The efficacy of smoking cessation interventions in low- and middle-income countries

a systematic review and meta-analysis

Maxwell Oluwole Akanbi*, Allison Jane Carroll, Chad J Achenbach, Linda O'Dwyer, Neil Jordan, Brian L Hitsman, Lucy Ann Bilaver, Megan Colleen McHugh, Robert Leo Murphy

*Corresponding author for this work

Research output: Contribution to journalReview article

Abstract

Aims: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: LMICs as defined by the World Bank. Participants: Adult current cigarette smokers residing in LMICs. Interventions: Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel–Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI). Findings: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30–2.77, P < 0.001, I 2  = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18–11.29, P < 0.001, I 2  = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56–3.88, P < 0.001, I 2  = 0%). Conclusion: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

Original languageEnglish (US)
Pages (from-to)620-635
Number of pages16
JournalAddiction
Volume114
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Smoking Cessation
Nicotine
Meta-Analysis
Odds Ratio
Confidence Intervals
Counseling
MEDLINE
Randomized Controlled Trials
United Nations
Therapeutics
PubMed
Tobacco Products
Placebos
Pharmacology
Drug Therapy
Research

Keywords

  • Developing countries
  • low- and middle-income countries
  • meta-analysis
  • smoking cessation
  • systematic review
  • tobacco use

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

@article{f3127de3337f490fb53aaeba549b0d92,
title = "The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis",
abstract = "Aims: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: LMICs as defined by the World Bank. Participants: Adult current cigarette smokers residing in LMICs. Interventions: Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel–Haenzel random-effect models reporting odds ratios (OR) and 95{\%} confidence intervals (CI). Findings: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95{\%} CI = 1.30–2.77, P < 0.001, I 2  = 13{\%}). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95{\%} CI = 4.18–11.29, P < 0.001, I 2  = 67{\%}). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95{\%} CI = 1.56–3.88, P < 0.001, I 2  = 0{\%}). Conclusion: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.",
keywords = "Developing countries, low- and middle-income countries, meta-analysis, smoking cessation, systematic review, tobacco use",
author = "Akanbi, {Maxwell Oluwole} and Carroll, {Allison Jane} and Achenbach, {Chad J} and Linda O'Dwyer and Neil Jordan and Hitsman, {Brian L} and Bilaver, {Lucy Ann} and McHugh, {Megan Colleen} and Murphy, {Robert Leo}",
year = "2019",
month = "4",
day = "1",
doi = "10.1111/add.14518",
language = "English (US)",
volume = "114",
pages = "620--635",
journal = "Addiction",
issn = "0965-2140",
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TY - JOUR

T1 - The efficacy of smoking cessation interventions in low- and middle-income countries

T2 - a systematic review and meta-analysis

AU - Akanbi, Maxwell Oluwole

AU - Carroll, Allison Jane

AU - Achenbach, Chad J

AU - O'Dwyer, Linda

AU - Jordan, Neil

AU - Hitsman, Brian L

AU - Bilaver, Lucy Ann

AU - McHugh, Megan Colleen

AU - Murphy, Robert Leo

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Aims: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: LMICs as defined by the World Bank. Participants: Adult current cigarette smokers residing in LMICs. Interventions: Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel–Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI). Findings: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30–2.77, P < 0.001, I 2  = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18–11.29, P < 0.001, I 2  = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56–3.88, P < 0.001, I 2  = 0%). Conclusion: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

AB - Aims: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: LMICs as defined by the World Bank. Participants: Adult current cigarette smokers residing in LMICs. Interventions: Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel–Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI). Findings: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30–2.77, P < 0.001, I 2  = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18–11.29, P < 0.001, I 2  = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56–3.88, P < 0.001, I 2  = 0%). Conclusion: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

KW - Developing countries

KW - low- and middle-income countries

KW - meta-analysis

KW - smoking cessation

KW - systematic review

KW - tobacco use

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U2 - 10.1111/add.14518

DO - 10.1111/add.14518

M3 - Review article

VL - 114

SP - 620

EP - 635

JO - Addiction

JF - Addiction

SN - 0965-2140

IS - 4

ER -