Introduction: Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. 

Aims: We conducted a systematic review and meta-analysis to determine the most effective delivery strategies for smoking cessation interventions conducted in a screening context. 

Methods We searched MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases, from inception to 20/07/2022, for published literature on interventions delivered during lung health screening.  Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, and assessed the risk of bias and confidence in findings using the GRADE criteria.

Results 10 randomised controlled trials (RCT) and 3 observational studies with a control group were identified. Meta-analysis of 9 RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (OR: 2.01, 95%: 1.49-2.72 p<0.001). 6 RCTs using intensive (>3  counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53-2.90, p<0.001). 2 RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26-3.40 p=0.004). 

Discussion Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.