Jamie Hartmann-Boyce

Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews.

BACKGROUND AND AIMS The Cochrane Collaboration is an international not-for-profit organization which produces and disseminates systematic reviews of health-care interventions. This paper is the first in a series of annual updates of Cochrane reviews on tobacco addiction interventions. It also provides an up-to-date overview of review findings in this area to date and summary statistics for cessation reviews in which meta-analyses were conducted. METHODS In 2012, the Group published seven new reviews and updated 13 others. This update summarizes and comments on these reviews. It also summarizes key findings from all the other reviews in this area. RESULTS New reviews in 2012 found that in smokers using pharmacotherapy, behavioural support improves success rates [risk ratio (RR) 1.16, 95% confidence interval (CI) = 1.09-1.24], and that combining behavioural support and pharmacotherapy aids cessation (RR 1.82, 95% CI = 1.66-2.00). Updated reviews established mobile phones as potentially helpful in aiding cessation (RR 1.71, 95% CI = 1.47-1.99), found that cytisine (RR 3.98, 95% CI = 2.01-7.87) and low-dose varenicline (RR 2.09, 95% CI = 1.56-2.78) aid smoking cessation, and found that training health professionals in smoking cessation improves patient cessation rates (RR 1.60, 95% CI = 1.26-2.03). The updated reviews confirmed the benefits of nicotine replacement therapy, standard dose varenicline and providing cessation treatment free of charge. Lack of demonstrated efficacy remained for partner support, expired-air carbon monoxide feedback and lung function feedback. CONCLUSIONS Cochrane systematic review evidence for the first time establishes the efficacy of behavioural support over and above pharmacotherapy, as well as the efficacy of cytisine, mobile phone technology, low-dose varenicline and health professional training in promoting smoking cessation.

Diet or Exercise Interventions vs Combined Behavioral Weight Management Programs: A Systematic Review and Meta-Analysis of Direct Comparisons

Weight loss can reduce the health risks associated with being overweight or obese. However, the most effective method of weight loss remains unclear. Some programs emphasize physical activity, others diet, but existing evidence is mixed as to whether these are more effective individually or in combination. We aimed to examine the clinical effectiveness of combined behavioral weight management programs (BWMPs) targeting weight loss in comparison to single component programs, using within study comparisons. We included randomized controlled trials of combined BWMPs compared with diet-only or physical activity-only programs with at least 12 months of follow-up, conducted in overweight and obese adults (body mass index ≥25). Systematic searches of nine databases were run and two reviewers extracted data independently. Random effects meta-analyses were conducted for mean difference in weight change at 3 to 6 months and 12 to 18 months using a baseline observation carried forward approach for combined BWMPs vs diet-only BWMPs and combined BWMPs vs physical activity-only BWMPs. In total, eight studies were included, representing 1,022 participants, the majority of whom were women. Six studies met the inclusion criteria for combined BWMP vs diet-only. Pooled results showed no significant difference in weight loss from baseline or at 3 to 6 months between the BWMPs and diet-only arms (–0.62 kg; 95% CI –1.67 to 0.44). However, at 12 months, a significantly greater weight-loss was detected in the combined BWMPs (–1.72 kg; 95% CI –2.80 to –0.64). Five studies met the inclusion criteria for combined BWMP vs physical activity-only. Pooled results showed significantly greater weight loss in the combined BWMPs at 3 to 6 months (–5.33 kg; 95% CI –7.61 to –3.04) and 12 to 18 months (–6.29 kg; 95% CI –7.33 to –5.25). Weight loss is similar in the short-term for diet-only and combined BWMPs but in the longer-term weight loss is increased when diet and physical activity are combined. Programs based on physical activity alone are less effective than combined BWMPs in both the short and long term.

