A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups
Article first published online: 22 JUL 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 106, Issue 9, pages 1568–1585, September 2011
How to Cite
Bryant, J., Bonevski, B., Paul, C., McElduff, P. and Attia, J. (2011), A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups. Addiction, 106: 1568–1585. doi: 10.1111/j.1360-0443.2011.03467.x
- Issue published online: 5 AUG 2011
- Article first published online: 22 JUL 2011
- Accepted manuscript online: 14 APR 2011 03:31AM EST
- Submitted 20 June 2010; initial review completed 19 August 2010; final version accepted 6 April 2011
- Homeless persons;
- indigenous population;
- low income population;
- mentally ill;
- smoking cessation
Aims A systematic review and meta-analysis was conducted to assess the methodological quality and effectiveness of behavioural smoking cessation interventions targeted at six disadvantaged groups; the homeless, prisoners, indigenous populations, at-risk youth, individuals with low socio-economic status and individuals with a mental illness.
Methods Medline, EMBASE, the Cochrane Library and PsycInfo databases were searched using MeSH and keywords for studies conducted in developed countries prior to October 2010. Included studies were assessed for methodological quality. A DerSimonian and Laird random effects meta-analysis was conducted where possible to explore the effectiveness of interventions for the different subgroups. A narrative review was conducted for studies unable to be included in the meta-analysis. Outcomes examined were abstinence rates at short-term (up to 3 months) and long-term (6 months or the longest) follow-up.
Results Thirty-two relevant studies were identified. The majority (n = 20) were rated low in methodological quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at low-income female smokers at short-term follow-up [relative risk (RR) 1.68, confidence interval (CI) 1.21–2.33], and behavioural support interventions targeted at individuals with a mental illness at long-term follow-up (RR 1.35, CI 1.01–1.81). Results of the narrative review showed several promising interventions that increased cessation rates at 6-month or longer follow-up.
Conclusions Few well-controlled trials have examined the most effective smoking cessation strategies for highly disadvantaged groups, especially among the homeless, indigenous smokers and prisoners. The use of behavioural smoking cessation interventions for some socially disadvantaged groups appears promising; however, overall findings are inconsistent. Further research is needed to establish the most effective interventions for vulnerable high-risk groups. Special attention should be given to increasing sample size and power, and to sound evaluation methodology to overcome methodological limitations of conducting research with these high-risk groups.