Cochrane review finds intensive counselling in hospital helps more smokers quit

“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.” So said American author Mark Twain and many people will relate to this. The World Health Organisation, which today marks World No Tobacco Day, is clear that in order to quit smoking you need to believe that it’s important and that you CAN.

The Cochrane Tobacco Addiction Group prepares Cochrane reviews on interventions to prevent people from starting smoking or to help smokers quit, providing high-quality evidence on what is known about works and what doesn’t. To coincide with World No Tobacco Day, the group has an updated Special Collection of reviews, free to access in the Cochrane Library.

Earlier this week I looked at a systematic review showing that smoking and surgery don’t mix, as smokers experience more problems with wound healing than non-smokers. A Cochrane review, looking at helping hospitalised people to quit smoking, has been updated this month, with 17 new studies added, bringing the total of included trials to 50. Here’s what they found:

  • Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased quit rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48)
  • Intensive intervention with follow-up support increased the rate of quitting in people admitted to hospital bcause of cardiovascular disease but less intensive intervention did not
  • Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased quit rates by 54% compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79). This is a new finding in this update
  • Adding varenicline or bupropion to intensive counselling did not produce a significant benefit
  • Intensive interventions were successful in both acute and rehabilitation hospitals

The authors concluded:

The results support the use of smoking cessation counselling interventions that begin during the hospitalisation period and include at least one month of follow-up supportive contact after discharge. There is no evidence of an effect of less intensive counselling interventions, particularly those that do not continue after hospital discharge, on smoking cessation… Adding nicotine replacement therapy to an intensive counselling intervention further increases the effect of hospital-initiated interventions and should be routinely offered.

They also noted that the estimated effect of intensive interventions was to increase the quit rate by 37% at six to 12 months after hospital discharge and that this finding remained when lower quality studies were excluded from the analysis. That’s a piece of good news for No Tobacco Day.


Rigotti NA, Clair C, Munafò MR, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3.



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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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