Biomedical risk assessment as an aid for smoking cessation

Raphaël Bize; Bernard Burnand; Yolanda Mueller; Myriam Rège Walther; Jacques Cornuz

doi:10.1002/14651858.CD004705.pub2

Biomedical risk assessment as an aid for smoking cessation

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Referencias

References to studies included in this review

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estudios excluidos
otras referencias

Audrain J, Boyd NR, Roth J, Main D, Caporaso NF, Lerman C. Genetic susceptibility testing in smoking‐cessation treatment: one‐year outcomes of a randomized trial. Addictive Behaviors 1997;22(6):741‐51.

Bovet P, Perret F, Cornuz J, Quilindo J, Paccaud F. Improved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques. Preventive Medicine 2002;34(2):215‐20.

Jamrozik K, Vessey M, Fowler G, Wald N, Parker G, Van Vunakis H. Controlled trial of three different antismoking interventions in general practice. British Medical Journal Clinical Research Ed 1984;.288(6429):1499‐503.

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.

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Sippel JM, Osborne ML, Bjornson W, Goldberg B, Buist AS. Smoking cessation in primary care clinics. Journal of General Internal Medicine 1999;14(11):670‐6.

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References to studies excluded from this review

Ir a:

estudios incluidos
otras referencias

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Borrelli B, McQuaid EL, Becker B, Hammond K, Papandonatos G, Fritz G, et al. Motivating parents of kids with asthma to quit smoking: the PAQS project. Health Education Research 2002;17(5):659‐69.

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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.

Humerfelt S, Eide GE, Kvale G, Aaro LE, Gulsvik A. Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure. European Respiratory Journal 1998;11(2):284‐90.

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Kanner RE, Connett JE, Williams DE, Buist AS. Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. American Journal of Medicine 1999;106(4):410‐6.

McBride CM, Bepler G, Lipkus IM, Lyna P, Samsa G, Albright J, et al. Incorporating genetic susceptibility feedback into a smoking cessation program for African‐American smokers with low income. Cancer Epidemiology, Biomarkers & Prevention 2002;11(6):521‐8.

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Richmond R, Webster I. A smoking cessation program for use in general practice. Medical Journal of Australia 1985;142:190‐4.

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Wakefield M, Banham D, McCaul K, Martin J, Ruffin R, Badcock N, et al. Effect of feedback regarding urinary cotinine and brief tailored advice on home smoking restrictions among low‐income parents of children with asthma: a controlled trial. Preventive Medicine 2002;34(1):58‐65.

Additional references

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Buist AS. Guidelines for the management of chronic obstructive pulmonary disease. Respiratory Medicine 2002;96(Suppl C):S11‐S16.

Curry SJ. Self‐help interventions for smoking cessation. Journal of Consulting and Clinical Psychology 1993;61:790‐803.

US Department of Health and Human Services. The health benefits of smoking cessation: A Report of the Surgeon General. DHHS Publication No. (CDC) 90‐8416. Rockville, MD: Public Health Service, Office on Smoking and Health, 1990.

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Gmel G. Prevalence of tobacco use in Switzerland in the 1990s‐estimation of consumption trends based on two methods [Pravalenz des Tabakkonsums in der Schweiz der 1990er Jahre‐‐Schatzung der Konsumtrends aufgrund zweier Methoden]. Sozial‐ und Praventivmedizin 2000;45:64‐72.

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Hepper NG, Drage CW, Davies SF, Rupp WM, LaMothe J, Schoenfelder PG, et al. Chronic obstructive pulmonary disease: a community‐oriented program including professional education and screening by a voluntary health agency. American Review of Respiratory Disease 1980;121:97‐104.

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Loss RW, Hall WJ, Speers DM. Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing. American Journal of the Medical Sciences 1979;278:27‐37.

McBride CM, Halabi S, Bepler G, Lyna P, McIntyre L, Lipkus I, et al. Maximizing the motivational impact of feedback of lung cancer susceptibility on smokers' desire to quit. Journal of Health Communication 2000;5:229‐41.

McClure JB. Are biomarkers a useful aid in smoking cessation? A review and analysis of the literature. Behavioral Medicine 2001;27:37‐41.

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Petty TL, Pierson DJ, Dick NP, Hudson LD, Walker SH. Follow‐up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction. American Review of Respiratory Disease 1976;114:881‐90.

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Schwartz JL. Review and evaluation of smoking cessation methods: the United States and Canada, 1978‐1985. U. S. DHHS no. 87‐2940. Washington DC: NIH, Division of Cancer Prevention and Control, National Cancer Institute, 1987.

