Effects of interventions to combat tobacco addiction: Cochrane update of 2019 and 2020 reviews

Abstract

Aims To summarize evidence on tobacco addiction interventions published by the Cochrane Tobacco Addiction Group (CTAG) from 2019 to 2020. Methods Narrative summary of all new and updated Cochrane Reviews published by CTAG in 2019 and 2020, outlining key results and promising avenues for future research. Results CTAG published six new reviews and updated 15 reviews. There is high‐certainty evidence that combining fast‐acting nicotine replacement therapy (NRT) with transdermal patches helped more people to quit than single‐form NRT [risk ratio (RR) = 1.25, 95% confidence interval (CI) = 1.15–1.36, 14 studies, n = 11 356; I2 = 4%] and moderate‐certainty evidence that using NRT before quitting can increase quit rates more than using NRT from quit day onwards (RR = 1.25, 95% CI = 1.08–1.44, nine studies, n = 4395; I2 = 0%). Reducing smoking in order to quit completely results in similar quit rates to abrupt quitting (RR = 1.01, 95% CI= 0.87–1.17; I2 = 29%; 22 studies, n = 9219; moderate‐certainty). Electronic cigarettes may help more people quit than NRT (RR = 1.53, 95% CI = 1.21–1.93; I2 = 0%; four studies, n = 1924; moderate certainty), nicotine‐free electronic cigarettes (RR = 1.94, 95% CI = 1.21–3.13; I2 = 0%; five studies, n = 1447; moderate‐certainty) and behavioural/no support (RR = 2.61, 95% CI = 1.44–4.74; I2 = 0%; six studies, n = 2886; very low‐certainty). Varenicline may help prevent relapse in abstainers (RR = 1.23, 95% CI = 1.08–1.41; I2 = 82%; 11 studies, n = 1297; moderate‐certainty), but behavioural support did not prevent relapse (RR = 0.98, 95% CI = 0.87–1.11; I2 = 52%; 11 studies, n = 5523; moderate‐certainty). Financial incentives increased quit rates in the general population (RR = 1.49, 95% CI = 1.28–1.73; I2 = 33%; 30 studies, adjusted n = 20 097; high‐certainty) and during pregnancy (RR = 2.38, 95% CI = 1.54–3.69; I2 = 41%; nine studies, n = 2273; moderate‐certainty). This overview also provides detail on a wider range of interventions. Conclusions There is high certainty that using nicotine replacement therapy from quit day increases smoking abstinence and no further research is required. Evidence is less certain that nicotine replacement increases abstinence when used in higher doses tailored to particular groups of smokers or use prior to quit day, and further research would be helpful. There is moderate‐certainty evidence to support the use of e‐cigarettes as cessation aids, but research on their role in preventing relapse would be particularly helpful.

Depressive and Anxiety Symptoms During Chemotherapy for Breast Cancer and the Potential Impact of Pre‐Treatment Health Behaviors

“…For example, psycho‐oncology providers may consider explicitly incorporating behavioral support for smoking cessation into psychotherapy and to address feelings of shame and guilt that might arise for patients who perceive that smoking may have caused their cancer [37]. Psychiatric medication management providers could consider the dual benefit that certain psychotropics may have for mental health and smoking cessation (e.g., bupropion, nortriptyline) when selecting optimal agents analogous to how providers may utilize duloxetine for patients with comorbid depression and pain [44]. Beyond confirming the associations observed in our study, future research could explore the potential efficacy of emerging smoking cessation interventions, such as mobile‐phone interventions, financial incentives, and electronic cigarettes [44], in cancer and unique considerations for patients with smoking‐related cancers, as well as the impact of smoking cessation interventions on downstream mental health symptoms.…”

Depressive and Anxiety Symptoms During Chemotherapy for Breast Cancer and the Potential Impact of Pre‐Treatment Health Behaviors

“…For example, psycho‐oncology providers may consider explicitly incorporating behavioral support for smoking cessation into psychotherapy and to address feelings of shame and guilt that might arise for patients who perceive that smoking may have caused their cancer [37]. Psychiatric medication management providers could consider the dual benefit that certain psychotropics may have for mental health and smoking cessation (e.g., bupropion, nortriptyline) when selecting optimal agents analogous to how providers may utilize duloxetine for patients with comorbid depression and pain [44]. Beyond confirming the associations observed in our study, future research could explore the potential efficacy of emerging smoking cessation interventions, such as mobile‐phone interventions, financial incentives, and electronic cigarettes [44], in cancer and unique considerations for patients with smoking‐related cancers, as well as the impact of smoking cessation interventions on downstream mental health symptoms.…”

