Supporting smoking cessation and preventing relapse following a stay in a smokefree setting: A meta-analysis and investigation of effective behaviour change techniques.

Shoesmith, Emily; Huddlestone, Lisa; Lorencatto, Fabiana; Shahab, Lion; Gilbody, Simon; Ratschen, Elena

BACKGROUND AND AIMS Admission to a smokefree 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 smokefree stay and determine their effectiveness, as well as the likely effectiveness of Behaviour Change Techniques (BCTs) used in these interventions. METHOD Systematic review and meta-analyses of studies of adult smokers ≥ 18 years of age who were temporarily or fully abstinent from smoking to comply with institutional smokefree policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random effects meta-analysis of randomised controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of likely effectiveness (if BCT was present in ≥2 long-term effective interventions) and feasibility (if BCT was also delivered in ≥25% of all interventions). RESULTS Thirty-seven studies (intervention n=9,041, control n=6,195) were included: 23 RCTs (intervention n=6,593, control n=5,801); three non-randomised trials (intervention n=845, control n=394), and 11 cohort studies (n=1,603). Meta-analysis of biochemically-verified abstinence (n=8,544) at longest follow-up (4 weeks to 18 months) found an overall effect in favour of intervention [risk ratio (RR)=1.27, 95% confidence interval (CI) 1.08 - 1.49, I2 =42%]. Nine BCTs (including 'pharmacological support', 'goal setting (behaviour)' and 'social support') were characterised as 'promising' in terms of likely effectiveness and feasibility. CONCLUSION A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smokefree institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.