Biomedical risk assessment as an aid for smoking cessation

Carole Clair; Yolanda Mueller; Jonathan Livingstone‐Banks; Bernard Burnand; Jean‐Yves Camain; Jacques Cornuz; Myriam Rège‐Walther; Kevin Selby; Raphaël Bize

doi:10.1002/14651858.CD004705.pub5

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Figure 1

Study flow diagram for 2019 update.

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Figure 2

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

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Figure 3

Forest plot of comparison: 1 All interventions, outcome: 1.1 Smoking cessation ‐ feedback on smoking exposure.

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Figure 4

Forest plot of comparison: 1 All interventions, outcome: 1.2 Smoking cessation ‐ feedback on smoking‐related disease risk.

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Figure 5

Forest plot of comparison: 1 All interventions, outcome: 1.3 Smoking cessation ‐ feedback on smoking‐related harm.

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Analysis 1.1

Comparison 1 All interventions, Outcome 1 Smoking cessation ‐ feedback on smoking exposure.

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Analysis 1.2

Comparison 1 All interventions, Outcome 2 Smoking cessation ‐ feedback on smoking‐related disease risk.

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Analysis 1.3

Comparison 1 All interventions, Outcome 3 Smoking cessation ‐ feedback on smoking‐related harm.

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Analysis 2.1

Comparison 2 Multiple versus single measurement, Outcome 1 Smoking cessation.

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Analysis 3.1

Comparison 3 All interventions, Outcome 1 Spirometry and/or lung age.

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Summary of findings for the main comparison. Biomedical risk assessment compared with standard care or minimal intervention for smoking cessation

Biomedical risk assessment compared with standard care or minimal intervention for smoking cessation
Patient or population: people who smoke Setting: mixed Intervention: biomedical risk assessment Comparison: standard care or minimal intervention
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)
	Risk with control	Risk with biomedical risk assessment
Feedback on smoking exposure Smoking cessation at longest follow‐up over 6 months	Study population		RR 1.00 (0.83 to 1.21)	2368 (5 studies)	⊕⊕⊕⊝¹ moderate
	153 per 1000	153 per 1000 (127 to 185)
Feedback on smoking‐related risk Smoking cessation at longest follow‐up over 6 months	Study population		RR 0.80 (0.63 to 1.01)	2064 (5 studies)	⊕⊕⊝⊝^1,2 low
	130 per 1000	104 per 1000 (82 to 131)
Feedback on smoking‐related harm Smoking cessation at longest follow‐up over 6 months	Study population		RR 1.26 (0.99 to 1.61)	3314 (11 studies)	⊕⊕⊕⊝³ moderate
	117 per 1000	147 per 1000 (116 to 188)
*The risk in the intervention group (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 certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
¹Downgraded one level for risk of bias: three out of five studies at high risk of bias, and remaining studies at unclear risk of bias. ²Downgraded one level for imprecision: fewer than 300 events. ³Downgraded one level for imprecision and risk of bias: sensitivity analysis removing studies at high risk of bias produced a statistically significant benefit.

Summary of findings for the main comparison. Biomedical risk assessment compared with standard care or minimal intervention for smoking cessation

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Comparison 1. All interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ feedback on smoking exposure Show forest plot	5	2368	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.83, 1.21]

2 Smoking cessation ‐ feedback on smoking‐related disease risk Show forest plot	5	2064	Risk Ratio (M‐H, Random, 95% CI)	0.80 [0.63, 1.01]

2.1 Genetic marker for cancer risk	3	1297	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.65, 1.10]
2.2 Genetic marker + CO	1	270	Risk Ratio (M‐H, Random, 95% CI)	0.63 [0.34, 1.17]
2.3 Genetic marker for risk of Crohn's disease	1	497	Risk Ratio (M‐H, Random, 95% CI)	0.74 [0.32, 1.71]
3 Smoking cessation ‐ feedback on smoking‐related harm Show forest plot	11	3314	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.99, 1.61]

3.1 Spirometry with or without lung age	5	1728	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.83, 1.84]
3.2 CO and spirometry feedback	4	895	Risk Ratio (M‐H, Random, 95% CI)	1.27 [0.74, 2.18]
3.3 Carotid ultrasound	2	691	Risk Ratio (M‐H, Random, 95% CI)	1.56 [0.67, 3.66]

Comparison 1. All interventions

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Comparison 2. Multiple versus single measurement

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

1.1 Genetic marker + CO vs CO only	1		Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Multiple versus single measurement

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Comparison 3. All interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Spirometry and/or lung age Show forest plot	5	1728	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.83, 1.84]

1.1 Spirometry with lung age	2	611	Risk Ratio (M‐H, Random, 95% CI)	1.77 [0.62, 5.05]
1.2 Spirometry without lung age	3	1117	Risk Ratio (M‐H, Random, 95% CI)	1.04 [0.73, 1.48]

Comparison 3. All interventions

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