Very brief advice and brief intervention for smoking cessation

Abstract

Very Brief Advice (VBA) is an ultra-brief smoking cessation intervention that can be delivered opportunistically during medical consultation. This is a practical and scalable intervention that takes <3 minutes to complete. However, the meta-analytic evidence for the effectiveness of VBA was uncertain and there had been no evaluation of the online training for delivering this intervention.

In study 1, a systematic review and meta-analysis was conducted to synthesize and assess the effectiveness of VBA on various smoking cessation outcomes. Five international databases (e.g., Embase, CINAHL), two trial registries (e.g., WHO-ICTRP), and six additional Chinese databases were systematically searched and selected from inception to 30 Sept 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Two independent reviewers used the Cochrane Risk of Bias Tool 1.0 to assess bias. The Grading of Recommendations, Assessment, Development, and Evaluations framework (GRADE) was used to assess the certainty of evidence of the meta-analytic findings. Thirteen randomized controlled trials from 15 articles were included. There was moderate-certainty evidence that VBA significantly increased self-reported tobacco abstinence at ≥6 months in both the crude model (RR 1.28, 95% CI: 1.10, 1.49) and adjusted model (RR 1.17, 95% CI: 1.07, 1.27) compared with no tobacco cessation advice or no contact. There was high-certainty evidence that VBA significantly increased self-reported abstinence at <6 months in both the crude model (RR 1.35, 95% CI: 1.15, 1.58) and adjusted model (RR 1.22, 95% CI: 1.01, 1.47). There was very low-certainty evidence on the treatment effects on quit attempts (Crude RR 1.18, 95% CI: 1.02, 1.35; Adjusted RR 1.03, 95% CI: 0.97, 1.08).

Study 2 explored whether the online smoking cessation training can equip clinicians with the perceived capacity, confidence, and importance regarding smoking cessation during the 3-month follow-up and assessed how their practice differed before and after training. This study also evaluated their satisfaction of the online learning platform. All healthcare professionals and students who joined the online training were asked to report (1) the current practice on delivery of the smoking cessation interventions at baseline and 3-month follow-up; and (2) their perceived capacity, confidence, and importance toward the smoking cessation interventions and their satisfaction of the online learning platform at the 3-month follow-up. Overall, 39 subjects (76.9% female) were included in the data analysis. The majority of subjects showed significantly increased median scores in the two current practice items (Scale: 1-5) according to Wilcoxon rank sum test: 1) Warn about the health risks of smoking (e.g., cancer, cardiovascular diseases) (median difference: 2.0, P = 0.048), and 2) Introduce quitting methods (median difference: 1.0, P = 0.031). Overall, 89.7% of subjects were satisfied with the online training (mean=4.10; SD=0.91; Scale: 1-5).

In conclusion, VBA delivered in a clinical setting is effective in increasing self-reported tobacco abstinence. We advocate VBA in all contacts with patients who smoke. The findings will inform global health practitioners to further develop clinical practice guidelines on smoking cessation interventions. The online training study confirms its feasibility and efficacy in promoting VBA and/or Brief Intervention.