A meta-analysis of brief tobacco interventions for use in integrated primary care

Introduction: The integration of behavioral health services in primary care settings presents an opportunity to enhance the delivery of tobacco cessation interventions in the primary care setting, but guidance on evidence-based treatments for tobacco use disorder that fits the brief format of integrated primary care (IPC) is limited. This meta-analysis summarizes the outcomes of brief behavioral interventions targeting tobacco use that can be delivered in IPC settings. Methods: A literature search was conducted to locate empirical studies examining tobacco cessation interventions that could be implemented in an IPC setting. A random effects meta-analytic approach was utilized with odds ratios as the effect size. Subgroup analyses were conducted to determine the extent to which a number of study, participant, and intervention characteristics affected treatment outcome. Results: A total of 36 studies were included (n = 12 975 patients). Patients in the intervention groups exhibited significantly greater odds of smoking cessation compared with those in the comparison groups (OR = 1.78, p < .001). Subgroup analyses did not reveal significant sources of heterogeneity attributable to moderators such as methodological quality, gender, bioverification, follow-up time period, or intervention characteristics (such as setting, type, or length of intervention). Conclusions: Brief tobacco cessation interventions that can be delivered in IPC settings were found to be effective. Future research in this area might evaluate ways to improve the dissemination and implementation of these types of interventions in IPC settings. Implications: The integration of behavioral health services into primary care presents a unique opportunity to increase the delivery of tobacco cessation interventions, as behavioral health providers in these settings are experts in behavior change interventions and may have more time to deliver these interventions than primary care providers. Results from the current meta-analysis demonstrate that brief tobacco cessation interventions that can be implemented in the IPC setting are effective. Future research in this area might examine ways to improve the dissemination and implementation of brief interventions for tobacco use in IPC settings.