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    Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development

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    Author
    West, R; Raw, M; McNeill, A; Stead, L; Aveyard, P; Bitton, J; Stapleton, J; McRobbie, H; Pokhrel, S; Lester-George, A; ...
    Date
    2015-09-01
    Source Title
    Addiction
    Publisher
    WILEY
    University of Melbourne Author/s
    Borland, Ronald
    Affiliation
    Melbourne School of Psychological Sciences
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    West, R., Raw, M., McNeill, A., Stead, L., Aveyard, P., Bitton, J., Stapleton, J., McRobbie, H., Pokhrel, S., Lester-George, A. & Borland, R. (2015). Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. ADDICTION, 110 (9), pp.1388-1403. https://doi.org/10.1111/add.12998.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255717
    DOI
    10.1111/add.12998
    Abstract
    AIMS: This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. METHODS: Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12-month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country. RESULTS: Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally. CONCLUSIONS: Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.

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