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Meta-Analysis
. 2025 Mar 24;27(4):575-585.
doi: 10.1093/ntr/ntae259.

Behavioral Interventions for Tobacco Cessation in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Abhijit Nadkarni  1   2 , Leena Gaikwad  2 , Miriam Sequeira  2 , Pranay Javeri  2 , Deepthy Benoy  2 , Marimilha Grace Pacheco  2 , Richard Velleman  2   3 , Pratima Murthy  4 , Felix Naughton  5
Affiliations
Meta-Analysis

Behavioral Interventions for Tobacco Cessation in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Abhijit Nadkarni et al. Nicotine Tob Res. .

Abstract

Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially.

Methods: We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up.

Results: For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95% CI 1.78 to 3.02) and usual care (RR 4.39; 95% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95% CI 1.28 to 2.44), and usual care (RR 2.37; 95% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes.

Conclusions: Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs.

Implications: Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
PRISMA 2020 flow diagram for study selection.
Figure 2.
Figure 2.
Behavioral intervention versus active intervention*. Outcome: 6-month continuous abstinence. *Active intervention included other behavioral intervention or pharmacological intervention.
Figure 3.
Figure 3.
Behavioral intervention versus usual care*. Outcome: continuous abstinence. *Usual care included printed self-help materials or unspecified usual care for tobacco cessation. Dogar 2013a: participants smoking cigarettes exclusively; Dogar 2013b: participants smoking both cigarettes and hookas, Dogar 2013c: participants smoking hookah exclusively.
Figure 4.
Figure 4.
Behavioral intervention versus active intervention*. Outcome: Point prevalence abstinence at 6 months. *Active intervention included other behavioral intervention or pharmacological intervention.
Figure 5.
Figure 5.
Behavioral intervention versus usual care*. Outcome: Point prevalence abstinence at 6 months. *Usual care included printed self-help materials or unspecified usual care for tobacco cessation.
Figure 6.
Figure 6.
Quality of studies included in the review.
See this image and copyright information in PMC

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