Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 2015 (10), CD004306

Interventions for Smokeless Tobacco Use Cessation

Affiliations
Review

Interventions for Smokeless Tobacco Use Cessation

Jon O Ebbert et al. Cochrane Database Syst Rev.

Abstract

Background: Use of smokeless tobacco (ST) can lead to tobacco dependence and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease.

Objectives: To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use.

Search methods: We searched the Cochrane Tobacco Addiction Group specialised register in June 2015.

Selection criteria: Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow-up of at least six months.

Data collection and analysis: We used standard methodological procedures as expected by the Cochrane Collaboration. We summarised outcomes as risk ratios (RRs). For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method.

Main results: We identified 34 trials that met the inclusion criteria, of which nine were new for this update, representing over 16,000 participants. There was moderate quality evidence from two studies suggesting that varenicline increases ST abstinence rates (risk ratio [RR] 1.34, 95% confidence interval (CI) 1.08 to 1.68, 507 participants). Pooled results from two trials of bupropion did not detect a benefit of treatment at six months or longer (RR 0.89, 95% CI 0.54 to 1.44, 293 participants) but the confidence interval was wide. Neither nicotine patch (five trials, RR 1.13, 95% CI 0.93 to 1.37, 1083 participants) nor nicotine gum (two trials, RR 0.99, 95% CI 0.68 to 1.43, 310 participants) increased abstinence. Pooling five studies of nicotine lozenges did increase tobacco abstinence (RR 1.36, 95% CI 1.17 to 1.59, 1529 participants) but confidence in this estimate is low as the result is sensitive to the exclusion of three trials which did not use a placebo control.Statistical heterogeneity was evident among the 17 trials of behavioural interventions: eight of them reported statistically and clinically significant benefits; six suggested benefit but with wide CIs and no statistical significance; and three had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by study design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. In a post hoc subgroup analysis, trials of behavioural interventions incorporating telephone support, with or without oral examination and feedback, were associated with larger effect sizes, but oral examination and feedback alone were not associated with benefit.In one trial an interactive website increased abstinence more than a static website. One trial comparing immediate cessation using nicotine patch versus a reduction approach using either nicotine lozenge or brand switching showed greater success for the abrupt cessation group.

Authors' conclusions: Varenicline, nicotine lozenges and behavioural interventions may help ST users to quit. Confidence in results for nicotine lozenges is limited. Confidence in the size of effect from behavioural interventions is limited because the components of behavioural interventions that contribute to their impact are not clear.

Conflict of interest statement

JE has served as a principal investigator and co‐investigator on some of the studies included in this review. Data extraction and interpretation of these studies was checked by LS. JE has received support for research involving varenicline from Pfizer; none of that research was eligible for this review.

LS and ME have no conflicts of interest to declare.

Figures

1
1
Behavioural interventions: Abstinence from all tobacco use (where reported) at 6 months or more.
1.1
1.1
Comparison 1 Pharmacotherapy: Buproprion versus placebo, Outcome 1 All tobacco abstinence at longest follow‐up.
2.1
2.1
Comparison 2 Pharmocotherapy: NRT versus placebo/no placebo/control, Outcome 1 6 months or greater abstinence, strictest criteria.
3.1
3.1
Comparison 3 Pharmacotherapy: Varenicline versus placebo, Outcome 1 All tobacco abstinence at 6 months.
4.1
4.1
Comparison 4 Behavioural interventions, Outcome 1 Abstinence from all tobacco use (where reported) at 6 months or more.
4.2
4.2
Comparison 4 Behavioural interventions, Outcome 2 Subgroup analysis: Motivation.
4.3
4.3
Comparison 4 Behavioural interventions, Outcome 3 Subgroup analysis: Use of oral examination and feedback.
4.4
4.4
Comparison 4 Behavioural interventions, Outcome 4 Subgroup analysis: Use of telephone support.
4.5
4.5
Comparison 4 Behavioural interventions, Outcome 5 Subgroup analysis: Combined oral examination and telephone.
4.6
4.6
Comparison 4 Behavioural interventions, Outcome 6 Behavioural intervention +/‐ pharmacotherapy versus minimal contact. Long term cessation.
4.7
4.7
Comparison 4 Behavioural interventions, Outcome 7 Sensitivity analysis: Abstinence from smokeless tobacco use (where reported) at 6 months or more.
4.8
4.8
Comparison 4 Behavioural interventions, Outcome 8 Inverse variance sensitivity Abstinence from all tobacco use (where reported) at 6 months or more.
5.1
5.1
Comparison 5 Abrupt cessation versus gradual reduction (using NRT), Outcome 1 6 months or greater abstinence, strictest criteria.

Update of

  • Interventions for Smokeless Tobacco Use Cessation
    J Ebbert et al. Cochrane Database Syst Rev (2), CD004306. PMID 21328266. - Review
    Varenicline and behavioural interventions may help ST users to quit. Behavioural interventions incorporating telephone counselling or an oral examination are likely to in …

Similar articles

  • Interventions for Smokeless Tobacco Use Cessation
    J Ebbert et al. Cochrane Database Syst Rev (2), CD004306. PMID 21328266. - Review
    Varenicline and behavioural interventions may help ST users to quit. Behavioural interventions incorporating telephone counselling or an oral examination are likely to in …
  • Nicotine Receptor Partial Agonists for Smoking Cessation
    K Cahill et al. Cochrane Database Syst Rev (4), CD006103. PMID 22513936. - Review
    Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials. Varenicline at standard dose increased the chances of successfu …
  • Nicotine Receptor Partial Agonists for Smoking Cessation
    K Cahill et al. Cochrane Database Syst Rev 2016 (5), CD006103. PMID 27158893. - Review
    Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials. Varenicline at standard dose increased the chances of successfu …
  • Nicotine Receptor Partial Agonists for Smoking Cessation
    K Cahill et al. Cochrane Database Syst Rev (2), CD006103. PMID 21328282. - Review
    Varenicline at standard dose increased the chances of successful long-term smoking cessation between two- and threefold compared with pharmacologically unassisted quit at …
  • Nicotine Receptor Partial Agonists for Smoking Cessation
    K Cahill et al. Cochrane Database Syst Rev (12), CD006103. PMID 21154363. - Review
    Varenicline at standard dose increased the chances of successful long-term smoking cessation between two- and threefold compared with pharmacologically unassisted quit at …
See all similar articles

Cited by 9 PubMed Central articles

See all "Cited by" articles
Feedback