); Differences between TCM and ECM in wk 1 non‐significant | Both CM arms combined for analysis |
| Paxton 1980 | 33 (I) | At least 7 days | 6 months | Random urine samples, but | ?43% (I) | N.S. | Weight and lung function monitored for 4 months | Quit rates presented as graphic % only |
| Paxton 1981 | 33 (D1) | At least 7 days | 6 months | Random urine samples, but | ?35% (D1) | N.S. | Weight and lung function monitored for 4 months | Quit rates presented as graphic % only. |
| Paxton 1983 | 60 (2LA) | No smoking since last measured | 12 months | Random urine samples, but | 26.7% (2LA) | N.S. | 'thinning' deposit repayments | |
| Rand 1989 | 17 contingent | Continuous | 6 months | CO<=11ppm | 1/17 contingent | N.S. | Numbers of abstinent CO samples and missed samples | Pairwise comparisons gave sig diffs @ 11ppm, but not @ 8ppm |
| Secades‐Villa 2014 | 43 CBT + CM 49 CBT | continuous | 6 months | CO < 4 ppm; | 17/43 CM 13/49 CBT | N.S. | Treatment retention; % attending all sessions for 6m | |
| Shoptaw (A) 2002 | 42 (P) | PPA | 12 months | CO<=8ppm | 4/36 (P) | N.S. | Treatment group and cocaine and opiate abuse | Quit rates supplied by authors. |
| Tevyaw 2009 | 28 (CM+MET) | 7‐day PPA | 6 months | CO<5ppm | 1/55 (CM) | N.S. | Attendance, sample returns. | |
| Volpp 2006 | 92 (I) | 7‐day PP | 6 months post‐completion (˜7.5m post‐quit date | Urinary cotinine <500 ng/mL | 6/92 (I) | N.S. | Enrolment, attendance, programme completion | Denominators could be Ns enrolled (I:38, C:17). No quitters outside the enrollers. |
| Volpp 2009 | 436 (I) | Prolonged | 15 or 18 months | Salivary cotinine < 15 ng/ml | 41/436 (I) 16/442 (C) | < 0.001 | Enrolment in SC course, completion of SC course | 15 ‐ 18 months results shown in 12‐month forest plot |
| White 2013 | 131 (I) 69 (C) | 7‐day PPA | 6 months | Urinary cotinine | 58/131 (I) 13/69 (C) | < 0.0005 | PPA @ 3m (verified), 14m (self‐report). Relative success of teams vs individuals? Yes Choosing team partner vs random assignment? No Did text messages help? No Cost effectiveness; No figures given. | |
| Windsor (A) 1988 | 95 (A) | Continuous | 12 months | SCN<= | ≃6% (A) | Not reported | Social enhancement vs self‐help manual (+/‐ incentives) gave a continuous quit rate of 14.4% at 12m, vs 5.8%. | Incentives comparison was abandoned @ 6w |
Comparison 1 RESULTS OF INCLUDED STUDIES, Outcome 1 RESULTS TABLE: Mixed populations.
