Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 11 (11), CD003289

Tobacco Cessation Interventions for Young People

Affiliations
Review

Tobacco Cessation Interventions for Young People

Thomas R Fanshawe et al. Cochrane Database Syst Rev.

Abstract

Background: Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

Objectives: To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

Selection criteria: We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

Data collection and analysis: Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

Main results: Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

Authors' conclusions: There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

Conflict of interest statement

TF declares no conflicts of interest.

WH declares no conflicts of interest.

NL is a co‐applicant on a completed trial investigating nicotine patch preloading for smoking cessation (not a harm reduction approach). The nicotine patches were provided free of charge by GlaxoSmithKline; however the trial was funded by the NIHR HTA (09/110/01), and the running and the reporting of the trial were carried out independently to the funder and treatment provider.

PA declares: PA is an author of one of the included studies.

JLB declares no conflicts of interest.

JHB declares no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 1 Individual counselling vs control.
Analysis 1.2
Analysis 1.2
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 2 Group counselling vs control.
Analysis 1.3
Analysis 1.3
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 3 Interventions using technology vs control.
Analysis 1.4
Analysis 1.4
Comparison 1 Behavioural interventions grouped by delivery method, Outcome 4 Interventions with multiple delivery methods vs control.
Analysis 2.1
Analysis 2.1
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 1 Stage of Change models vs control.
Analysis 2.2
Analysis 2.2
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 2 Motivational interviewing vs control.
Analysis 2.3
Analysis 2.3
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 3 Social cognitive theory vs control.
Analysis 2.4
Analysis 2.4
Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 4 Complex theoretical model with stage of change, motivational interviewing, cognitive behavioural therapy and/or social cognitive theory vs control.
Analysis 3.1
Analysis 3.1
Comparison 3 Pharmacological interventions, Outcome 1 Nicotine replacement therapy vs placebo.
Analysis 3.2
Analysis 3.2
Comparison 3 Pharmacological interventions, Outcome 2 Bupropion vs placebo.
Analysis 3.3
Analysis 3.3
Comparison 3 Pharmacological interventions, Outcome 3 Nicotine patch + bupropion vs nicotine patch + placebo.
Analysis 4.1
Analysis 4.1
Comparison 4 Project EX interventions, Outcome 1 Project EX vs control.

Update of

  • Tobacco Cessation Interventions for Young People
    A Stanton et al. Cochrane Database Syst Rev (8), CD003289. PMID 23975659. - Review
    Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorp …

Similar articles

  • Tobacco Cessation Interventions for Young People
    A Stanton et al. Cochrane Database Syst Rev (8), CD003289. PMID 23975659. - Review
    Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorp …
  • Tobacco Cessation Interventions for Young People
    GM Grimshaw et al. Cochrane Database Syst Rev (4), CD003289. PMID 17054164. - Review
    Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitiv …
  • Smoking Reduction Interventions for Smoking Cessation
    N Lindson et al. Cochrane Database Syst Rev 9 (9), CD013183. PMID 31565800.
    There is moderate-certainty evidence that neither reduction-to-quit nor abrupt quitting interventions result in superior long-term quit rates when compared with one anoth …
  • Interventions for Waterpipe Smoking Cessation
    W Maziak et al. Cochrane Database Syst Rev 2015 (7), CD005549. PMID 26228266. - Review
    Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area. The lack of s …
  • Interventions to Increase Adherence to Medications for Tobacco Dependence
    GJ Hollands et al. Cochrane Database Syst Rev 8 (8), CD009164. PMID 31425618.
    In people who are stopping smoking and receiving behavioural support, there is moderate-certainty evidence that enhanced behavioural support focusing on adherence to smok …
See all similar articles

Cited by 14 PubMed Central articles

See all "Cited by" articles

MeSH terms

Substances

Feedback