Key messages
- When people who smoke are admitted to a hospital, they can be helped to quit smoking if they receive stop-smoking counselling that begins in hospital and continues for at least a month after they return home, compared to no counselling.
- Medications, such as nicotine patches and varenicline, in combination with counselling also help people quit smoking post-discharge. These treatments work better than not starting counselling or medication during a hospitalisation.
- Evidence supports hospitals and hospital clinicians offering in-hospital and post-discharge cessation support to patients, and demonstrates that patients may benefit from beginning their quit-smoking journey prior to, or upon, hospital discharge, in order to stay quit post-discharge.
What did we want to find out?
We wanted to find out what interventions are helpful to support hospitalised people who smoke in quitting cigarette smoking. Our main goal was to find out which treatments can help hospitalised patients stop smoking for at least six months. This is important because smoking contributes to many health problems, including cancers, heart disease, and lung disease. People who smoke and are admitted to a hospital to treat a medical illness, especially an illness that is related to smoking, might be more receptive to advice to quit smoking. The smoke-free hospital environment may also help them to try out not smoking and to start treatment to remain smoke-free after leaving the hospital.
What did we do?
We searched for studies that looked at stop smoking interventions (medications versus no medications or dummy pill and/or counselling versus no counselling) that began during a medical hospitalisation. Smoking cessation medications generally work to reduce withdrawal symptoms and stave off cravings; NRT by providing low levels of nicotine without the poisonous chemicals, and drugs such varenicline and bupropion, which do not contain nicotine, by directly targeting the reward and pleasure/addictive centres in the brain. Providing these treatments before someone is discharged from the hospital allows them to get a headstart on quitting smoking, as their hospitalisation is smoke-free. We looked for randomised controlled trials or quasi-randomised controlled trials, in which the treatments people received were decided at random or semi-random. Randomised studies typically give the most reliable and robust evidence about the effects of a treatment.
What did we find?
We found 82 studies of smoking cessation interventions that began in the hospital with 42,273 participants. These studies compared counselling (versus no counselling) and/or medications such as nicotine replacement therapy, varenicline, and bupropion (versus no medication or placebo). The studies took place across 17 countries (Australia, Belgium, Brazil, Canada, China, Denmark, France, Ireland, Israel, Japan, the Netherlands, Norway, South Korea, Spain, Tunisia, United Kingdom, and the United States).
Main results
People are more likely to stop smoking for at least six months if they receive stop-smoking counselling that begins in hospital and continues for more than a month after discharge than if they receive no counselling (28 studies, 8234 people). Shorter and less intensive counselling was less effective. People are also more likely to stop smoking for at least six months if nicotine replacement therapy (NRT) is started in the hospital (8 studies, 3838 people), or if varenicline is started in the hospital (4 studies, 829 people), than if they do not receive medication or if they receive a placebo medication. There was minimal evidence for bupropion's effectiveness in helping individuals quit smoking at six months. People who receive counselling in the hospital are more likely to quit smoking after discharge when using a combination of counselling and medication than when receiving neither (7 studies, 5610 people). Finally, there was insufficient evidence of quitlines' effectiveness for providing support after hospital discharge.
What are the limitations of the evidence?
Our results are based on numerous studies. However, we need more studies to confirm some of our findings, including buproprion and varenicline and lower-intensity counselling. We also need more studies to test whether digital interventions work - these interventions are promising as they might have greater reach at a lower cost. Some of our studies also had issues with their design and conduct, which made us less certain about our findings. These results could change when more evidence becomes available.
How up to date is this evidence?
The evidence is up to date to September 2022.