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Study flow diagram
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Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Behavioural interventions grouped by delivery method, Outcome 1 Individual counselling vs control.
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Analysis 1.1

Comparison 1 Behavioural interventions grouped by delivery method, Outcome 1 Individual counselling vs control.

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Comparison 1 Behavioural interventions grouped by delivery method, Outcome 2 Group counselling vs control.
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Analysis 1.2

Comparison 1 Behavioural interventions grouped by delivery method, Outcome 2 Group counselling vs control.

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Comparison 1 Behavioural interventions grouped by delivery method, Outcome 3 Interventions using technology vs control.
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Analysis 1.3

Comparison 1 Behavioural interventions grouped by delivery method, Outcome 3 Interventions using technology vs control.

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Comparison 1 Behavioural interventions grouped by delivery method, Outcome 4 Interventions with multiple delivery methods vs control.
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Analysis 1.4

Comparison 1 Behavioural interventions grouped by delivery method, Outcome 4 Interventions with multiple delivery methods vs control.

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Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 1 Stage of Change models vs control.
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Analysis 2.1

Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 1 Stage of Change models vs control.

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Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 2 Motivational interviewing vs control.
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Analysis 2.2

Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 2 Motivational interviewing vs control.

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Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 3 Social cognitive theory vs control.
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Analysis 2.3

Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 3 Social cognitive theory vs control.

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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.
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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.

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Comparison 3 Pharmacological interventions, Outcome 1 Nicotine replacement therapy vs placebo.
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Analysis 3.1

Comparison 3 Pharmacological interventions, Outcome 1 Nicotine replacement therapy vs placebo.

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Comparison 3 Pharmacological interventions, Outcome 2 Bupropion vs placebo.
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Analysis 3.2

Comparison 3 Pharmacological interventions, Outcome 2 Bupropion vs placebo.

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Comparison 3 Pharmacological interventions, Outcome 3 Nicotine patch + bupropion vs nicotine patch + placebo.
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Analysis 3.3

Comparison 3 Pharmacological interventions, Outcome 3 Nicotine patch + bupropion vs nicotine patch + placebo.

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Comparison 4 Project EX interventions, Outcome 1 Project EX vs control.
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Analysis 4.1

Comparison 4 Project EX interventions, Outcome 1 Project EX vs control.

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Summary of findings for the main comparison. Behavioural interventions compared to minimal control for smoking cessation in young people

Behavioural interventions compared to minimal control for smoking cessation in young people

Patient or population: young people
Setting: community, school and healthcare settings
Intervention: behavioural interventions
Comparison: minimal control

Comparisons and outcomes1

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with minimal control

Risk with behavioural interventions

Individual counselling (in‐person) vs control
Smoking cessation assessed with: biochemical validation and self‐report
Follow‐up: range 6 months to 12 months

Study population

RR 1.07
(0.83 to 1.39)

2088
(7 RCTs)

⊕⊕⊝⊝
Low2,3

Control risk based on rates in included studies

90 per 1000

97 per 1000
(75 to 126)

Group counselling vs control
Smoking cessation assessed with: biochemical validation and self‐report
Follow‐up: range 6 months to 12 months

Study population

RR 1.35
(1.03 to 1.77)

1910
(9 RCTs)

⊕⊕⊝⊝
Low3,4

Control risk based on rates in included studies

142 per 1000

191 per 1000
(146 to 251)

Computer‐based interventions vs control
Smoking cessation assessed with: biochemical validation and self‐report
Follow‐up: range 6 months to 12 months

Study population

RR 0.79
(0.50 to 1.24)

340
(3 RCTs)

⊕⊕⊝⊝
Low4,5

Control risk based on rates in included studies

191 per 1000

151 per 1000
(96 to 237)

Text messaging‐based interventions vs control
Smoking cessation assessed with: self‐report
Follow up: range 6 months to 12 months

Study population

RR 1.18
(0.90 to 1.56)

2985
(3 RCTs)

⊕⊕⊝⊝
Low4,5

Some interventions also included access to intervention website. Control risk based on rates in included studies

57 per 1000

67 per 1000
(51 to 89)

Interventions with multiple delivery methods vs control

Smoking cessation assessed with: biochemical validation and self‐report

Follow‐up: 6 months to 14 months

Study population

RR 1.26
(0.95 to 1.66)

2755
(8 RCTs)

⊕⊝⊝⊝
Very low3,4,5

This represents a diverse set of delivery modes; all interventions included self‐help materials alongside other, more intensive delivery modes. Control risk based on rates in included studies

59 per 1000

74 per 1000
(56 to 98)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Adverse events not included as not assessed for behavioural interventions.
2Downgraded one level due to risk of bias: all but one study at high or unclear risk of bias.
3Downgraded one level due to inconsistency: interventions were clinically heterogeneous.
4Downgraded one level due to risk of bias: all studies at high or unclear risk of bias.
5Downgraded one level due to imprecision: confidence intervals are consistent with no effect and clinically significant effect.

