School of Medicine Health Policy and Practice, University of East Anglia, Norwich, UK.
J Public Health (Oxf). 2010 Sep;32(3):350-9. doi: 10.1093/pubmed/fdp109. Epub 2009 Nov 24.
Existing systematic reviews have concluded that psycho-educational interventions for smoking relapse prevention were ineffective. Our objective was to conduct an exploratory meta-analysis, guided by mechanisms of these complex interventions for preventing smoking relapse.
Relevant trials were identified from a Cochrane review and by an updated search of MEDLINE and PsycINFO (up to August 2009). We examined theories or mechanisms underlying relapse prevention interventions, and process variables reported in trials. Odds ratios (ORs) for the rate of smoking abstinence at the longest follow-up were pooled in meta-analysis.
Forty-nine trials were included, and interventions were at least partly based on the cognitive-behavioural approach to coping skills training in 41 trials. Only a few trials reported data on process variables. Coping skills training for smoking relapse prevention was effective for community quitters (OR 1.27, 95% CI: 1.08-1.49), and particularly for those who stopped smoking for at least 1 week at baseline (OR 1.52, 95% CI: 1.20-1.93). These findings were interpretable with mechanisms of coping skills training for relapse prevention.
On the basis of post hoc subgroup analyses, coping skills training for smoking relapse prevention is effective for motivated community quitters. This finding has important public health implications and needs to be confirmed by further trials.
现有的系统评价得出结论，心理教育干预对预防吸烟复发无效。我们的目的是进行探索性荟萃分析，以预防吸烟复发的这些复杂干预措施的机制为指导。
从 Cochrane 综述和 MEDLINE 及 PsycINFO 的最新检索中确定了相关试验（截至 2009 年 8 月）。我们研究了预防复发干预的理论或机制，以及试验中报告的过程变量。最长随访时吸烟戒断率的比值比（OR）在荟萃分析中汇总。
纳入了 49 项试验，其中 41 项试验的干预措施至少部分基于认知行为方法应对技能培训。只有少数试验报告了过程变量的数据。预防吸烟复发的应对技能培训对社区戒烟者有效（OR 1.27，95%CI：1.08-1.49），对那些在基线时至少戒烟 1 周的人尤其有效（OR 1.52，95%CI：1.20-1.93）。这些发现可以用预防复发的应对技能培训机制来解释。
基于事后亚组分析，预防吸烟复发的应对技能培训对有动力的社区戒烟者有效。这一发现具有重要的公共卫生意义，需要进一步的试验来证实。