Scott RR, Mayer JA, Denier CA, Dawson BL, Lamparski D. Long‐term smoking status of cardiac patients following symptom‐specific cessation advice. Addictive Behaviors 1990;15:549‐52.

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Stitzer ML, .Bigelow GE. Contingent reinforcement for reduced carbon monoxide levels in cigarette smokers. Addictive Behaviors 1982;7:403‐12.

The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. JAMA 2000;283:3244‐54.

Weinberger M, Greene JY, Mamlin JJ, Jerin MJ. Health beliefs and smoking behavior. American Journal of Public Health 1981;71:1253‐5.

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Yach D, Bettcher D. Globalisation of tobacco industry influence and new global responses. Tobacco Control 2000;9:206‐16.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Audrain 1997

Methods	Setting: 'smoking clinic', USA Design: Randomized controlled trial, 2 intervention and 1 control group. Recruitment: lay press. Selected: advertisement: 'free smoking‐cessation study'. Randomization: not detailed.
Participants	550 smokers (defined as >=5 cpd for >=1 year) out of 1104 eligible. Mean age 44yrs, 62.8% female, 83.9% white, Mean cpd: 22.7 SoC: Preparation stage: 37.5%, Mean Fagerström score: 5.4 Therapist: trained health educator.
Interventions	Intervention: Intervention 1: EBF group: Exposure Biomarker (CO) Feedback + 10 min motivational counseling before QSC. Intervention 2: SBF group: Susceptibility Biomarker (CYP2D6) Feedback + 10 min motivational intervention + EBF + QSC. Control: QSC group: 60 min Quit‐Smoking Consultation (quit plan, gaining support).
Outcomes	Definition of abstinence: 30‐days abstinence Duration of follow up: 12 months. Biochemical validation of non‐smokers: none
Notes	Per protocol analysis. Distribution of baseline 550 participants among the 3 groups not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Bovet 2002

Methods	Setting: Seychelles Heart Study II Design: Randomized controlled trial. Recruitment: Age‐ and sex‐stratified sample drawn from general population of Mahé, invited by letter to a cardiovascular risk factor survey. Selected: last 155 participants to the Seychelles Heart Study II. Randomization: pre‐established random sequences of numbers matched to rank of arrival. Assessors blinded.
Participants	155 smokers (defined as >=1 cpd during previous week). Mean age 46 yrs, 15% female, Mean cpd: 11.9 Therapist: physician.
Interventions	Intervention: Ultrasonography of carotid and femoral arteries. Smokers with >= 1 plaque given 2 photographs of their plaque + explanation. + quit‐smoking counselling. Control: Quit‐smoking counselling
Outcomes	Definition of abstinence: 7‐days abstinence Duration of follow up: 6 months. Biochemical validation of non‐smokers: none
Notes	Two participants lost to follow up not included in analysis
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Jamrozik 1984

Methods	Setting: 6 general practices, United Kingdom Design: Randomized controlled trial Recruitment: clinic, first visit Selected: outpatients Randomization: according to day of attendance, balanced over 4 weeks.
Participants	2110 smoker (defined as a person admitting to smoking cigarettes) out of 6052 screened. 61% female, No detailed patient characteristics given. Significant difference of social classes between groups. Therapist: physician
Interventions	Intervention: demonstration of patient exhaled CO + verbal advice + booklet. Control: verbal advice + booklet.
Outcomes	Definition of abstinence: point prevalence Duration of follow up: 12 months. Biochemical validation of non‐smokers: urinary cotinine in a sample (41%) of self‐reported non‐smokers.
Notes	Odds ratio based on unvalidated data.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Risser 1990

Methods	Setting: US Veterans Administration Demonstration Project. Design: Randomized controlled trial. Recruitment: veterans attending a health promotion clinic. Selected: responding to mailed invitations for health promotion. Some second visit. Randomization: not detailed.
Participants	90 smokers (not defined) Mean age=53.7 years (55.5 vs 51.7), 4% female, Mean cpd: 23.5, Mean pack‐year: 60.4 Initial cessation intent 51% vs 44%. Therapist: nurse‐practitioner
Interventions	Intervention: spirometry, exhaled CO, discussion of pulmonary symptoms + control intervention. Control: 50 min educational intervention, review of self‐help manual, invitation to a nine‐session one‐to‐one counselling programme.
Outcomes	Definition of abstinence: point prevalence Duration of follow up: 12 months. Biochemical validation of non‐smokers: exhaled CO<=10 ppm.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Sanders 1989

