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      Intensive versus short face-to-face smoking cessation interventions: a meta-analysis

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          Abstract

          Objectives

          To evaluate the efficacy of intensive smoking cessation interventions (ISCIs) directly compared with shorter interventions (SIs), measured as successful quitting.

          Method

          Medline, Embase, the Cochrane Library and CINAHL were searched on 15 October 2021. Peer-reviewed randomised controlled trials (RCTs) of adult, daily smokers undergoing an ISCI were included. No setting, time or language restrictions were imposed. Risk of bias and quality of evidence was assessed using the Cochrane tool and Grading of Recommendations, Assessment, Development and Evaluation, respectively. Meta-analyses were conducted using a random-effects model.

          Results

          17 550 unique articles were identified and 17 RCTs evaluating 9812 smokers were included. 14 studies were conducted in Europe or the USA. The quality of the evidence was assessed as low or moderate. Continuous abstinence was significantly higher in ISCIs in the long term (risk ratio 2.60, 95% CI 1.71–3.97). Direction and magnitude were similar in the short term; however, they were not statistically significant (risk ratio 2.49, 95% CI: 0.94–6.56). When measured as point prevalence, successful quitting was still statistically significant in favour of ISCIs, but lower (long term: 1.64, 1.08–2.47; short term: 1.68, 1.10–2.56). Sensitivity analysis confirmed the robustness of the results.

          Conclusion

          ISCIs are highly effective compared to SIs. This important knowledge should be used to avoid additional morbidity and mortality caused by smoking.

          Abstract

          In this meta-analysis, the chance of maintaining successful quitting is higher after attending intensive smoking cessation interventions compared with shorter interventions. Results can be used to avoid additional morbidity and mortality caused by smoking. https://bit.ly/3c4CEYX

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          Most cited references72

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Bias in meta-analysis detected by a simple, graphical test.

            Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews. Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution.
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              Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials

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                Author and article information

                Journal
                Eur Respir Rev
                Eur Respir Rev
                ERR
                errev
                European Respiratory Review
                European Respiratory Society
                0905-9180
                1600-0617
                30 September 2022
                24 August 2022
                : 31
                : 165
                : 220063
                Affiliations
                [1 ]Clinical Health Promotion Centre (WHO-CC), the Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark
                [2 ]Clinical Health Promotion Centre (WHO-CC), Department of Health Sciences, Lund University, Lund, Sweden
                [3 ]Department of Urology, Rigshospital, Copenhagen University Hospital, Copenhagen, Denmark
                [4 ]Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
                Author notes
                Corresponding author: Mette Rasmussen ( mette.rasmussen.03@ 123456regionh.dk )
                Author information
                https://orcid.org/0000-0003-2847-1544
                https://orcid.org/0000-0002-7806-7219
                https://orcid.org/0000-0002-7161-3416
                Article
                ERR-0063-2022
                10.1183/16000617.0063-2022
                9724829
                36002170
                98ade441-2cde-48ef-8a62-685cfc2e1401
                Copyright ©The authors 2022

                This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org

                History
                : 11 April 2022
                : 04 July 2022
                Funding
                Funded by: Oak Foundation, doi 10.13039/100001275;
                Award ID: OCAY-18-774-OFIL
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                Reviews
                1

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