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Review
. 2025 Apr 21;13(8):953.
doi: 10.3390/healthcare13080953.

Effectiveness and Adherence of Pharmacological vs. Non-Pharmacological Technology-Supported Smoking Cessation Interventions: An Umbrella Review

Federica Di Spirito  1 , Maria Pia Di Palo  1 , Marina Garofano  1 , Rosaria Del Sorbo  1 , Gianluca Allegretti  1 , Iman Rizki  1 , Marianna Bartolomeo  1 , Massimo Giordano  1 , Massimo Amato  1 , Alessia Bramanti  1
Affiliations
Review

Effectiveness and Adherence of Pharmacological vs. Non-Pharmacological Technology-Supported Smoking Cessation Interventions: An Umbrella Review

Federica Di Spirito et al. Healthcare (Basel). .

Abstract

Background: Smoking cessation has a crucial public health role. To overcome non-technological and technology-based smoking cessation intervention limitations, technology-supported programs were developed. Objectives: The present umbrella review aimed to evaluate the long-term effectiveness (≥6 months) of pharmacological vs. non-pharmacological technology-supported smoking cessation interventions on adult daily smokers and the related human health benefits. Methods: Following PRISMA guidelines, the protocol was registered on PROSPERO (CRD42024601824). Fifty systematic reviews were included, evaluated through AMSTAR-2, and qualitatively synthesized. Results: A total of 69,269 smokers underwent pharmacological (39,367) and non-pharmacological (29,902) technology-supported interventions. The biochemically-verified effectiveness assessed as continuous abstinence rates (CARs) and seven-day point prevalence abstinence (PPA) of pharmacological vs. non-pharmacological at 6 and 12 months were, respectively, CARs 9.06% vs. 14.85%, 7-day PPA 17.37% vs. 17.15%; CARs 8.51% vs. 9.08%, 7-day PPA 14.00% vs. 5.63%. The 6-month adherence rates were higher in the non-pharmacological group (41.37% vs. 83.43%). Conclusions: Non-pharmacological technology-supported interventions showed similar effectiveness and higher adherence at 6 months. At 12 months, the CARs were similar despite lower adherence. Adherence quality and consistency may be important for sustained success, probably due to the "reverse causality". Non-pharmacological interventions showed similar effectiveness, lower costs, and shorter durations than pharmacological interventions.

Keywords: adherence; effectiveness; health; humans; medication adherence; pharmaceutical preparations; smoke; smoking cessation; technology.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The study selection process of records retrieved through electronic and manual searches illustrated in a PRISMA 2020 flowchart.
Figure 2
Figure 2
Biochemically verified long-term effectiveness assessed as CARs and PPA over time of pharmacological vs. non-pharmacological technology-supported smoking cessation interventions.
Figure 3
Figure 3
Adherence vs. CARs biochemically verified over time of pharmacological vs. non-pharmacological technology-supported smoking cessation interventions.
See this image and copyright information in PMC

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