| Study | Denominator | Abstinence | Time point | Biological criteria | Quit rate | Stat sig? | Other outcomes | Comment |
| Donatelle 2000a | 112 (I) 108 (C) | 7‐day PPA | 8m gestation | Salivary cotinine < 30 ng/ml | 34/105; 32% (I) 9/102; 9% (C) | Chi² = 18.4; P < 0.0001 | None stated | Differential losses to follow‐up; (I) 32% at 8m, vs (C) 51.5%. |
| Donatelle 2000a | 112 (I) 108 (C) | 7‐day PPA | 2m post‐partum | Salivary cotinine < 30 ng/ml | 22/103; 21% (I) 6/102; 5.9% (C) | Chi² = 11; | None stated | Differential losses to follow‐up; (I) 36% at 2m pp, vs (C) 52%. |
| Donatelle 2000b | 67 (E1) | "biochemically confirmed abstinence" | end of pregnancy | Salivary cotinine < 30 ng/ml | 19% (E1) 22% (E2) 12% (C) | Not stated | None stated | Very little information available. |
| Donatelle 2000b | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Donatelle 2002 | 102 (E1) 96 (E2) 95 (C) | Self report (telephone call) | 8m gestation | Salivary cotinine < 30 ng/ml | N.S. | Not stated. | High vs low incentives; cost per quitter | Results are interim analysis only, based on 298 enrolled; target was 600. |
| Donatelle 2002 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Heil 2008 | 37 (I) 40 (C) | PPA | End of pregnancy; | Urine cotinine < 80 ng/ml CO ≤ 6 ppm | 15/37; 41% (I) 4/40; 10% (C) | P = 0.003 | Foetal growth | |
| Heil 2008 | antepartum CA; 24 wks post‐partum | Urine cotinine < 80 ng/ml CO ≤ 6 ppm | 3/37; 8% (I) 1/40; 3% (C) | N.S. | Baby health Total voucher earnings | |||
| Higgins 2004 | 30 (I) 23 (C) | 7‐day PPA | End of pregnancy | Urine cotinine < 80 ng/ml CO ≤ 6 ppm | 11/30 (I) | P < 0.05 | Mean voucher earnings | This was the pilot study for Heil 2008 |
| Higgins 2004 | 30 (I) | 7‐day PPA | 24 wks post‐partum | Urine cotinine < 80 ng/ml CO ≤ 6 ppm | 8/30 (I) 0/23 (C) | P < 0.05 | ||
| Higgins 2014 | 44 (RCV; E1) 44 (CV; E2 42 (NCV; C) | 7‐day PPA | 28 wks gestation | Urinary cotinine ≤ 80 ng/ml CO < 4ppm or 6 ppm | 18/40; 45% (E1) 14/39; 36% (E2) 7/39; 18% (C) | N.S. | Foetal growth | |
| Higgins 2014 | 44 (RCV; E1) 44 (CV; E2 42 (NCV; C) | 7‐day PPA | 24 wks post‐partum | Urinary cotinine ≤ 80 ng/ml CO < 4ppm or 6 ppm | 7/40; 18% (E1) 6/39; 15% (E2) 3/39; 8% (C) | Foetal growth Birth outcomes | ||
| Ondersma 2012 | 26 (E1) 28 (E2) 30 (E3) 26 (C) | 7‐day PPA | 30‐day CA 7‐day PPA | Urinary cotinine ≤ 100 ng/ml CO < 4 ppm | 6/23: 26% (E1) 2/22: 10% (E2) 5/26: 19% (E3) 1/23: 4% (C) | E1 P < 0.05 | ||
| Ondersma 2012 | 42 (E1) 28 (E2) 32 (C) | PPA | 12 wks | CO < 4 ppm Urine sample (for cocaine) | 13/42; 31% (E1) 0/28; 0% (E2) 0/32; 0% (C) | |||
| Tappin 2015 | 306 (I) 306 (C) | "even a puff" in past 2 wks "even a puff" in past 4 wks < 5 cigs in past 8 wks | 4 wks 12 wks (if quit at 4) 34‐38 wks gest (all pts) | CO < 10 ppm Cotinine: Urine 44.7 ng/ml; saliva 14.2 ng/ml | 69/306 (I) 26/303 (C) | P = 0.0000 | Adverse events engagement birth weight cost effectiveness | 3 controls dropped out after randomisation ‐ not included in denominators |
| Tappin 2015 | 306 (I) 306 (C) | still quit or < 5 cigs for since TQD | 6m post‐natal (for 34/38‐wk quitters) | Cotinine: Urine 44.7 ng/ml; saliva 14.2 ng/ml | 47/306 (I) 12/303 (C) | P = 0.0000 | 3 controls dropped out after randomisation ‐ not included in denominators | |
| Tuten 2012 | 42 (E1) 28 (E2) 32 (C) | Self‐reported 24‐hr PPA | 6 wks pp | none | 13/42; 31% (E1) 0/28; 0% (E2) 0/32; 0% (C) | N.S. | Mean cpd | |
| Tuten 2012 | 42 (E1) 28 (E2) 32 (C) | Self‐reported 24‐hr PPA | 6 wks pp | none | 13/42; 31% (E1) 0/28; 0% (E2) 0/32; 0% (C) | N.S. | Mean cpd | Abstinence not reported for this time point |
Comparison 1 RESULTS OF INCLUDED STUDIES, Outcome 2 RESULTS TABLE: Pregnant women.
