The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis

被引:43
作者
Akanbi, Maxwell Oluwole [1 ,2 ]
Carroll, Allison Jane [3 ]
Achenbach, Chad [2 ,4 ]
O'Dwyer, Linda Catherine [5 ]
Jordan, Neil [1 ,6 ]
Hitsman, Brian [3 ]
Bilaver, Lucy Ann [1 ]
McHugh, Megan Colleen [1 ]
Murphy, Robert [2 ,4 ]
机构
[1] Northwestern Univ, Hlth Sci Integrated PhD Program, Ctr Educ Hlth Sci, Inst Publ Hlth & Med,Feinberg Sch Med, Chicago, IL 60611 USA
[2] Northwestern Univ, Ctr Global Hlth, Chicago, IL 60611 USA
[3] Northwestern Univ, Dept Prevent Med, Feinberg Sch Med, Chicago, IL 60611 USA
[4] Northwestern Univ, Dept Infect Dis, Feinberg Sch Med, Chicago, IL 60611 USA
[5] Northwestern Univ, Galter Hlth Sci Lib & Learning Ctr, Feinberg Sch Med, Chicago, IL 60611 USA
[6] Hines VA Hosp, Hines, IL USA
关键词
Developing countries; low- and middle-income countries; meta-analysis; smoking cessation; systematic review; tobacco use; RANDOMIZED CONTROLLED-TRIAL; COST-EFFECTIVENESS ANALYSIS; TOBACCO CESSATION; PRIMARY-CARE; HEALTH-CARE; VARENICLINE; NICOTINE; SMOKERS; DEPENDENCE; REDUCTION;
D O I
10.1111/add.14518
中图分类号
R194 [卫生标准、卫生检查、医药管理];
学科分类号
摘要
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.
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收藏
页码:620 / 635
页数:16
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