Methods	Setting: 11 United Kingdom general practices Design: Randomized controlled trial. Recruitment: screening of all outpatients. Selected: outpatients + made appointment for health check. Randomization: by day of attendance on a 1:2 basis. Desktop card reminding doctors of right allocation. 120 wrongly allocated patients, excluded from further analysis. Second step randomization for the CO intervention.
Participants	751 participants out of 4330 identified smokers (self‐defined) Mean age 38.5 years. Other characteristics not mentionned. Therapist: practice nurse
Interventions	Intervention: exhaled CO measure + discussion of significance + control intervention Control: Counselling by practice nurse + written material given + offer of a follow‐up appointment.
Outcomes	Definition of abstinence: point prevalence. Duration of follow up: 12 months. Biochemical validation of non‐smokers: urinary cotinine. Cut‐off not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Segnan 1991

Methods	Setting: 44 general practices, Italy. Design: Randomized controlled trial. Recruitment: screening of outpatients on specific days. Selected: outpatients. Randomization: sequence of random numbers, sealed envelopes.
Participants	923 included out of 1009 screened. smoker definition not given. Age: 20.1% <31yrs; 28.0% 31‐40yrs; 26.8% 41‐50yrs; 25.0% >50yrs. 38% female, cpd: 16.7% <=10 cpd; 55.2% 11‐20 cpd; 28.1% >20 cpd. 51% reporting symptoms. Therapist:: physician
Interventions	Intervention: Spirometry prescription + control intervention. Control: Repeated counselling with reinforcement sessions. (2 other groups not used in our comparison: minimal intervention and repeated counselling + nicotine gum).
Outcomes	Definition of abstinence: 7 days abstinence Duration of follow up: 12 months. Biochemical validation of non‐smokers: urinary cotinine < 100 ng/mg.
Notes	In the intervention group, 124 subjects out of 292 reported to have actually had a spirometry test.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Sippel 1999

Methods	Setting:2 primary care clinics, USA Design: Randomized controlled trial. Recruitment: all smokers among outpatients. Selected: outpatients Randomization: questionnaires numbered consecutively (time of check‐in). Odd‐numbered=intervention
Participants	205 included out of 360 smokers (self‐defined). Mean age 38.5 yrs, 62.5% female, Mean cpd: 20.0, Mean pack‐years: 28.9 SoC: 36% in preparation stage. Therapist: study staff
Interventions	Intervention group: Spirometry and exhaled CO + control intervention Control: counselling according to transtheoretical model stage + written material + NRT encouraged if prepared to stop.
Outcomes	Definition of abstinence: sustained quitting rate Duration of follow up: 9 months. Biochemical validation of non‐smokers: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Walker 1985

Methods	Setting: 'stop‐smoking clinic', USA Design: 2x2x2 randomized controlled trial Recruitment: public service anouncement + media advertising. Selected: those responding to advertising, paying US$45. Randomization: not detailed.
Participants	64 out of 141 eligible. (smoker self‐defined) Mean age: 35.5yrs, 59% female, Mean cpd: 29.2, mean 3.4 previous quit attempts Therapist: first author
Interventions	Intervention: exhaled CO and spirometry feedback + Taste Satiation (TS) (in 50%) or Fopcused smoking (FS) (in 50%) and booster sessions for half of each subgroup. Control: 50% TS sessions or 50% FS sessions, booster sessions for half of each subgroup.
Outcomes	Definition of abstinence: 10 days abstinence Duration of follow up: 6 months. Biochemical validation of non‐smokers: exhaled CO <8ppm
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

CO: Carbon Monoxide
cpd: cigarettes per day
NRT: Nicotine Replacement Therapy
OPD: Outpatient Department
ppm: parts per million
SoC: stage of change

