Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis.

IF 3 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Nicotine & Tobacco Research Pub Date : 2024-11-01 DOI:10.1093/ntr/ntae259

Abhijit Nadkarni, Leena Gaikwad, Miriam Sequeira, Pranay Javeri, Deepthy Benoy, Marimilha Grace Pacheco, Richard Velleman, Pratima Murthy, Felix Naughton

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Abstract

Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers including upper aero-digestive tract cancer, stomach cancer, ischaemic heart disease (IHD) and stroke; with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially.

Methods: We synthesised the effectiveness of behavioural interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioural intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at six months post-intervention follow up.

Results: For continuous abstinence at six months, the intervention was superior to active comparator (RR 2.32; 95% CI 1.78-3.02), and usual care (RR 4.39; 95% CI 2.38-8.11). For point prevalence abstinence at six months, the intervention was superior to active comparator (RR 1.76; 95% CI 1.28-2.44), and usual care (RR 2.37; 95% CI 1.47-3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons, except for 6-month continuous outcomes.

Conclusion: Implementation research is needed to understand factors for programme sustainability and equity of impact of behavioural interventions in reducing tobacco use in LMICs.

Implications: Our review is an important step towards the understanding of effectiveness of behaviour interventions for tobacco cessation suited for low- and middle-income countries and which are responsive to the contextual needs of such countries.

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中低收入国家的戒烟行为干预：系统回顾和元分析》。

导言：据估计，2019 年中低收入国家（LMICs）因吸烟造成的死亡人数占总死亡人数的 78%。此外，无烟烟草增加了全因死亡、包括上消化道癌在内的所有癌症、胃癌、缺血性心脏病（IHD）和中风的风险；东南亚地区承担了88%的死亡负担。由于烟草使用模式、与烟草使用相关的健康观念以及对特定健康风险的认识存在很大差异，因此高收入国家（HICs）的循证干预措施不易推广到低收入国家（LMICs）：方法：我们通过系统综述和荟萃分析，总结了低收入和中等收入国家戒烟行为干预的有效性。研究纳入了提供个人行为干预并评估戒烟情况的干预研究。我们对干预后 6 个月随访的干预效果进行了汇总：结果：就六个月的连续戒烟率而言，干预效果优于积极的比较者（RR 2.32；95% CI 1.78-3.02）和常规护理（RR 4.39；95% CI 2.38-8.11）。在六个月的点戒断率方面，干预优于积极的比较者（RR 1.76；95% CI 1.28-2.44）和常规护理（RR 2.37；95% CI 1.47-3.81）。所有比较的统计异质性都很大。只有六项研究的总体偏倚风险较低。除6个月连续结果外，所有比较均存在发表偏倚：需要开展实施研究，以了解在低收入和中等收入国家减少烟草使用的行为干预项目的可持续性和公平性：我们的综述是了解适合中低收入国家的戒烟行为干预措施有效性的重要一步，这些干预措施能满足这些国家的具体需求。

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来源期刊

Nicotine & Tobacco Research 医学-公共卫生、环境卫生与职业卫生

CiteScore

8.10

自引率

10.60%

发文量

268

审稿时长

3-8 weeks

期刊介绍： Nicotine & Tobacco Research is one of the world''s few peer-reviewed journals devoted exclusively to the study of nicotine and tobacco. It aims to provide a forum for empirical findings, critical reviews, and conceptual papers on the many aspects of nicotine and tobacco, including research from the biobehavioral, neurobiological, molecular biologic, epidemiological, prevention, and treatment arenas. Along with manuscripts from each of the areas mentioned above, the editors encourage submissions that are integrative in nature and that cross traditional disciplinary boundaries. The journal is sponsored by the Society for Research on Nicotine and Tobacco (SRNT). It publishes twelve times a year.