Meta-analysis of the efficacy of tobacco counseling by health care providers

Given the proportion of American adults who smoke, even if health professionals only have a small effect on quit rates, the public health impact of this change could potentially be enormous. Yet, health care providers may differ in their cessation efficacy. The purpose of this study was to evaluate recent rigorous trials of smoking cessation counseling among physicians, nurses, dentists, and teams of providers: (1) to compare providers on the efficacy of cessation and (2) to determine which intervention and study characteristics explain variations in intervention effects. Thirty-seven randomized clinical trials or quasi-experiments (with control groups) of health care provider-delivered smoking cessation interventions, out of over 200 articles that were published between 1990 and 2004 were collected through searches of Medline, CINAHL, PSYCINFO, and dissertation abstracts, as well as hand searches. The outcome modeled was the mean difference between intervention and control groups in the cessation rates using Hedges g. The univariate results revealed that receiving advice from any health care professional produced increases in quit rates. Multivariate analyses of intervention effects on cessation revealed that physicians were most effective, followed by multiprovider teams, dentists, and nurses. The findings suggest that contact with a health care professional will increase cessation; however, additional training in tobacco control for nurses is warranted. Longer-term studies of smoking cessation, particularly among dentists, are necessary.