Effectiveness of stop smoking interventions among adults: an overview of systematic reviews

Abstract

Abstract Background: This review aims to identify evidence on the benefits and harms of varied smoking cessation interventions (i.e., pharmacotherapies, behavioural therapies, electronic cigarettes, and other therapies) among adults. Methods: We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the CADTH Health Technology Assessment Database for grey literature, where applicable. Searches were conducted on November 12, 2018, and updated on September 24, 2020. Two reviewers independently performed title-abstract and full-text screening according to pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e., 73% of included studies (n=22)), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another. Results: A total of twenty-two Cochrane systematic reviews were included. Pharmaceutical (i.e., inclusive of varenicline, cytisine, nicotine replacement therapy, bupropion) and behavioural interventions (i.e., physician advice, non-tailored print-based self-help materials, stage-based individual counselling, stage-based expert systems, individual counselling, and group therapy) showed to have effectively increased smoking cessation; whereas, data on interventions like mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John’s wort, S-Adenosyl-L-Methionine (SAMe), electronic cigarettes, interactive voice response systems, and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e., increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e., individual or group counselling self-help materials, internet interventions), combination therapies, or other therapies (i.e., laser therapy, electrostimulation, acupressure, St John’s wort, SAMe). For e-cigarettes, data on harms showed little to no difference in smoking cessation groups. Conclusion: This review suggests that pharmacological and behavioural interventions may help the general smoking population quit smoking; however, with some small or mild harms to consider following NRT or varenicline use. The evidence does not provide clarity regarding ideal intervention strategies, nor the long-term impact of these interventions for preventing smoking. Registration and protocol: The protocol for this overview was published [1], and the review was registered with PROSPERO (CRD42018099691).