Centre for Health Research & Psycho-oncology, Cancer Council New South Wales, Faculty of Health, University of Newcastle and Hunter Medical Research Institute, New South Wales, Australia.
J Natl Cancer Inst. 2011 Jun 22;103(12):922-41. doi: 10.1093/jnci/djr169. Epub 2011 Jun 10.
Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence.
Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I(2). All statistical tests were two-sided.
Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6-9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I(2) = 21.4%) but not at 12-15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6-9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I(2) = 49.1%) and 12-18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I(2) = 18.5%).
With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers.
系统评价表明，主动电话咨询可提高戒烟率。然而，这些综述并未按招募渠道对研究进行区分，也没有充分评估方法学质量，并且结合了不同的戒烟衡量标准。
纳入了 2008 年 12 月 31 日前发表的 24 项随机对照试验，其中 7 项为主动招募，16 项为被动招募，1 项为混合招募。我们根据选择偏倚、研究设计、混杂因素、盲法、数据收集方法、失访和脱落情况，使用定量研究质量评估工具（Quality Assessment Tool for Quantitative Studies）对方法学质量进行了评分。我们根据总体和按招募渠道以及方法学质量进行的戒烟类型和随访时间进行了随机效应荟萃分析，以汇总结果。采用 I(2) 来量化统计学异质性水平。所有统计检验均为双侧。
方法学质量评分表明，有 2 项为强研究，10 项为中等级研究，12 项为弱研究。总体而言，与自助材料或无干预对照组相比，主动电话咨询在 6-9 个月时（随访前 7 天或随访时至少 24 小时不吸烟）对点现患率戒烟（有或无吸烟）的效果具有统计学显著意义（相对危险度[RR] = 1.26，95%置信区间[CI] = 1.11 至 1.43，P <.001，I(2) = 21.4%），但在招募后 12-15 个月时则没有统计学显著意义。当按招募渠道（主动、被动）或方法学质量（强/中等级、弱）对研究进行细分时，也出现了这种模式。总体而言，在 6-9 个月（RR = 1.58，CI = 1.26 至 1.98，P <.001，I(2) = 49.1%）和 12-18 个月（RR = 1.40，CI = 1.23 至 1.60，P <.001，I(2) = 18.5%）时，对长期/持续戒烟（随访前至少 3 个月不吸烟）的积极影响也具有统计学显著意义。
除了长期的点现患率戒烟之外，这些数据支持先前的结果，表明主动电话咨询对戒烟有积极影响。主动和被动招募的吸烟者长期持续戒烟的比例都有所增加。
