Zhu Shu-Hong, Anderson Christopher M, Tedeschi Gary J, Rosbrook Bradley, Johnson Cynthia E, Byrd Michael, Gutiérrez-Terrell Elsa
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093-0905, USA.
N Engl J Med. 2002 Oct 3;347(14):1087-93. doi: 10.1056/NEJMsa020660.
Telephone services that offer smoking-cessation counseling (quitlines) have proliferated in recent years, encouraged by positive results of clinical trials. The question remains, however, whether those results can be translated into real-world effectiveness.
We embedded a randomized, controlled trial into the ongoing service of the California Smokers' Helpline. Callers were randomly assigned to a treatment group (1973 callers) or a control group (1309 callers). All participants received self-help materials. Those in the treatment group were assigned to receive up to seven counseling sessions; those in the control group could also receive counseling if they called back for it after randomization.
Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group (mean, 3.0 sessions). The rates of abstinence for 1, 3, 6, and 12 months, according to an intention-to-treat analysis, were 23.7 percent, 17.9 percent, 12.8 percent, and 9.1 percent, respectively, for those in the treatment group and 16.5 percent, 12.1 percent, 8.6 percent, and 6.9 percent, respectively, for those in the control group (P<0.001). Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates: rates of abstinence for 1, 3, 6, and 12 months were 20.7 percent, 15.9 percent, 11.7 percent, and 7.5 percent, respectively, in the remaining subjects in the treatment group and 9.6 percent, 6.7 percent, 5.2 percent, and 4.1 percent, respectively, in the remaining subjects in the control group (P<0.001). Therefore, the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent. The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group (P<0.001).
A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Its success supports Public Health Service guidelines calling for greater availability of quitlines.
在临床试验取得积极成果的推动下，提供戒烟咨询的电话服务（戒烟热线）近年来迅速增加。然而，这些成果能否转化为实际效果仍是个问题。
我们在加利福尼亚吸烟者帮助热线的日常服务中嵌入了一项随机对照试验。来电者被随机分配到治疗组（1973名来电者）或对照组（1309名来电者）。所有参与者都收到了自助材料。治疗组的参与者被安排接受最多七次咨询；对照组的参与者如果在随机分组后回电要求，也可以接受咨询。
治疗组72.1%的参与者和对照组31.6%的参与者接受了咨询（平均3.0次咨询）。根据意向性分析，治疗组参与者1个月、3个月、6个月和12个月的戒烟率分别为23.7%、17.9%、12.8%和9.1%，对照组分别为16.5%、12.1%、8.6%和6.9%（P<0.001）。对接受咨询的对照组亚组和相应治疗亚组进行因素分析表明，咨询使戒烟率提高了约一倍：治疗组其余参与者1个月、3个月、6个月和12个月的戒烟率分别为20.7%、15.9%、11.7%和7.5%，对照组其余参与者分别为9.6%、6.7%、5.2%和4.1%（P<0.001）。因此，治疗组和对照组其余参与者12个月戒烟率的绝对差异为3.4%。至少尝试戒烟一次的参与者12个月戒烟率在治疗组为23.3%，在对照组为18.4%（P<0.001）。
一种先前已被证明有效的戒烟电话咨询方案，在转化为实际应用时是有效的。其成功支持了公共卫生服务指南中要求增加戒烟热线可及性的呼吁。
