Key messages:
- Very brief advice on smoking cessation can be delivered in 3 minutes or less and effectively increases tobacco abstinence.
- These interventions include AAR, AWARD, and ABC. AAR (Ask, Advise, Refer) involves three steps: ask about tobacco use, advise to quit, and refer for more intensive tobacco treatment counselling or pharmacotherapy.
- Providing very brief advice is easily implemented during all appointments with clients who smoke.
Introduction
Tobacco cessation helps prevent premature death, many types of cancers and cardiovascular and pulmonary diseases. However, many smokers do not received advice to quit.
Brief interventions deliver evidence-based smoking cessation interventions within a short time frame. These interventions identify smokers and advise and assist them to quit and are effective in directing clients to smoking cessation treatments and improving tobacco abstinence. The 5As (Ask, Advise, Assess, Assist, Arrange follow-up) and 5Rs (Relevance, Risk, Rewards, Roadblocks, Repetition) are the most known brief intervention models. However, many healthcare providers cannot implement the full brief intervention.
Simplified smoking cessation intervention models, known as very brief advice, include AAR (Ask, Advise, Refer), AWARD (Ask, Warn, Advise, Refer, Do it Again), and ABC (Ask about smoking, provide Brief advice to quit, and offer Cessation assistance). These models were developed for healthcare providers to easily implement during routine appointments, requiring only a short amount of time. While brief interventions primarily focus on motivating individuals to attempt quitting and providing aids, very brief advice aims to give opportunistic advice to all smokers, regardless of their motivation to quit.
Two factors make it easier for healthcare providers to implement very brief advice instead of brief interventions for smoking cessation. First, clinical settings often have time constraints, allowing only for discussions on smoking cessation lasting 1 to 2 minutes. Second, not all healthcare providers are trained in tobacco cessation and counselling to offer more intensive treatments. As a result, very brief advice is the most practical approach for advising and referring clients who smoke to cessation services.
Randomized controlled trials have tested very brief advice (as short as 30 seconds) and support its effectiveness. Both healthcare providers and clients prefer very brief advice for smoking cessation due to its feasibility, simplicity, and ease. Very brief advice may help reduce the barriers associated with the increased time demands on healthcare workers when providing smoking cessation support, making it a practical solution in busy clinical settings.
Objectives
This study synthesized the effectiveness of very brief advice delivered in 3 minutes or less on smoking cessation and summarized the implementation strategies.
Methods
The authors searched several databases for randomized controlled trials that focused on tobacco cessation and compared the effects of very brief advice to no smoking advice or no contact.
Results
Thirteen randomized controlled trials from 15 articles involving 26,437 participants were included. There was moderate-certainty evidence that very brief advice significantly increased self-reported tobacco abstinence for 6 months or more, compared with control groups. The sensitivity analysis showed similar results when abstinence was verified by biochemical validation. There was high-certainty evidence that very brief advice significantly increased abstinence for less than 6 months. The evidence of its effect on quit attempts was of very low certainty.
Conclusions
This study showed very brief advice significantly increased abstinence rates (though the effect size was small) when assessed at ≥6 months or <6 months after treatment initiation. These findings support delivering very brief advice in clinical settings during all interactions with clients who smoke. The simplicity, low cost, and broad reach of very brief advice make it a viable option for wider implementation to increase tobacco abstinence rates.