Comparison 2 Smoking cessation: mixed populations, Outcome 1 Smoking cessation in mixed populations.
Comparison 3 Smoking cessation: pregnancy, Outcome 1 Pregnancy trials at longest follow‐up (adjusted OR).
Comparison 3 Smoking cessation: pregnancy, Outcome 2 Pregnancy trials: abstinence at end of pregnancy.
Comparison 3 Smoking cessation: pregnancy, Outcome 3 Pregnancy: contingent rewards vs guaranteed payments.
Comparison 3 Smoking cessation: pregnancy, Outcome 4 Pregnancy: front‐loading vs incremental payments.
Comparison 3 Smoking cessation: pregnancy, Outcome 5 Pregnancy: Participant‐initiated CM.
| Incentives for smoking cessation | ||||||
| Participant or population: Adult smokers | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Incentives | |||||
| Smoking cessation in mixed populations ‐ longest follow‐up | 84 per 1000 | 112 per 1000 | OR 1.42 | 7715 | ⊕⊕⊝⊝ | Beyond the 6‐month assessment, only 2 studies (Halpern (A) 2015; Volpp 2009) demonstrated sustained cessation. |
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 111/20 trials failed to conduct adequate randomisation and allocation procedures, and 6 of them were rated at high risk of bias in one or both of these domains. | ||||||
| incentives for smoking cessation in pregnant women at longest follow‐up | ||||||
| Participantnt or population: Pregnant women who smoke | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Incentives | |||||
| Smoking cessation in pregnant women at longest follow‐up | 48 per 1000 | 154 per 1000 | OR 3.60 | 1295 | ⊕⊕⊕⊝ | 1 included study (Donatelle 2002) did not contribute to the analysis because of lack of usable data |
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1Only 2 studies (Ondersma 2012; Tappin 2015) were rated at low risk of selection bias; the rest were at unclear risk, apart from Higgins 2004 (high risk). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 RESULTS TABLE: Mixed populations Show forest plot | Other data | No numeric data | ||
| 2 RESULTS TABLE: Pregnant women Show forest plot | Other data | No numeric data | ||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Smoking cessation in mixed populations Show forest plot | 20 | Adjusted Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 1.1 Longest follow‐up | 20 | 7715 | Adjusted Odds Ratio (Fixed, 95% CI) | 1.42 [1.19, 1.69] |
| 1.2 Six months | 19 | 6945 | Adjusted Odds Ratio (Fixed, 95% CI) | 1.72 [1.43, 2.08] |
| 1.3 12 months | 8 | 4245 | Adjusted Odds Ratio (Fixed, 95% CI) | 1.17 [0.94, 1.46] |
| 1.4 18 months | 1 | 561 | Adjusted Odds Ratio (Fixed, 95% CI) | 1.59 [0.89, 2.83] |
| 1.5 24 months | 2 | 1331 | Adjusted Odds Ratio (Fixed, 95% CI) | 1.29 [0.93, 1.79] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Pregnancy trials at longest follow‐up (adjusted OR) Show forest plot | 8 | 1295 | Odds Ratio (Fixed, 95% CI) | 3.60 [2.39, 5.43] |
| 2 Pregnancy trials: abstinence at end of pregnancy Show forest plot | 8 | 1297 | Odds Ratio (M‐H, Fixed, 95% CI) | 3.79 [2.74, 5.25] |
| 3 Pregnancy: contingent rewards vs guaranteed payments Show forest plot | 4 | 278 | Odds Ratio (M‐H, Fixed, 95% CI) | 6.26 [2.35, 16.68] |
| 4 Pregnancy: front‐loading vs incremental payments Show forest plot | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 5 Pregnancy: Participant‐initiated CM Show forest plot | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
