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A Systematic Review of Trials

Tim Lancaster, MSc, MB, BS; Peter Hajek, PhD; Lindsay F. Stead, MSc; Robert West, PhD; Martin J. Jarvis, DSc

Arch Intern Med. 2006;166:828-835.

Background  After initially successful quit attempts, many people return to smoking within a year, reducing the public health benefits of investment in smoking cessation. We aimed to assess whether interventions designed to prevent relapse after a successful quit attempt reduce the proportion of recent quitters who return to smoking.

Methods  We searched the Cochrane Tobacco Addiction Review Group trials' register. We selected randomized or quasi-randomized controlled trials of relapse prevention interventions with a minimum follow-up of 6 months. We included people who quit on their own, underwent enforced abstinence, or were in treatment programs. We included trials comparing relapse prevention interventions with no intervention or cessation plus relapse prevention with cessation intervention alone. Two of us independently extracted data from each report, with disagreements referred to a third author.

Results  Forty-two studies met the inclusion criteria. The most common interventions were skills training to identify and resolve tempting situations and extended treatment contact. A few studies tested pharmacotherapy. We separately analyzed studies that randomized abstainers and those that randomized participants before their quit date. Within subgroups of trials, pooled odds ratios ranged from 0.86 to 1.30, and in most analyses, 95% confidence intervals included 1. Most studies had limited power to detect moderate differences between interventions.

Conclusion  The evidence to date does not support the adoption of skills training or other specific interventions to help individuals who have successfully quit smoking to avoid relapse, but this is an important area for future study.

Author Affiliations: Department of Primary Health Care, University of Oxford, Oxford, England (Dr Lancaster and Ms Stead); Clinical Psychology, The Royal London Hospital, and Tobacco Dependence Research Centre, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, England (Dr Hajek); and Department of Epidemiology and Public Health (Drs West and Jarvis) and Tobacco Studies (Dr West), Cancer Research UK Health Behaviour Unit, University College London, London.

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