Brief opportunistic smoking cessation interventions: a systematic review and meta-analysis to compare advice to quit and offer of assistance.

Aims  This study aimed to assess the effects of opportunistic brief physician advice to stop smoking and offer of assistance on incidence of attempts to stop and quit success in smokers not selected by motivation to quit. Methods  We included relevant trials from the Cochrane reviews of physician advice for smoking cessation, nicotine replacement therapy (NRT), varenicline, and bupropion. We extracted data on quit attempts and quit success. Estimates were combined using the Mantel-Haentszel method and heterogeneity assessed with the I(2) statistic. Study quality was assessed by method of randomisation, allocation concealment, and follow-up blind to allocation. Results  Thirteen studies were included. Compared to no intervention, advice to quit on medical grounds increased the frequency of quit attempts (RR 1.24, 95%CI: 1.16 to 1.33), but not as much as behavioural support for cessation (RR 2.17, 95%CI 1.52 to 3.11) or offering NRT (RR 1.68, 95%CI: 1.48 to 1.89). In a direct comparison, offering assistance generated more quit attempts than giving advice to quit on medical grounds (RR 1.69, 95%CI 1.24 to 2.31 for behavioural support and 1.39, 95%CI 1.25 to 1.54 for offering medication). There was evidence that medical advice increased the success of quit attempts and inconclusive evidence that offering assistance increased their success. Conclusions  Physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and only offering assistance to those that express an interest in doing so.