The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers' websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students' counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I² 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I² 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I² = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.

Keywords: education; health professional students; randomized controlled trials; smoking cessation; systematic review; tobacco dependence intervention.

Figure 1

PRISMA flow diagram of search results and study selection process for published studies, 1990–2017. Note: PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Review authors’ judgements about each risk of bias item presented as percentages across all meta-analysis articles.

Figure 3

Risk-of-bias summary for meta-analysis articles. Note: To avoid double-counting the risk-of-bias in the assessment for Cannick et al. [76], Year 2 students is left blank. The risk of bias is a summary for both years.

Figure 4

Forest plot for change in tobacco cessation counseling skills using the 5As with standardized or real patients.

Figure 5

Forest plot for change in tobacco cessation counseling skills with standardized patients guided by Motivational Interviewing.

Figure 6

Forest plot for change in students’ self-efficacy in tobacco cessation counseling.

Figure 7

Forest plot for patient smoking cessation at six months after counseling.

Figure 8

Forest plot for patient smoking cessation at one year after counseling.