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Anthonisen 1994	Effect of spirometry cannot be isolated. Spirometry performed in all patients. Randomization to 3 groups: smoking intervention (12‐session programme) + bronchodilatator, smoking intervention + placebo, no intervention.
Borrelli 2002	Effect of CO cannot be isolated. No results available. Intervention: Precaution Adoption Model: CO feedback + environmental tobacco smoke to the child feedback+ motivational counselling. Control: Behavioral Action Model: self‐efficacy enhancing counselling
Frank 1999	Full text not available. Intervention: urinary cotinine feedback to prenatal patients.
Hajek 2001	Effect of CO cannot be isolated. Intervention: counselling, written materials, CO Control: standard anti‐smoking leaflets
Hajek 2002	Effect of CO cannot isolated. Intervention: CO feedback, booklet, quiz, 'buddy', declaration of commitment to give up, sticker in patient's notes. Control: verbal advice + different booklet
Humerfelt 1998	Effect of spirometry cannot isolated. Intervention: spirometry + written counselling + pamphlet Control: spirometry
Kanner 1996	Effect of spirometry cannot be isolated. Spirometry performed in all patients. Randomization to 3 groups: smoking intervention (12‐session program) + bronchodilatator, smoking intervention + placebo, no intervention.
Kanner 1999	Effect of spirometry cannot be isolated. Spirometry performed in all patients. Randomization to 3 groups: smoking intervention (12‐session program) + bronchodilatator, smoking intervention + placebo, no intervention.
McBride 2002	Effect of genetic biomarker feedback cannot be isolated. Intervention: feedback on GSTM1 + 4 phone calls + control intervention. Control: self‐help manual +/‐ NRT. No phone calls.
McIntosh 1994	Smoking cessation is not considered as an outcome.
Richmond 1986	Effect of biomarker feedback cannot be isolated. Spirometry, blood CO, urinary cotinine in both groups. Intervention: four visits and discussion of manual..
Shoptaw 2002	Effect of CO feedback cannot be isolated. CO feedback given to all groups. 2x2 design: 1. relapse prevention counselling + NRT 2. contingency management: vouchers given for validated abstinence + NRT control: NRT
Terazawa 2001	Effect of biomarker feedback (CO and urinary cotinine) cannot be isolated, combined with 1 counselling session and 4 follow‐up calls.
Wakefield 2002	Biomarker feedback given on the subject's child health, not on his own health. The motivational component here differs from the approach in the other included studies.

CO: carbone monoxide
NRT: Nicotine Replacement Therapy

Data and analyses

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Comparison 1. Smoking cessation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 CO (primary care) Show forest plot	2	1791	Odds Ratio (M‐H, Fixed, 95% CI)	1.07 [0.83, 1.39]
Open in figure viewer Analysis 1.1 Comparison 1 Smoking cessation, Outcome 1 CO (primary care).
2 All interventions Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Smoking cessation, Outcome 2 All interventions.
2.1 CO (primary care)	2		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Genetic marker (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Carotid US (health survey, Seychelles)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Spirometry (primary care)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.5 CO and Spirometry (primary care)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.6 CO and Genetic marker (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.7 CO (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.8 CO and Spirometry (veterans health prom. clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.9 CO and Spirometry (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Analysis 1.1

Comparison 1 Smoking cessation, Outcome 1 CO (primary care).

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Analysis 1.2

Comparison 1 Smoking cessation, Outcome 2 All interventions.

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Comparison 1. Smoking cessation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 CO (primary care) Show forest plot	2	1791	Odds Ratio (M‐H, Fixed, 95% CI)	1.07 [0.83, 1.39]

2 All interventions Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 CO (primary care)	2		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Genetic marker (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Carotid US (health survey, Seychelles)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Spirometry (primary care)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.5 CO and Spirometry (primary care)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.6 CO and Genetic marker (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.7 CO (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.8 CO and Spirometry (veterans health prom. clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.9 CO and Spirometry (smoking clinic)	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Smoking cessation

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Referencias

References to studies included in this review

Audrain 1997 {published data only}

Bovet 2002 {published data only}

Jamrozik 1984 {published data only}

Risser 1990 {published data only}

Sanders 1989 {published data only}

Segnan 1991 {published data only}

Sippel 1999 {published data only}

Walker 1985 {published data only}

References to studies excluded from this review

Anthonisen 1994 {published data only}

Borrelli 2002 {published data only}

Frank 1999 {published data only}

Hajek 2001 {published data only}

Hajek 2002 {published data only}

Humerfelt 1998 {published data only}

Kanner 1996 {published data only}

Kanner 1999 {published data only}

McBride 2002 {published data only}

McIntosh 1994 {published data only}

Richmond 1986 {published data only}

Shoptaw 2002 {published data only}

Terazawa 2001 {published data only}

Wakefield 2002 {published data only}

Additional references

Bauman 1983

Buist 2002

Curry 1993

DHHS 1990

DHHS 2004

Doll 2004

Gmel 2000

Haddow 1991

Heatherton 1991

Hepper 1980

Hoffman 1998

Kilburn 1990

Kottke 1988

Lancaster 2004

Lancaster 2005a

Lancaster 2005b

Lerman 1993

Lerman 1997

Lewitt 1997

Li 1984

Loss 1979

McBride 2000

McClure 2001

Miller 1991

Petty 1976

Phillips 1995

Prochaska 1983

Richmond 1985

Riemsma 2003

Romer 2001

Sargeant 2001

Schwartz 1987

Scott 1990

Silagy 2004

Stitzer 1982

TUDCPGP 2000

Weinberger 1981

West 2000

Yach 2000

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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