Tobacco cessation interventions for young people
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 an 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 August 2009. This includes reports for trials identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsyclNFO.
Selection criteria
We included randomized controlled trials, cluster‐randomized controlled trials and other controlled trials recruiting young people, aged less than 20, who were regular tobacco smokers. We included any interventions; 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
Both authors independently assessed the eligibility of candidate trials and extracted data. Where meta‐analysis was appropriate we estimated pooled odds ratios using a Mantel‐Haenszel fixed effect method, based on the quit rates at longest follow up.
Main results
Twenty four trials involving over 5000 young people met our inclusion criteria (eleven cluster‐randomized controlled trials, eleven randomized controlled trials and two controlled trials). Many studies combined
components from various theoretical backgrounds to form complex interventions.The majority used some form of motivational enhancement combined with psychological support such as cognitive behavioural therapy (CBT) and some were tailored to stage of change using the transtheoretical model (TTM). Two trials based mainly on TTM interventions achieved moderate long‐term success, with a pooled odds ratio (OR) at one year of 1.70 (95% confidence interval (CI) 1.25 to 2.33). The eleven trials that included some form of motivational enhancement gave an estimated OR of 1.70 (95% CI 1.31 to 2.20). The six trials which included cognitive behavioural therapy did not individually achieve statistically significant results, but there was a marginally significant effect of pooling four studies using the Not on Tobacco programme (OR of 1.77, 95% CI 1.00 to 3.11) although 3 of the trials used abstinence for as little as 24 hours at six months as the cessation outcome. Neither of the small trials using NRT products detected statistically significant effects. A trial of bupropion alone, showed no significant effect for either a standard or lower dose.
Authors' conclusions
Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorporating elements sensitive to stage of change and using motivational enhancement and CBT. We await results of recent trials of Not on Tobacco trials and more data is needed on sustained quitting that allows for the episodic nature of much adolescent smoking. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. There is not yet sufficient evidence to recommend widespread implementation of any one model.
There continues to be a need for well‐designed adequately powered randomized controlled trials of interventions for this population of smokers.
PICOs
Plain language summary
Are there any smoking cessation programmes which can help adolescents to stop smoking
Worldwide, between 80,000 and 100,000 young people start smoking every day and up to one in four UK and American teenagers smoke. Many adolescent tobacco programmes focus on preventing teenagers from starting to smoke, but some programmes have been aimed at helping those teenagers already smoking to quit. We identified 24 good quality studies (>5000 participants) that researched ways of helping teenagers to quit. Programmes that combine a variety of approaches, including taking into account the young person's preparation for quitting, support behavioural change and enhance motivation show promise. The number of trials and participants are beginning to be adequate to provide evidence to judge effectiveness. Medications such as nicotine replacement and bupropion have not yet been shown to be successful with adolescents. Trials so far have had different definitions of quitting and many smaller trials did not have enough participants for us to be confident about wider application of the results. Some approaches may be worthy of consideration but there is still a need to provide better evidence before the likely success and costs of large scale service programmes can be estimated accurately.
