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Meta-Analysis
. 2012 Aug 15;2012(8):CD009325.
doi: 10.1002/14651858.CD009325.pub2.

Interventions for tobacco use prevention in Indigenous youth

Affiliations
Meta-Analysis

Interventions for tobacco use prevention in Indigenous youth

Kristin V Carson et al. Cochrane Database Syst Rev. .

Retraction in

  • Interventions for tobacco use prevention in Indigenous youth.
    Carson-Chahhoud KV, Brinn MP, Labiszewski NA, Peters M, Chang AB, Veale A, Esterman AJ, Smith BJ. Carson-Chahhoud KV, et al. Cochrane Database Syst Rev. 2021 Nov 30;11(11):CD009325. doi: 10.1002/14651858.CD009325.pub3. Cochrane Database Syst Rev. 2021. PMID: 34847239 Free PMC article.

Abstract

Background: Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that in the non-Indigenous population. Addiction to nicotine usually begins during early adolescence and young people who reach the age of 18 as non-smokers are unlikely to become smokers thereafter. Indigenous youth in particular commence smoking at an early age, and a disproportionate burden of substance-related morbidity and mortality exists as a result.

Objectives: To evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research.

Search methods: The Cochrane Tobacco Addiction Group Specialised Register was searched in November 2011, with additional searches run in MEDLINE. Online clinical trial databases and publication references were also searched for potential studies.

Selection criteria: We included randomized and non-randomized controlled trials aiming to prevent tobacco use initiation or progression from experimentation to regular tobacco use in Indigenous youth. Interventions could include school-based initiatives, mass media, multi-component community level interventions, family-based programmes or public policy.

Data collection and analysis: Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst information on risk of bias was extracted independently by a combination of two reviewers. Studies were assessed by qualitative narrative synthesis, as insufficient data were available to conduct a meta-analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content.

Main results: Two studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi-component community-based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow-up in the one study assessing this outcome (skills-community group versus control: risk ratio [RR] 0.95, 95% CI 0.78 to 1.14; skills-only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills-community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills-only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow-up (change score -0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10).

Authors' conclusions: Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth. This review highlights the paucity of data and the need for more research in this area. Smoking prevalence in Indigenous youth is twice that of the non-Indigenous population, with tobacco experimentation commencing at an early age. As such, a significant health disparity exists where Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco-related health disparities in Indigenous and non-Indigenous populations.

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Conflict of interest statement

ABC has received a grant provided by GSK which is unrelated to this topic. She is also the principal investigator on a study examining azithromycin for bronchiolitis in Indigenous children. MJP has received honoria in relation to attendance at a Smoking Cessation Advisory Board from Pfizer Ltd. No other conflicts of interest are known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Reported tobacco use, Outcome 1 Smoking ‐ Weekly at 42 months follow‐up.
1.2
1.2. Analysis
Comparison 1 Reported tobacco use, Outcome 2 Smokeless tobacco use ‐ Weekly at 42 months follow‐up.

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