“PICO” structured question element | Inclusion | Exclusion |
---|---|---|
Population | KQ1a/b: adults (≥ 18 years) who are current tobacco smokers (as defined by a given study/review) The overview of reviews will seek information on various population groups: • Fewer versus more quit attempts • Opportunistic versus individuals seeking treatment • Baseline level of nicotine dependence (e.g. using a validated scale or cigarettes per day as a proxy) • By demographic factors (age, SES, sex, ethnicity, LGBTQ+) • By comorbid conditions (e.g. mental illness, HIV infection, cardiovascular disease, COPD, obesity, substance use disorder) • By pregnancy status | ▪ Reviews exclusively in children/adolescents (i.e. under 18 years old) ▪ Studies that involve interventions targeted to adults other than the tobacco smoker (e.g. partners, healthcare providers) |
Intervention | KQ1a/b: interventions to promote abrupt (i.e. “all at once”) or gradual (reducing smoking to quit) tobacco smoking cessation that can be directly delivered or referred to by primary care practitioners and are available in Canadaa • Practitioner advice (of varying length/intensity, and by various provider types) o Very brief/minimal advice (as defined by a given review) o Brief advice (as defined by a given review) • Intensive individual counselling (of varying length, of varying number of sessions, and by various provider types) • Intensive group counselling (of varying length, of varying number of sessions, and by various provider types) • Self-help interventionsc(print-based or web/computer-based) • Internet or computer-based interventions with counselling/supportc • Telephone-based interventions (e.g. mobile phone-based, quit lines/help lines) with counselling/support c • Nicotine receptor partial agonists (varenicline and cytisined) • Bupropion • Nicotine replacement therapye(e.g. patch, gum, lozenge, mist, inhaler) • E-cigarettesf • Exercise interventions • “Alternative” therapies (e.g. acupuncture, acupressure, electrostimulation, hypnosis, St. John’s Wortd, S-adenosylmethionined) • Combinations of interventions Other interventions encountered in the literature will be assessed on a case-by-case basis in consultation with the WG. The overview of reviews will seek information on the effects of variations in the delivery of stop smoking interventions (e.g. dose, duration of intervention, number of session) | Interventions that cannot feasibly or readily be delivered or referred to by a wide variety of primary care practitioners: • Quit-to-win contests • Biomedical risk assessment • Aversive smoking (e.g. rapid smoking) • Incentivized cessation Reviews that focus solely on specialized behavioural counselling interventions (e.g. motivational interviewing, stage of change-based interventions).b Pharmacotherapies that are not approved by Health Canada as smoking cessation aids (e.g. clonidine, lobeline, anxiolytics, nortriptyline, opioid antagonists, silver acetate, rimonabant) or not available in Canada (e.g. Nicobrevin, Nicobloc, nicotine vaccines, mecamylamine) Broader public health interventions (e.g. mass media, taxation, packaging restrictions) Reviews on broad lifestyle interventions not specific to tobacco smoking behaviour and that do not attempt to isolate for the effect of our included interventions (when delivered as part of a multifaceted lifestyle intervention, for example) |
Comparator | KQ1a: ▪ Placebo ▪ No intervention ▪ Usual care ▪ Waitlist ▪ Minimal intervention KQ1b: ▪ Other intervention (e.g. head-to-head comparisons, comparisons of types or intensities of advice/counselling) ▪ Other combination of interventions ▪ The same intervention, but used to promote cessation by reducing smoking to quit as opposed to quitting abruptly or vice versa | |
Outcomes | Critical • Tobacco use abstinence (as defined in a given review) Important • Reduction in tobacco smoking frequency/quantity • Relapse (KQ1b only)g • Quality of life (using validated scales) • Adverse events (as defined in a given review) • Possible adverse outcomes: o Weight gain o Changes in emotional state (e.g. increases in anxiety, changes in mood, irritability) o Loss of social grouph | |
Timing of outcome assessment | For abstinence/relapse, and quality of life outcomes: ▪ Minimum 6 months from quit date (if reported) or from initiation of intervention (if quit date not specified) All other outcomes: Any point after initiation of intervention | |
Setting | ▪ Reviews in which some or all of the included studies are in settings that could serve as the primary point of contact for individuals to receive smoking cessation advice, including: • Family medicine clinics • Walk-in clinics • Smoking cessation clinics • Urgent care facilities • Emergency departments • Public health units • Pharmacies • Dental offices • Behavioural health/substance use treatment facilities (ambulatory or outpatient) • Telehealth • Academic research settings The effect of various settings may be examined | ▪ Reviews exclusively in settings not relevant to primary care including workplaces, schools, inpatient settings, and medical specialist settings ▪ Reviews in which > 50% of included studies took place in countries “high”, “medium”, or “low” on the Human Development Index http://hdr.undp.org/en/composite/HDI |
Study design | Systematici reviews Overviewsj of systematici reviews that include a network meta-analysis | • Primary studies • Editorials • Commentaries |
Language | ▪ English ▪ French | |
Dates of publications | 2008 to present |