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

“…Ultimately, in Chile, the situation for smokers could be improved by adopting a comprehensive national-level strategy for quitting. Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty 49–52. It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals’ time for counselling outside regular follow-up visits 48.…”

“…Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty. [49][50][51][52] It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals' time for counselling outside regular follow-up visits. 48 Additionally, other measures already put forth in Chile have the potential to tackle tobacco cessation, like the reinforcement of advertising bans.…”

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…Of note, despite it being established that a combination of behavioural support combined with pharmacotherapy is likely to be the most effective modality for smoking cessation in general, [48][49][50] many of the studies included in the review chose a less intensive approach. This may be attributed to the country the study was conducted in, in the USA pharmacotherapy prescriptions will likely have to be sourced via an individual's health insurance plan.…”

Depressive and Anxiety Symptoms During Chemotherapy for Breast Cancer and the Potential Impact of Pre‐Treatment Health Behaviors

“…For example, psycho‐oncology providers may consider explicitly incorporating behavioral support for smoking cessation into psychotherapy and to address feelings of shame and guilt that might arise for patients who perceive that smoking may have caused their cancer [37]. Psychiatric medication management providers could consider the dual benefit that certain psychotropics may have for mental health and smoking cessation (e.g., bupropion, nortriptyline) when selecting optimal agents analogous to how providers may utilize duloxetine for patients with comorbid depression and pain [44]. Beyond confirming the associations observed in our study, future research could explore the potential efficacy of emerging smoking cessation interventions, such as mobile‐phone interventions, financial incentives, and electronic cigarettes [44], in cancer and unique considerations for patients with smoking‐related cancers, as well as the impact of smoking cessation interventions on downstream mental health symptoms.…”

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

“…Ultimately, in Chile, the situation for smokers could be improved by adopting a comprehensive national-level strategy for quitting. Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty 49–52. It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals’ time for counselling outside regular follow-up visits 48.…”

“…Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty. [49][50][51][52] It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals' time for counselling outside regular follow-up visits. 48 Additionally, other measures already put forth in Chile have the potential to tackle tobacco cessation, like the reinforcement of advertising bans.…”

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…Of note, despite it being established that a combination of behavioural support combined with pharmacotherapy is likely to be the most effective modality for smoking cessation in general, [48][49][50] many of the studies included in the review chose a less intensive approach. This may be attributed to the country the study was conducted in, in the USA pharmacotherapy prescriptions will likely have to be sourced via an individual's health insurance plan.…”

Depressive and Anxiety Symptoms During Chemotherapy for Breast Cancer and the Potential Impact of Pre‐Treatment Health Behaviors

“…For example, psycho‐oncology providers may consider explicitly incorporating behavioral support for smoking cessation into psychotherapy and to address feelings of shame and guilt that might arise for patients who perceive that smoking may have caused their cancer [37]. Psychiatric medication management providers could consider the dual benefit that certain psychotropics may have for mental health and smoking cessation (e.g., bupropion, nortriptyline) when selecting optimal agents analogous to how providers may utilize duloxetine for patients with comorbid depression and pain [44]. Beyond confirming the associations observed in our study, future research could explore the potential efficacy of emerging smoking cessation interventions, such as mobile‐phone interventions, financial incentives, and electronic cigarettes [44], in cancer and unique considerations for patients with smoking‐related cancers, as well as the impact of smoking cessation interventions on downstream mental health symptoms.…”

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

“…Ultimately, in Chile, the situation for smokers could be improved by adopting a comprehensive national-level strategy for quitting. Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty 49–52. It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals’ time for counselling outside regular follow-up visits 48.…”

“…Current evidence points to counselling, guaranteed financial incentives and nicotine replacement therapies as the interventions with the highest level of certainty. [49][50][51][52] It is important to note that such interventions should be accompanied by efforts to enhance delivery capacity in the health system, such as ensuring the availability of technology and professionals' time for counselling outside regular follow-up visits. 48 Additionally, other measures already put forth in Chile have the potential to tackle tobacco cessation, like the reinforcement of advertising bans.…”

Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis

“…Of note, despite it being established that a combination of behavioural support combined with pharmacotherapy is likely to be the most effective modality for smoking cessation in general, [48][49][50] many of the studies included in the review chose a less intensive approach. This may be attributed to the country the study was conducted in, in the USA pharmacotherapy prescriptions will likely have to be sourced via an individual's health insurance plan.…”