Extra counseling doesn't help smokers quit

By Michelle Rizzo

NEW YORK (Reuters Health) - Neither basic nor weekly smoking cessation support offered by primary care practices improve quit rates more than that achieved with nicotine replacement therapy alone, according to study results published in the journal Thorax.

"There is insufficient and conflicting evidence about whether more intensive behavioral support is more effective than basic behavioral support for smoking cessation and whether primary care nurses can deliver effective behavioral support," Dr. Paul Aveyard, of the University of Birmingham, UK, and colleagues write.

The researchers conducted clinical trial in 26 UK general practices in which a total of 925 subjects who smoked at least 10 cigarettes per day were randomly assigned to basic or weekly support provided by trained nurses.

All of the subjects were seen by practice nurses for an initial assessment. Medication was prescribed at this time and all of the participants received nicotine patches. They were telephoned around quit day, and seen 1 and 4 weeks after the initial appointment (basic support).

Those assigned to weekly support received an additional telephone call 10 days and 3 weeks after the initial assessment and they had an additional visit at 2 weeks.

The main outcomes the researchers looked for were confirmed and sustained abstinence from cigarettes 1, 4, 12, and 26 weeks from quit day.

The subjects in the weekly contact group had higher confirmed sustained abstinence at week 1 than those in the basic support group with a risk difference of 11.6 percent. However, at the rest of the time points, the subjects in the weekly contact group were no more likely to have quit than those in the basic support group.

"The quit rates we observed were double those expected with no help, but about the same as those observed from giving medication alone," Aveyard said in an interview with Reuters Health.

"We know that medication for smoking cessation is effective with or without support, for example, when given over the counter," he explained. "Thus, we conclude that the basic and the weekly support were not adding anything to the quit rate."

Even basic support still involves more than an hour of nursing time, Aveyard pointed out. "If, as implied by our findings, such support is ineffective, then it need not be given," he said. "Brief advice and medication will achieve as much."

SOURCE: Thorax, October 2007.