Incentivizing university students to quit smoking: a randomized controlled trial of a contingency management intervention in a developing country

Prevalence of health risk behaviours related to non-communicable diseases amongst South African university students: a systematic review

BACKGROUND

Engagement in risk behaviours adopted during university continues after graduation, increasing the risk of non-communicable diseases (NCDs). This systematic review aimed to investigate the prevalence of NCD risk behaviours amongst South African university students.

METHODS

PubMed and Scopus databases were searched (January 1990-April 2022) for studies investigating alcohol consumption, cigarette smoking, inadequate consumption of fruits and vegetables and physical inactivity. Study qualities were assessed with the Joanna Briggs Institute critical appraisal and levels of evidence checklists. An overall prevalence percentage was obtained for each risk behaviour.

RESULTS

A total of 50 studies (n = 26 624 students) were included. A range of 44.8-75.0% of students consumed inadequate servings of fruits and vegetables. Just over 54% consumed alcohol (95% confidence intervals [95%CI]:54.0-55.5%). A significantly higher percentage of males (44.2%) than females (25.8%) drank heavily (P < 0.001). Approximately one-third (34.8%, 95%CI:33.4-36.3%) were sedentary and 39.0% (95%CI:37.5-40.4%) were insufficiently active. Almost one-fifth (17.9%, 95%CI:17.3-18.5%) smoked cigarettes, being significantly more prevalent amongst males (21.8%) than females (13.5%) (P < 0.001). A total of 10% smoked 1-10 cigarettes/day and 1.2% smoked >10 cigarettes/day.

CONCLUSION

High percentages of South African students eat inadequate servings of fruits and vegetables, consume alcohol are physically inactive and smoke cigarettes. South African universities should implement screening measures and health campaigns.

A Systematic Review of the Efficacy of Contingency Management for Substance Use Disorders in Low and Middle Income Countries

BACKGROUND

The impact of illicit substance use is especially devastating in low-resourced countries where factors such as poverty, unemployment, and inadequate services impede successful treatment. Contingency management (CM) is a treatment for substance use disorders that has shown to be effective in eliciting behaviour change. The efficacy of CM interventions in low and middle income countries (LMICs) has been under explored.

METHODS

The aim of this systematic review of randomized controlled trials was to assess measures of CM efficacy in addressing substance use disorders, while also considering contextual moderators of CM in LMICs. A search of PubMed, Scopus, and Cochrane library databases yielded 18 studies for inclusion, from which relevant data were extracted using modified versions of the Cochrane Characteristics of Studies tool.

RESULTS

Two studies were located in a low-income country, two in lower-middle income countries, and fourteen in upper middle-income countries. Overall, estimated efficacy estimates were similar to those from higher income countries. However, context-specific challenges that warrant further investigation included limited access to trained staff and structural and financial constraints.

CONCLUSIONS

While CM in LMICs is in its early stages of development, efficacy estimates were not substantially different compared to high income countries. Challenges such as costs, willingness to implement, and the stigma associated with addiction sets the stage for further research in these contexts.

A narrative systematic review of tobacco cessation interventions in Sub-Saharan Africa

AIM

In the face of increasing tobacco consumption in Sub-Saharan Africa, it is crucial to not only curb the uptake of tobacco, but to ensure that tobacco users quit. Considering the minimal attention that tobacco cessation interventions receive in Sub-Saharan Africa, this review aims to describe studies that evaluated tobacco cessation interventions in the region.

METHODS

A search of studies published till December 2019 that evaluated tobacco cessation interventions in Sub-Saharan Africa and examined tobacco quit rates was conducted in PubMed-Medline, Web of Science and Scopus. Study designs were not limited to randomised control trials but needed to include a control group.

RESULTS

Of the 454 titles and abstracts reviewed, eight studies, all conducted in South Africa, were included. The earliest publication was from 1988 and the most recent from 2019. Five studies were randomised control trials, two were quasi-experimental and one was a case-control study. Populations studied included community-based smokers (four studies) and university students, while the relevant clinic-based studies were conducted in pregnant women, tuberculosis patients and HIV-infected patients. Sample sizes were 23 in the case-control study, 87-561 in randomised control trials, and 979 (pregnant women) and 4090 (three rural communities) in the quasi-experimental studies. Four studies included nicotine replacement therapy in the interventions while four utilised only psychotherapy without adjunct pharmacotherapy. Quit rates were evaluated by exhaled carbon monoxide levels (five studies), blood carbon monoxide, urinary cotinine levels and self-reported quit rates. Four studies (two each with and without pharmacotherapy) reported significantly better outcomes in the intervention versus the control groups while one study findings (without pharmacotherapy) were significant in women but not men.

CONCLUSION

This review highlights that scant attention has been paid to tobacco cessation intervention in Sub-Saharan Africa. The heterogeneity of these studies precluded comparisons across interventions or populations. There is a need for evidence-based low-cost tobacco cessation intervention that target high-risk population in Sub-Saharan Africa.