1
|
Leinberger-Jabari A, Golob MM, Lindson N, Hartmann-Boyce J. Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses. Addiction 2024; 119:629-648. [PMID: 38105395 DOI: 10.1111/add.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. METHOD We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. RESULTS We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. CONCLUSION Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.
Collapse
Affiliation(s)
- Andrea Leinberger-Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Melanie M Golob
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Nicola Lindson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, United States
| |
Collapse
|
2
|
Pahwa V, Pimple SA, Bhattacharjee A, Kuberkar D, Mishra GA, Chaturvedi P. Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2542-2551. [PMID: 38186806 PMCID: PMC10771179 DOI: 10.4103/jfmpc.jfmpc_1017_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/09/2024] Open
Abstract
Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58-1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64-2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55-2.11] and 1.96 [95% CI: 1.52-2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50-1.90] and 2.12 [95% CI: 1.49-3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.
Collapse
Affiliation(s)
- Vandita Pahwa
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Center, New Chandigarh, Punjab, India
| | - Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepali Kuberkar
- Department of Library Science, Digital Library, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head Neck Surgery, Deputy Director, Centre for Cancer Epidemiology (CCE), Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| |
Collapse
|
3
|
Alsaidi Y, AlMaskari B, Chan MF, Al Sumri S, Alhamrashdi H. Knowledge, Attitudes and Practices of Primary Care Physicians Regarding Tobacco Dependence Treatment in Muscat Governorate, Oman: A cross-sectional study. Sultan Qaboos Univ Med J 2021; 21:563-571. [PMID: 34888075 PMCID: PMC8631224 DOI: 10.18295/squmj.4.2021.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/30/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to assess the knowledge, attitudes and practices (KAPs) of primary care physicians (PCPs) regarding tobacco dependence treatment (TDT) and to identify barriers to TDT practice in Muscat, Oman. Methods This cross-sectional study was carried out from September 2019 to December 2019 at all 27 health centres in Muscat. All 313 PCPs working in these health centres were invited to participate. An adapted version of a previously validated 36-item questionnaire was used to assess KAPs regarding TDT services. Results A total of 255 PCPs completed the survey (response rate: 81.5%) and they demonstrated poor knowledge (40%) but positive attitudes (60%) about TDT services. Of these, the majority were female (85.9%), had never smoked (99.2%) and were general practitioners (64.3%). The mean age was 34.3 ± 6.3 years. Only 28.2% had previously received TDT training and less than half displayed accurate TDT-related knowledge, with undergraduate medical school representing the main source of such knowledge (58.8%). While 96.9% of the PCPs agreed on the importance of TDT, only 28.6% reported feeling sufficiently confident to provide such services themselves. Lack of training (83.5%) and time (71.4%) were the main barriers to TDT practice. Conclusion Overall, PCPs in Muscat demonstrated poor knowledge but positive attitudes with regard to TDT; however, further knowledge and training is required in order to ensure the effective and accurate provision of TDT services. These findings provide baseline data which may be of value for further research and in overcoming barriers to TDT practice in Oman; for instance, establishing cessation services as part of the package of care in primary health centres could address the time constraints barriers identified by the PCPs.
Collapse
Affiliation(s)
- Yaqoub Alsaidi
- Department of Family Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Buthaina AlMaskari
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat, Oman
| | - Sanaa Al Sumri
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat, Oman
| | | |
Collapse
|
4
|
Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, Chumo F, Cueto L, Niaura R, Zhang A. Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav 2021; 112:106612. [PMID: 33002679 DOI: 10.1016/j.addbeh.2020.106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The growing prevalence of tobacco use in low "to middle" income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. METHODS Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. RESULTS Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. CONCLUSIONS Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.
Collapse
|
5
|
Kumar N, Ainooson J, Billings A, Chen G, Cueto L, Janmohamed K, Jiang J, Niaura R, Zhang A. The scope of tobacco cessation randomized controlled trials in low- to middle-income countries: protocol for a scoping review. Syst Rev 2020; 9:86. [PMID: 32317003 PMCID: PMC7171801 DOI: 10.1186/s13643-020-01361-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tobacco consumption is the leading cause of preventable death globally. The global mortality burden of tobacco use lies predominantly in low- to middle-income countries (LMICs). There is much evidence on the effectiveness of tobacco cessation RCTs in high-income nations. However, the evidence base in LMICs is far more limited. To effectively design randomized controlled trials (RCTs) that mitigate tobacco-related harms in LMICs, further understanding of RCTs in this environment will be helpful. We will provide quality evidence regarding the scope of tobacco cessation RCTs in LMICs. METHODS A scoping review of tobacco cessation RCTs will be conducted. MEDLINE, Embase, PsycINFO, Global Health, Web of Science and Sociological Abstracts will be searched to capture current literature. We will review RCTs that have already been done on tobacco cessation in the LMICs. The key outcome will be tobacco cessation in adults. Examples of the key outcome include smoking abstinence and reduction of tobacco use. Study selection will conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and study quality assessed with a modified version of the Cochrane Collaboration's instrument. DISCUSSION As researchers attempt to minimize the harms from tobacco in LMICs, they need to be aware of scientific evidence to develop RCTs to achieve their aim. The review will complement the evidence base on tobacco cessation in LMICs.
Collapse
Affiliation(s)
- Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA.
| | - Jessica Ainooson
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Ameera Billings
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Grace Chen
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Lauren Cueto
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Kamila Janmohamed
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Jeannette Jiang
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| | - Raymond Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY, USA.,Department of Epidemiology, College of Global Public Health, New York University, 715 Broadway, New York, NY, USA
| | - Amy Zhang
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT, USA
| |
Collapse
|