Abstract
Background and Aims
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.
Methods
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).
Results
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
2 = 42%]. Nine BCTs (including ‘pharmacological support’, ‘goal‐setting (behaviour)’ and ‘social support’) were characterized as ‘promising’ in terms of probable effectiveness and feasibility.
Conclusions
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.