Behavioural weight management programmes for adults assessed by trials conducted in everyday contexts: systematic review and meta-analysis

This systematic review and meta‐analysis of effectiveness trials comparing multicomponent behavioural weight management programmes with controls in overweight and obese adults set out to determine the effectiveness of these interventions implemented in routine practice. To be included, interventions must have been multicomponent, delivered by the therapists who would deliver the intervention in routine practice and in that same context, and must be widely available or feasible to implement with little additional infrastructure or staffing. Searches of electronic databases were conducted, and augmented by screening reference lists and contacting experts (November 2012). Data were extracted by two reviewers, with mean difference between intervention and control for 12‐month change in weight, blood pressure, lipids and glucose calculated using baseline observation carried forward. Data were also extracted on adverse events, quality of life and mood measures. Although there were many published efficacy trials, only eight effectiveness trials met the inclusion criteria. Pooled results from five study arms providing access to commercial weight management programmes detected significant weight loss at 12 months (mean difference −2.22 kg, 95% confidence interval [CI] −2.90 to −1.54). Results from two arms of a study testing a commercial programme providing meal replacements also detected significant weight loss (mean difference −6.83 kg, 95% CI −8.39 to −5.26). In contrast, pooled results from five interventions delivered by primary care teams showed no evidence of an effect on weight (mean difference −0.45 kg, 95% CI −1.34 to 0.43). One study testing an interactive web‐based intervention detected a significant effect in favour of the intervention at 12 months, but the study was judged to be at high risk of bias and the effect did not persist at 18 months. Few studies reported other outcomes, limiting comparisons between interventions. Few trials have examined the effectiveness of behavioural weight loss programmes delivered in everyday contexts. These trials suggest that commercial interventions delivered in the community are effective for achieving weight loss. There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.

Efficacy of interventions to combat tobacco addiction: Cochrane update of 2013 reviews: Cochrane update of 2013 reviews

AIMS The Cochrane Collaboration is an international not-for profit organization which produces and disseminates systematic reviews. This paper is the second in a series of annual updates of Cochrane reviews on tobacco addiction interventions, covering new and updated reviews from 2013. METHODS In 2013, the Group published two new reviews and updated 11 others. This update summarizes and comments on these reviews as well as on a review of psychosocial interventions for smoking cessation in pregnant women, and presents pooled results from reviews of cessation interventions. RESULTS New reviews in 2013 found: low-quality evidence that behavioural interventions with mood management components could significantly increase long-term quit rates in people with current [risk ratio (RR) = 1.47, 95% confidence interval (CI) = 1.13-1.92) and past (RR = 1.41, 95% CI = 1.13-1.77] depression; evidence from network meta-analysis that varenicline and combined forms of nicotine replacement therapy (NRT) are associated with higher quit rates than bupropion or single-form NRT (varenicline versus single-form NRT odds ratio (OR) = 1.57, 95% credibility interval (CredI) = 1.29-1.91; versus bupropion OR = 1.59, 95% CredI = 1.29-1.96); and no evidence of a significant increase in serious adverse events in trial participants randomized to varenicline or bupropion when compared to placebo controls. New evidence emerging from updated reviews suggests that counselling interventions can increase quit rates in pregnant women and that school-based smoking programmes with social competence curricula can lead to a significant reduction in uptake of smoking at more than a year. Updated reviews also suggested that naltrexone, selective serotonin re-uptake inhibitors and St Johns wort do not have a significant effect on long-term smoking cessation. CONCLUSIONS Cochrane systematic review evidence from 2013 suggests that adding mood management to behavioural support may improve cessation outcomes in smokers with current or past depression and strengthens evidence for previous conclusions, including the safety of varenicline and bupropion and the benefits of behavioural support for smoking cessation in pregnancy.

Self-Help for Weight Loss in Overweight and Obese Adults: Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis investigating the components and effectiveness of self-help weight-loss interventions and their applicability to less-advantaged populations. We searched (November 2013) for randomized controlled trials comparing self-help interventions with each other or with minimal controls in overweight and obese adults, with 6 months or longer follow-up. We calculated mean difference between intervention and control for 6- and 12-month weight change. Twenty-three studies met the inclusion criteria (9632 participants; 39 intervention arms). Intervention participants lost significantly more weight than controls at 6 months (mean difference -1.85 kg; 95% confidence interval [CI]=-2.86, -0.83; 7 studies). No significant effect was detected at 12 months but results were sensitive to the inclusion of 1 study at high risk of bias. Interactive programs appeared more effective than standard ones at 6 months (mean difference -0.94 kg; 95% CI=-1.50, -0.38). Evidence is insufficient to reach conclusions on effectiveness in socioeconomically disadvantaged people, but suggests self-help interventions may be less effective in this group.

