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Meta-Analysis
. 2017 Nov 17;11(11):CD003289.
doi: 10.1002/14651858.CD003289.pub6.

Tobacco cessation interventions for young people

Thomas R Fanshawe  1 , William Halliwell, Nicola Lindson, Paul Aveyard, Jonathan Livingstone-Banks, Jamie Hartmann-Boyce
Affiliations
Meta-Analysis

Tobacco cessation interventions for young people

Thomas R Fanshawe et al. Cochrane Database Syst Rev. .

Abstract

Background: Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

Objectives: To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

Selection criteria: We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

Data collection and analysis: Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

Main results: Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

Authors' conclusions: There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

PubMed Disclaimer

Conflict of interest statement

TF declares no conflicts of interest.

WH declares no conflicts of interest.

NL is a co‐applicant on a completed trial investigating nicotine patch preloading for smoking cessation (not a harm reduction approach). The nicotine patches were provided free of charge by GlaxoSmithKline; however the trial was funded by the NIHR HTA (09/110/01), and the running and the reporting of the trial were carried out independently to the funder and treatment provider.

PA declares: PA is an author of one of the included studies.

JLB declares no conflicts of interest.

JHB declares no conflicts of interest.

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 1 Individual counselling vs control.
1.2
1.2. Analysis
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 2 Group counselling vs control.
1.3
1.3. Analysis
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 3 Interventions using technology vs control.
1.4
1.4. Analysis
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 4 Interventions with multiple delivery methods vs control.
2.1
2.1. Analysis
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 1 Stage of Change models vs control.
2.2
2.2. Analysis
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 2 Motivational interviewing vs control.
2.3
2.3. Analysis
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 3 Social cognitive theory vs control.
2.4
2.4. Analysis
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 4 Complex theoretical model with stage of change, motivational interviewing, cognitive behavioural therapy and/or social cognitive theory vs control.
3.1
3.1. Analysis
Comparison 3 Pharmacological interventions, Outcome 1 Nicotine replacement therapy vs placebo.
3.2
3.2. Analysis
Comparison 3 Pharmacological interventions, Outcome 2 Bupropion vs placebo.
3.3
3.3. Analysis
Comparison 3 Pharmacological interventions, Outcome 3 Nicotine patch + bupropion vs nicotine patch + placebo.
4.1
4.1. Analysis
Comparison 4 Project EX interventions, Outcome 1 Project EX vs control.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Joffe 2009 {published data only}
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Kelly 2006 {published data only}
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Killen 2004 {published data only}
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Lipkus 2004 {published data only}
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Mason 2016 {published data only}
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Patten 2006 {published data only}
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Pbert 2011 {published data only}
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Peterson 2009 {published data only}
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Prochaska 2015 {published data only (unpublished sought but not used)}
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Project EX‐1 2001 {published data only}
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Project EX‐4 2007 {published data only}
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Project EX Russia 2013 {published data only}
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Project EX Spain 2015a {published data only}
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Redding 2015 {published data only}
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Robinson 2003 {published data only}
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Scherphof 2014 {published data only}
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Sherbot 2005 {published data only}
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Skov‐Ettrup 2014 {published data only}
    1. Skov‐Ettrup LS, Ringgaard LW, Dalum P, Flensborg‐Madsen T, Thygesen LC, Tolstrup JS. Comparing tailored and untailored text messages for smoking cessation: a randomized controlled trial among adolescent and young adult smokers. Health Education Research 2014;29(2):195‐205. - PubMed
Woodruff 2007 {published data only}
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    1. Woodruff SI, Conway TL, Edwards CC, Elliott SP, Crittenden J. Evaluation of an internet virtual world chat room for adolescent smoking cessation. Addictive Behaviors 2007;32:1769‐86. - PubMed

References to studies excluded from this review

Abelin 1989 {published data only}
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Adelman 2001 {published data only}
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Adelman 2009 {published data only}
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Ames 2007 {published data only}
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Krishnan‐Sarin 2013 {published data only}
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References to other published versions of this review

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