Clinical Review ABC of smoking cessation

Use of simple advice and behavioural support

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7436.397 (Published 12 February 2004) Cite this as: BMJ 2004;328:397
  1. Tim Coleman, senior lecturer in general practice
  1. School of Community Health Sciences in the Division of Primary Care at University Hospital, Queen's Medical Centre, Nottingham

    Introduction

    The most effective methods of helping smokers to quit smoking combine pharmacotherapy (such as nicotine or bupropion) with advice and behavioural support. These two components contribute about equally to the success of the intervention. Doctors and other health professionals should therefore be familiar with what these strategies offer, encourage smokers to use them, and be able at least to provide simple advice and behavioural support to smokers. They also need to be familiar with other sources of support, such as written materials, telephone helplines, and strategies for preventing relapses. This article focuses on non-pharmacological interventions.

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    Brief advice

    The Cochrane Tobacco Addiction Group defines brief advice against smoking as “verbal instructions to stop smoking with or without added information about the harmful effects of smoking.” All the published guidelines on managing smoking cessation recommend that all health professionals should give simple brief advice routinely to all smokers whom they encounter. The success rate of brief advice is modest, achieving cessation in about 1 in 40 smokers, but brief advice is one of the most cost effective interventions in medicine. The previous article in this series gave tips on how to take account of smokers' motivation to stop, but the key point is that only one or two minutes are needed for effective brief advice to be delivered in routine consultations.

    Cost effectiveness of brief advice versus common medical interventions

    Advice along these lines is probably most effective in smokers with established smoking related disease. It is also more effective if more time is spent discussing smoking and cessation and if a follow up visit is arranged to review progress. More intensive advice (taking more than 20 minutes at the initial consultation), inclusion of additional methods of reinforcing advice (such as self …

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