Self-monitoring blood pressure in hypertension, patient and provider perspectives: A systematic review and thematic synthesis.

OBJECTIVE To systematically review the qualitative evidence for patient and clinician perspectives on self-measurement of blood pressure (SMBP) in the management of hypertension focussing on: how SMBP was discussed in consultations; the motivation for patients to start self-monitoring; how both patients and clinicians used SMBP to promote behaviour change; perceived barriers and facilitators to SMBP use by patients and clinicians. METHODS Medline, Embase, PsycINFO, Cinahl, Web of Science, SocAbs were searched for empirical qualitative studies that met the review objectives. Reporting of included studies was assessed using the COREQ framework. All relevant data from results/findings sections of included reports were extracted, coded inductively using thematic analysis, and overarching themes across studies were abstracted. RESULTS Twelve studies were included in the synthesis involving 358 patients and 91 clinicians. Three major themes are presented: interpretation, attribution and action; convenience and reassurance v anxiety and uncertainty; and patient autonomy and empowerment improve patient-clinician alliance. CONCLUSIONS SMBP was successful facilitating the interaction in consultations about hypertension, bridging a potential gap in the traditional patient-clinician relationship. PRACTICE IMPLICATIONS Uncertainty could be reduced by providing information specifically about how to interpret SMBP, what variation is acceptable, adjustment for home-clinic difference, and for patients what they should be concerned about and how to act.

Weight change among people randomized to minimal intervention control groups in weight loss trials

Evidence on the effectiveness of behavioral weight management programs often comes from uncontrolled program evaluations. These frequently make the assumption that, without intervention, people will gain weight. The aim of this study was to use data from minimal intervention control groups in randomized controlled trials to examine the evidence for this assumption and the effect of frequency of weighing on weight change.

Electronic cigarettes for smoking cessation

### What you need to know A 42 year old electrician has tried to stop smoking several times, including with the aid of pharmacotherapy and behavioural support. He asks you about using electronic cigarettes (e-cigarettes). His work partner stopped smoking a year ago and is still using e-cigarettes now. He has heard that e-cigarettes are as damaging as the real things and worries that if he ends up addicted to e-cigarettes he’ll not have gained anything. About 60% of current adult smokers in Great Britain have tried electronic cigarettes (e-cigarettes), and 18% are current e-cigarette users.1 In England, over 40% of people who try to stop smoking do so with the aid of e-cigarettes.2 About 52% of current e-cigarettes users are former smokers.1 Some people who stop smoking with an e-cigarette are still using e-cigarettes a year later.1 In this article we look at whether e-cigarettes help people who smoke to cut down and stop smoking, what are the health risks from e-cigarette use, and how these compare with smoking. ### Cigarette and nicotine addiction Most people who smoke cigarettes are addicted, and the main vehicle of that addiction is nicotine. When stopping smoking, people experience cravings for cigarettes, which drives return to smoking. These cravings for smoking are less intense when nicotine is substituted; thus replacing nicotine from sources other than cigarettes can facilitate achieving abstinence. Transferring from cigarettes to other nicotine delivery devices, such as nicotine replacement therapy (NRT) or e-cigarettes, can transfer cigarette addiction to nicotine addiction. …

Development of tools to study personal weight control strategies: OxFAB taxonomy

To describe the development of the Oxford Food and Activity Behaviors (OxFAB) taxonomy and questionnaire to explore the cognitive and behavioral strategies used by individuals during weight management attempts.

Drugs for smoking cessation

#### What you need to know A 49 year old woman who smokes attends the general practitioner for help with troubling menopausal symptoms. During the course of the consultation, the doctor offers her help to stop smoking. She has tried stopping smoking previously without help and found it intolerable. She asks if she can use drug therapy this time. Of the drugs available for smoking cessation, three are widely licensed and have proved efficacy: Cochrane reviews give strong evidence that all three drugs are effective. Compared with placebo, the relative risks of abstinence are 1.60 (95% confidence interval 1.53 to 1.68) for NRT, 1.62 (1.49 to 1.76) for bupropion, and 2.27 (2.02 to 2.55) for varenicline.1 2 3 These relative risks seem to be constant over time from early in the quitting process to the long term and do not depend on …