Reducing Smoking Among Indigenous Populations: New Evidence From a Review of Trials

Johnston, Vanessa; Westphal, Darren W; Glover, Marewa; Thomas, D.; Segan, Catherine; Walker, Natalie

doi:10.1093/ntr/ntt022

Cited by 21 publications

(43 citation statements)

References 19 publications

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“…The remaining four studies also referred to evidence among general populations and/or included studies which compared outcomes between Indigenous and non-Indigenous people [21–24]. Specific sub-groups of populations that were reported as the focus of the reviews included pregnant women ( n = 2) [25, 26], adolescents ( n = 2) [27, 28], school students ( n = 1) [28] and Aboriginal Health Workers ( n = 1) [29].…”

Section: Resultsmentioning

confidence: 99%

“…Three reviews assessed the effect of culturally tailored interventions [21, 36, 37], and one review looked for evidence of Indigenous knowledge to support smoking cessation [38]. Two reviews included all tobacco control interventions to reduce smoking among Indigenous adolescents [27] and among Indigenous pregnant women [26].…”

Section: Resultsmentioning

confidence: 99%

“…Only two reviews included meta-analysis [34, 36], one reported effect estimates of single studies [27], two reported statements of statistical significance [21, 32] and the remainder reported mainly qualitative statements, such as ‘increase’, or ‘no difference’ to describe smoking cessation outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of reviewers findings highlighted the importance of tobacco control in improving Indigenous health and recommended multifaceted interventions [18–20, 25, 32, 33, 36] or ‘multi-component policies’ [18, 19, 32, 33] which included Indigenous leadership/partnership/engagement [18–20, 22, 30, 32, 36] and cultural tailoring [25, 29, 32, 33, 36, 37] when appropriate [21]. Several reviews cited as evidence an evaluation of ‘multi-component tobacco control activities’ in six Australian communities in the Northern Territory, which showed a decrease in tobacco consumption in Indigenous communities [18], but the differences were not statistically significant and there was high variation.…”

Section: Resultsmentioning

confidence: 99%

“…effect (8 studies)Knowledge: Mostly positive impact (8 studies)Engagement: Increased community interestIncreasing priority and readiness to tackle high rates of commercial tobacco use employing comprehensive (multiple activities, centring of Aboriginal leadership, long-term community investments) and tailored interventions (provision of culturally appropriate health materials and activities).Carson 2014 [33](Up to 15 Aug 2014)Low‘Smoking cessation and tobacco prevention in Indigenous populations’AllAny91Randomised controlled trials [10], controlled clinical trials [5], pre-post studies [10], government reports [53], and protocols [4]Mainly qualitative statementsSmoking cessation:Reduced smoking levels at follow-up in 12/15 controlled trials.Prevention of initiation:Results for youth not clear (9 studies).Recommend multifaceted programmes that concurrently address behavioural, psychological and biochemical sides of addiction, using culturally tailored resources for individual Indigenous population needs. Interventions with more components, and greater intensity, were more likely to be effective than those of shorter duration and lower intensity.Johnston 2013 [21]1980 to May 2012Moderate‘Reducing smoking among indigenous populations: new evidence from a review of trials’AllAny (if reporting Indigenous and non-Indigenous outcomes to assess effect of cultural tailoring)5Randomised controlled trials and cluster RCT’s [5]Mainly statements about statistical significanceSmoking cessation: No sig. effect for either Indigenous or non-Indigenous participants in 3/5 studies.No significant difference between Indigenous and non-Indigenous populations for smoking cessation and suggest not all tobacco control interventions can/need to be culturally adapted.…”

Section: Methodsmentioning

confidence: 99%

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Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

et al. 2017

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BackgroundTobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014–15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities.MethodsMEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement.ResultsTwenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or ‘pubs, clubs and restaurants’.ConclusionsThere is limited Indigenous-specific evidence for most tobacco interventions. A ‘comprehensive approach’ incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0520-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

et al. 2017

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Interventions for Tobacco Cessation in Adults, Including Pregnant Persons

Patnode

Henderson

Coppola

et al. 2021

JAMA

142

132

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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.

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Psychosocial interventions for supporting women to stop smoking in pregnancy

Chamberlain

O’Mara-Eves

Oliver

et al. 2013

Cochrane Database of Systematic Reviews

223

232

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Background Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. Objectives To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. Search methods In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. Selection criteria Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. Data collection and analysis Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. Main results Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy. In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small. Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11). Feedback interventions demonstrated a significa...

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Reducing Smoking Among Indigenous Populations: New Evidence From a Review of Trials

Cited by 21 publications

References 19 publications

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

Interventions for Tobacco Cessation in Adults, Including Pregnant Persons

Psychosocial interventions for supporting women to stop smoking in pregnancy

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