Enhancing partner support to improve smoking cessation.
Enhancing partner support to improve smoking cessation.
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DOI：
10.1002/14651858.cd002928.pub4
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发表时间：
2018-08-13
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影响因子：
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通讯作者：
Park EW
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作者：
Faseru B;Richter KP;Scheuermann TS;Park EW
虽然有许多戒烟计划可以帮助吸烟者戒烟，但研究表明，来自伴侣、家庭成员或“朋友”的支持可能会鼓励戒烟。确定与缺乏伴侣支持成分的戒烟干预相比，加强对试图戒烟的吸烟者的一对一伴侣支持的干预是否能改善戒烟结果。我们将搜索范围限制在2018年4月更新的Cochrane烟草成瘾组专门登记处。这包括Cochrane Central Register of Controlled Trials （Central）的检索结果；MEDLINE（通过OVID）；Embase（通过OVID）；PsycINFO（通过OVID）。搜索词包括吸烟（预防、控制、治疗）、戒烟和支持（家庭、婚姻、配偶、伴侣、性伴侣、伙伴、朋友、同居者和同事）。我们还审查了所有纳入文章的参考书目，以进行其他试验。我们纳入了招募吸烟者的随机对照试验。如果试验至少有一个治疗组包括有伴侣支持成分的戒烟干预，而对照组提供类似强度的行为支持，没有伴侣支持成分，则试验符合条件。试验还要求在六个月或更长时间的随访中报告戒烟情况。两位综述作者从搜索结果中独立确定纳入的研究，并使用结构化形式提取数据。第三位综述作者帮助解决差异，符合Cochrane期望的标准方法学程序。在可能的情况下，经生化验证的戒烟是主要的结局指标，并在治疗后的两个可能的时间间隔中提取：6至9个月和12个月或更长时间。我们使用随机效应模型汇总每项研究的风险比，并估计总效应。我们的更新搜索确定了465条引用，我们评估了它们的资格。3项新研究符合纳入标准，共纳入14项研究（n = 3370）。不同研究对伴侣的定义有所不同。我们在6至9个月的随访和12个月或更长时间的随访中比较了伴侣支持与对照干预。我们还检查了三个亚组的结果：针对亲戚、朋友或同事的干预措施；针对配偶或同居伴侣的干预措施；以及针对其他戒烟计划参与者的干预措施。所有的研究都给出了自我报告的戒烟率，并对戒烟进行了有限的生化验证。戒断的合并风险比（RR）为0.97(95%可信区间（CI） 0.83 ~ 1.14；12的研究;治疗后12个月或更长时间为1.04 （95% CI 0.88至1.22；7项研究；2573名受试者）。在随访中测量伴侣支持的11项研究中，只有两项报告了干预组中伴侣支持的显著增加。其中一项研究报告了干预组中伴侣支持的显著增加，但吸烟者报告的伴侣支持并没有显著差异。我们判断其中一项纳入的研究存在选择偏倚的高风险，但敏感性分析表明这对结果没有影响。由于14项研究中有5项缺乏对禁欲的验证，也存在检测偏差的潜在问题；然而，这在不同研究的统计结果中并不明显。使用GRADE系统，我们将两个主要结局的证据总体质量评为低。由于存在偏倚风险，我们将其降级，因为我们判断分析中权重较高的研究存在较高的检测偏倚风险。此外，两项分析的研究都没有充分随机化。我们还降低了间接证据的质量，因为很少有研究提供任何证据证明所测试的干预措施实际上增加了相关干预组参与者获得的伴侣支持的数量。旨在加强伴侣支持的干预措施似乎对增加长期戒烟没有影响。然而，大多数评估伴侣支持的干预措施显示，没有证据表明干预措施实际上达到了目的，并增加了伴侣对戒烟的支持。因此，未来的研究应侧重于开发实际增加伴侣支持的行为干预措施，并在小规模研究中进行测试，然后再进行评估对戒烟影响的大规模试验。当他们社交圈中的其他人戒烟时，吸烟者更有可能戒烟。当他们得到积极的戒烟支持时，他们也更有可能成功。生活伴侣、家庭成员、朋友和其他人都是可行的支持来源。本综述调查了旨在培训或指导个人向试图戒烟的吸烟者提供支持的干预措施是否比不含伴侣支持元素的戒烟计划更能帮助吸烟者戒烟。这是对以前评论的更新。我们检索了截至2018年4月发表的研究，发现了3项新的研究，我们可以纳入，总共有14项研究，有3370名参与者。研究必须是随机对照试验，招募试图戒烟的吸烟者，并测量参与者是否在研究开始后至少六个月戒烟。这项研究必须包括至少一组参与戒烟计划以增加伴侣支持的人，以及至少一组接受类似戒烟计划但没有伴侣支持的人。大多数研究都是在美国进行的。在招募时，研究参与者的平均吸烟量在每天13到29支之间。提供支持的伴侣的吸烟状况各不相同，但大多数不吸烟。干预技术从低强度到高强度不等；在某些情况下，帮助是通过自助小册子，在其他情况下，通过面对面的咨询。在一些研究中，研究人员没有与“伴侣”直接接触，而是鼓励吸烟者自己找一个“伙伴”，但在另一些研究中，吸烟者和他们的“伙伴”都得到了面对面的支持。我们结合了12项研究（2818名参与者）来衡量6至9个月随访后成功戒烟的情况，以及7项研究（2573名参与者）来衡量12个月随访后戒烟的情况。伴侣的支持在任何时间点都不会增加戒烟的机会。我们还根据给予支持的伴侣类型（亲戚/朋友/同事vs配偶/同居伴侣vs其他戒烟计划参与者）对每个分析进行了拆分。研究小组之间的戒烟率没有差异，无论提供支持的伴侣类型如何。只有一项研究报告说，在给予伴侣支持干预的小组中，伴侣支持比没有提供伴侣支持干预的小组改善得更多。另一项研究报告说，在更密集的伴侣支持干预中，伴侣支持比不那么密集的伴侣支持干预改善得更多。我们认为证据的整体质量较低。这是因为一些研究的设计存在问题。许多重要的研究只使用参与者的自我报告来衡量人们是否戒烟，这些报告有可能是不准确的。此外，很少有研究发现干预实际上增加了参与者获得的伴侣支持水平。因此，这篇综述并不能告诉我们从伴侣那里得到更多的支持是否能帮助一个人戒烟。
While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or ‘buddies’ may encourage abstinence. To determine if an intervention to enhance one-to-one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner-support component. We limited the search to the Cochrane Tobacco Addiction Group Specialised Register, which was updated in April 2018. This includes the results of searches of the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (via OVID); Embase (via OVID); and PsycINFO (via OVID). The search terms used were smoking (prevention, control, therapy), smoking cessation and support (family, marriage, spouse, partner, sexual partner, buddy, friend, cohabitant and co-worker). We also reviewed the bibliographies of all included articles for additional trials. We included randomised controlled trials recruiting people who smoked. Trials were eligible if they had at least one treatment arm that included a smoking cessation intervention with a partner-support component, compared to a control condition providing behavioural support of similar intensity, without a partner-support component. Trials were also required to report smoking cessation at six months follow-up or more. Two review authors independently identified the included studies from the search results, and extracted data using a structured form. A third review author helped resolve discrepancies, in line with standard methodological procedures expected by Cochrane. Smoking abstinence, biochemically verified where possible, was the primary outcome measure and was extracted at two post-treatment intervals where possible: at six to nine months and at 12 months or longer. We used a random-effects model to pool risk ratios from each study and estimate a summary