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Biomedical risk assessment may not be better than standard methods to improve smoking cessation rates

Jane Gillette DDS .


Systematic Review Conclusion

There is scarce and inconclusive evidence to support the hypothesis that either individual or combination feedback of physiological risk assessment given to patients promotes smoking cessation compared to the use of standard protocols.

Critical Summary Assessment

A well-conducted systematic review with only minor methodological flaws utilizing the best available evidence found mostly negative evidence to support the use of physiological risk assessment as an improved aid over standard protocols.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

For patients who smoke: (a) Will feedback on physiological measurements indicating the effects of smoking on an individual’s susceptibility to developing smoking-related illness improve the rate of smoking cessation? (b) Are multiple combinations of physiological measurements (e.g. spirometry and exhaled carbon monoxide (CO) measurement used together) more effective than any stand alone measurement?

Review Methods:

The authors searched 5 electronic databases (1966 to January 2009) and 2 relevant research meetings for abstracts. Studies that met the inclusion criteria were those limited to 1) individuals who smoked and who participated in smoking cessation programs or in screening for respiratory disease, and 2) individuals who participated in health check-ups with any intervention that included a physical measurement as a means of risk assessment. The main outcome was smoking cessation for at least 6 months. Abstracts were reviewed independently and discrepancies resolved by consensus. All trials were evaluated for bias and methodological quality.

Main Results:

Eleven trials were included in this review, of which two pairs could be grouped for meta-analysis. The meta-analyses pooled data that evaluated the impact of measuring and providing feedback on exhaled CO measurement and spirometry in attaining smoking cessation. Neither meta-analysis revealed any significant benefit. Only 2 trials found any considerable increase in smoking cessation rates: a trial that provided feedback on "lung age" after spirometry and a trial that used ultrasonography of carotid and femoral arteries and photographs of plaques; however, this latter trial considered only "light smokers" and delivered more than typical extensive smoking cessation counseling.


There is negative evidence to support the hypothesis that feedback on physiological risk assessment increased smoking cessation rates when supplemented with standard smoking cessation protocols such as counseling, pharmacological therapies and possibly self-help methods. Methodological quality improvements are needed in trials aimed at assessing the efficacy of physiological risk assessment as an aid to smoking cessation.

Source of Funding:

There was no source of funding stated.


Importance and Context:

Smoking remains one of the leading causes of preventable morbidity and mortality in the United States and other industrialized nations. The adverse impacts of smoking on oral health are significant, including but not limited to periodontal disease and oral cancer. Smokers may underestimate their personal risk of smoking-related illness. The development of a predictable protocol may help smokers to better understand their risks, thus increasing smoking cessation rates while improving the general and oral health of smokers. A predictable risk assessment shared with patients may aid dental professionals in assisting patients with smoking cessation.

Strengths and Weaknesses of the Systematic Review:

This was a high quality systematic review that considered only randomized or quasi-randomized controlled trials. A thorough critique of the methodological quality of each trial was completed, including assessment of bias. Multiple databases were utilized by the review team and abstracts were evaluated by independent reviewers. A few minor weaknesses were associated with this review: 1) The study lacked a clear statement about language limitation; and 2) the authors did not mention if they attempted to acquire unpublished data, though some data may have been obtained through accessing relevant research meeting abstracts. Lastly, a reviewer co-authored one of the studies that was included in this review, a study that positively impacted smoking cessation.

Strengths and Weaknesses of the Evidence:

The biggest strength with respect to the evidence is that all of the trials considered patient-centered outcomes such a smoking cessation for 6 months or longer. There was heterogeneity between trials with two reporting positive findings, but nine reported no significant improvement with the addition of physiological risk assessment feedback over standard smoking cessation protocols. There were several methodological quality weaknesses found in most of the trials, including failure to blind the therapists, small sample sizes, lack of a common definition of a smoker and lack of the systematic use of biological testing of patients to confirm smoking abstinence.

Implications for Dental Practice:

Dental professionals should consider continuing the use of standard smoking cessation methods as physiological risk assessment has failed to consistently and significantly show improvement in smoking cessation rates.

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019