title: Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality.
abstract: BACKGROUND
  Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence.
  
  
  METHODS
  Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I(2). All statistical tests were two-sided.
  
  
  RESULTS
  Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6-9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I(2) = 21.4%) but not at 12-15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6-9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I(2) = 49.1%) and 12-18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I(2) = 18.5%).
  
  
  CONCLUSIONS
  With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers.
authors.affiliation: Centre for Health Research & Psycho-oncology, Cancer Council New South Wales, Faculty of Health, University of Newcastle and Hunter Medical Research Institute, New South Wales, Australia. flora.tzelepis@newcastle.edu.au
authors.forename: Flora
authors.initials: F
authors.lastname: Tzelepis
authors.forename: Christine L
authors.initials: CL
authors.lastname: Paul
authors.forename: Raoul A
authors.initials: RA
authors.lastname: Walsh
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: Jenny
authors.initials: J
authors.lastname: Knight
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D015277:Hotlines; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D012107:Research Design / Q000592:standards*; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D013689:Telephone; D013997:Time Factors