effect. Our update search identified 465 citations, which we assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n = 3370). The definition of partner varied among the studies. We compared partner support versus control interventions at six- to nine-month follow-up and at 12 or more months follow-up. We also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self-reported smoking cessation rates, with limited biochemical verification of abstinence. The pooled risk ratio (RR) for abstinence was 0.97 (95% confidence interval (CI) 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post-treatment. Of the 11 studies that measured partner support at follow-up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers’ reports of partner support received did not differ significantly. We judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system we rated the overall quality of the evidence for the two primary outcomes as low. We downgraded due to the risk of bias, as we judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. We also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. Interventions that aim to enhance partner support appear to have no impact on increasing long-term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small-scale studies, before large trials assessing the impact on smoking cessation can be justified. Smokers are more likely to quit when others in their social circle quit. They are also more likely to be successful when they receive active support to quit. Life partners, family members, friends, and others are all viable sources of support. This review investigated whether interventions designed to train or guide individuals to provide support to smokers trying to quit helped more smokers to quit than stop-smoking programmes without a partner-support element. This is an update of previous reviews. We searched for studies published up to April 2018, and found three new studies that we could include, giving a total of 14 studies with 3370 participants. Studies had to be randomised controlled trials that recruited smokers trying to quit, and measured whether participants had quit smoking at least six months after the beginning of the study. The study had to include at least one group who were part of a stop-smoking programme to increase partner support, and at least one group who received a comparable stop-smoking programme without partner support. Most of the studies were conducted in the USA. At recruitment the average amount participants smoked was between 13 to 29 cigarettes a day across studies. The smoking status of partners providing support varied, but most were non-smokers. Intervention techniques ranged from low to high intensity; in some cases help was by a self-help booklet and in other cases by face-to-face counselling. In some studies researchers did not make direct contact with ‘partners’ and the smokers themselves were encouraged to find a ‘buddy’, but in other studies both the smoker and their ‘buddy’ received face-to-face support. We combined 12 studies (2818 participants) to measure successful quitting at six to nine months follow-up, and seven studies (2573 participants) to measure quitting at 12-month follow-up. Partner support did not increase the chances of stopping smoking at either time point. We also split the studies in each analysis based on the type of partner giving support (relatives/friends/co-workers versus spouses/cohabiting partners versus fellow cessation-programme participants). There was no difference in quit rates between study groups, regardless of the type of partner providing the support. Only one study reported that partner support improved more in the group given the partner-support intervention than in the group where no partner-support intervention was provided. Another study reported that partner support improved more in a more intensive partner-support intervention than a less intensive partner-support intervention. We rated the overall quality of the evidence as low. This is because there were problems with the design of some of the studies. A number of important studies only used participant self-report to measure if people had quit smoking, and there is a chance that these reports may have been inaccurate. Also, very few studies found that the intervention actually increased the level of partner support that participants received. This review therefore cannot tell us whether receiving more support from a partner can help a person to give up smoking.