Smoking cessation : comparing the effectiveness of NRT with behavioural therapy

Abstract

Background - Tobacco smoke is associated with chemical and psychosocial addictions, and many health risks. This review of the evidence aims to explore which smoking cessation interventions provide smokers with the best chance to quit. Thus the research question: Does NRT offer adult smokers aged 18+, smoking two or more cigarettes daily, a better chance to quit smoking for over 6 months than Behavioural Therapy or a combination of both? Method - A search for randomised controlled trials, meta-analysis of trials and systematic reviews of studies conducted in economically developed countries was conducted, excluding literature published prior to 2005, studies of participants that did not smoke daily, or studies on adolescents and pregnant women. Eight research studies and 10 systematic reviews were found and appraised using the U.S. Preventive Services Task Force critical appraisal tool, the Harbour and Miller Tool, the Cochrane Collaboration Quality Assessment Tool and the AMSTAR tool. Results - Combination of therapies resulted in the highest smoking cessation rates. Success rates for NRT alone resulted in quit rates ranging from 20-70%. Behavioural Therapies were most successful when delivered face-to-face over~ 20 minutes with success rates of up to 25%. Health-professional delivered therapy remains the focus of smoking cessation interventions. Conclusion - The evidence suggests that a combination of Behavioural Therapy with sessions lasting over 20 minutes, supported by written material, and NRT tailored to the smoker's nicotine dependence level, offered in the form of patches and lozenges in reducing dosages for 8-12 weeks enhance chances of quitting smoking. Implications and Recommendations - Accessibility of smoking cessation interventions can be improved by offering sessions in various settings. Nicotine Replacement Therapy should be offered for free under the Schedule V Act so as to encourage its use. Further research is needed to determine the most effective intensity and frequency of Behavioural Therapy.