Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
Centre for Behaviour Change, University College London, London, UK.
Addiction. 2021 Nov;116(11):2978-2994. doi: 10.1111/add.15452. Epub 2021 Mar 6.
Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions.
Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions).
Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks-18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08-1.49, I = 42%]. Nine BCTs (including 'pharmacological support', 'goal-setting (behaviour)' and 'social support') were characterized as 'promising' in terms of probable effectiveness and feasibility.
A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.
进入无烟环境是鼓励吸烟者戒烟的独特机会。然而，出院后复发的风险很高，对于支持出院后戒烟的有效策略知之甚少。我们旨在确定维持无烟逗留期间戒烟的干预措施，并确定其有效性，以及这些干预措施中使用的行为改变技术（BCT）的可能有效性。
对年龄≥18 岁的成年吸烟者进行系统评价和荟萃分析，这些吸烟者因遵守机构无烟政策而暂时或完全戒烟。机构包括监狱、住院精神卫生、药物滥用或急性医院环境。对符合条件的随机对照试验（RCT）进行 Mantel-Haenszel 随机效应荟萃分析，使用生物化学验证的戒烟（7 天点流行率或连续戒烟）。BCT 被定义为“有希望的”，即根据可能的有效性（如果 BCT 存在于两个或更多长期有效的干预措施中）和可行性（如果 BCT 也在≥25%的所有干预措施中提供）。
共纳入 37 项研究（干预组 n=9041，对照组 n=6195）：23 项 RCT（干预组 n=6593，对照组 n=5801）；3 项非随机试验（干预组 n=845，对照组 n=394）和 11 项队列研究（n=1603）。最长随访（4 周-18 个月）时生物化学验证的戒烟的荟萃分析发现干预组总体效果有利[风险比（RR）=1.27，95%置信区间（CI）=1.08-1.49，I=42%]。有 9 种 BCT（包括“药物支持”、“目标设定（行为）”和“社会支持”）被描述为“有希望的”，这是基于可能的有效性和可行性。
系统评价和荟萃分析表明，行为和药物支持在维持无烟环境逗留期间的戒烟方面是有效的。几种行为改变技术可能有助于在出院后 18 个月内保持戒烟。
