Interventions for Tobacco Cessation in Adults, Including Pregnant Persons

Abstract

ImportanceIt has been estimated that in 2018 nearly 20% of adults in the US were currently using a tobacco product.ObjectiveTo systematically review the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation among adults, including pregnant persons, to inform the US Preventive Services Task Force.Data SourcesPubMed, PsycInfo, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination of Health Technology Assessment; surveillance through September 25, 2020.Study SelectionSystematic reviews of tobacco cessation interventions and randomized clinical trials that evaluated the effects of electronic cigarettes (e-cigarettes) or pharmacotherapy among pregnant persons.Data Extraction and SynthesisIndependent critical appraisal and data abstraction; qualitative synthesis and random-effects meta-analyses.Main Outcomes and MeasuresHealth outcomes, tobacco cessation at 6 months or more, and adverse events.ResultsSixty-seven reviews addressing pharmacotherapy and behavioral interventions were included as well as 9 trials (N = 3942) addressing e-cigarettes for smoking cessation and 7 trials (N = 2285) of nicotine replacement therapy (NRT) use in pregnancy. Combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83 [95% CI, 1.68-1.98]), NRT (RR, 1.55 [95% CI, 1.49-1.61]), bupropion (RR, 1.64 [95% CI, 1.52-1.77]), varenicline (RR, 2.24 [95% CI, 2.06-2.43]), and behavioral interventions such as advice from clinicians (RR, 1.76 [95% CI, 1.58-1.96]) were all associated with increased quit rates compared with minimal support or placebo at 6 months or longer. None of the drugs were associated with serious adverse events. Five trials (n = 3117) reported inconsistent findings on the effectiveness of electronic cigarettes on smoking cessation at 6 to 12 months among smokers when compared with placebo or NRT, and none suggested higher rates of serious adverse events. Among pregnant persons, behavioral interventions were associated with greater smoking cessation during late pregnancy (RR, 1.35 [95% CI, 1.23-1.48]), compared with no intervention. Rates of validated cessation among pregnant women allocated to NRT compared with placebo were not significantly different (pooled RR, 1.11 [95% CI, 0.79-1.56], n = 2033).Conclusions and RelevanceThere is strong evidence that a range of pharmacologic and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in nonpregnant adults. In pregnancy, behavioral interventions are effective for smoking cessation, but data are limited on the use of pharmacotherapy for smoking cessation. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are also limited and results are inconsistent.

The impact of a regional smoking cessation program on referrals and use of Quitline services in Queensland, Australia: a controlled interrupted time series analysis

“…[7] Hence, people living in CQ have access to an evidence-based free smoking cessation intervention that provides combined pharmacological and behavioural support. [10] , [11] , [12] , [13] However, under-use of the Quitline service limits the impact of this program. For example, fewer than 2% of Australians who smoke used a Quitline service in 2019.…”

Smoking Cessation Apps: A Systematic Review of Format, Outcomes, and Features

“…Regarding before-and-after studies, the abstinence rates obtained ranged between 12.5 and 51.5%. Despite these abstinence outcomes being lower than those obtained in conventional psychological and pharmacological interventions [ 56 ], the possibility of increasing treatment access to a wider population of smokers makes them promising tools in terms of public health impact. Additionally, results from studies measuring CPD suggest that smoking cessation apps are also as effective as control groups (e.g., print-based self-help materials, other mobile apps) in reducing cigarette use.…”

Special Issue on the Effects of Prenatal Smoking/Nicotine Exposure on the Child’s Health

“…Many pregnant smokers and health care professionals believe that using ANDS is safer than cigarettes. However, the US Preventive Services Task Force identified no studies that addressed the benefits or harms of ANDS to help pregnant women quit smoking [10] and to the best of our knowledge there is no report on the postnatal effects of ANDS used during pregnancy on the child's health.…”