Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: A systematic review

Carlos Martín Cantera, Elisa Puigdomènech, Jose Luis Ballvé, Olga Lucía Arias, Lourdes Clemente, Ramon Casas, Lydia Roig, Santiago Pérez-Tortosa, Laura Díaz-Gete, Sílvia Granollers

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    35 Citations (Scopus)


    Objective: The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. Design: A systematic review of randomised and nonrandomised controlled trials was undertaken. Eligibility criteria for included studies: Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-totreat analysis and results published in English/Spanish. Methods: We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. Results: Of 1147 references identified, 9 studies were selected (10 204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quitsmoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. Conclusions: Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.
    Original languageEnglish
    Article numbere008807
    JournalBMJ Open
    Publication statusPublished - 1 Jan 2015


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