Figuras y tablas -
Summary of findings for the main comparison. Behavioural interventions compared to minimal control for smoking cessation in young people
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Summary of findings 2. Pharmacological interventions compared to placebo for smoking cessation in young people

Pharmacological interventions compared to placebo for smoking cessation in young people

Patient or population: young people
Setting: schools, community
Intervention: pharmacological interventions
Comparison: placebo

Comparisons and outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with placebo

Risk with pharmacological interventions

NRT vs placebo
Smoking cessation assessed with: biochemical verification
Follow‐up: range 6 months to 12 months

Study population

RR 1.11
(0.48 to 2.58)

385
(2 RCTs)

⊕⊝⊝⊝
Very low1,2

Both studies included single forms of NRT (patch or gum). No evidence of significant subgroup differences based on NRT type. Control risk based on rates in included studies

59 per 1000

66 per 1000
(28 to 153)

NRT vs placebo
Adverse events

assessed with: participant report
Follow‐up: range 6 months to 12 months

No serious adverse events reported. NRT associated with increase in some mild adverse events: sore throat; hiccups; erythema; pruritus; shoulder/arm pain; headache; cough; abnormal dreams; and muscle pain. In the patch studies, successful quitters in NRT group reported a lower level of insomnia than those in the control group.

385
(2 RCTs)

⊕⊝⊝⊝
Very low1,2

Both studies included single forms of NRT (patch or gum)

Bupropion vs placebo
Smoking cessation assessed with: biochemical validation
Follow‐up: 26 weeks

Study population

RR 1.49
(0.55 to 4.02)

207
(1 RCT)

⊕⊝⊝⊝
Very low1,3

Control risk based on rates in included studies

58 per 1000

87 per 1000
(32 to 234)

Bupropion vs placebo
Adverse events assessed with: participant report
Follow‐up: 26 weeks

2 serious adverse events resulting in hospitalization among intervention participants: anticholinergic crisis after ingesting Datura innoxia; intentional overdose on study medication and other substances. High level of mild adverse events reported in both groups (headache, cough, throat symptoms, sleep disturbance and nausea each reported by more than 10% of participants). 8 participants discontinued bupropion because of adverse events.

207
(1 RCT)

⊕⊝⊝⊝
Very low1,3

Nicotine patch + bupropion vs nicotine patch + placebo
Smoking cessation assessed with: biochemical validation
Follow‐up: 6 months

Study population

RR 1.05
(0.41 to 2.69)

211
(1 RCT)

⊕⊝⊝⊝
Very low1,3

Control risk based on rates in included studies

74 per 1000

78 per 1000
(30 to 199)

Nicotine patch + bupropion vs nicotine patch + placebo
Adverse events assessed with: participant report
Follow‐up: 6 months

No serious adverse events reported. Nausea most commonly reported adverse event.

211
(1 RCT)

⊕⊝⊝⊝
Very low1,3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; NRT: nicotine replacement therapy; RR: risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Downgraded two levels due to serious imprecision: small number of events (< 300 overall), confidence intervals are consistent with no effect and a clinically significant effect.
2Downgraded one level due to risk of bias: both studies at unclear risk of bias in at least one domain.
3Downgraded one level due to risk of bias: study at unclear risk of bias.

Figuras y tablas -
Summary of findings 2. Pharmacological interventions compared to placebo for smoking cessation in young people
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Comparison 1. Behavioural interventions grouped by delivery method

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Individual counselling vs control Show forest plot

7

2088

Risk Ratio (Fixed, 95% CI)

1.07 [0.83, 1.39]

2 Group counselling vs control Show forest plot

9

1910

Risk Ratio (Fixed, 95% CI)

1.35 [1.03, 1.77]

3 Interventions using technology vs control Show forest plot

9

Risk Ratio (Fixed, 95% CI)

Subtotals only

3.1 Computer‐based interventions

3

340

Risk Ratio (Fixed, 95% CI)

0.79 [0.50, 1.24]

3.2 Interventions using messaging

3

2985

Risk Ratio (Fixed, 95% CI)

1.18 [0.90, 1.56]

3.3 Computer‐based and face‐to‐face counselling interventions

3

1703

Risk Ratio (Fixed, 95% CI)

1.18 [0.96, 1.46]

4 Interventions with multiple delivery methods vs control Show forest plot

8

2755

Risk Ratio (Fixed, 95% CI)

1.26 [0.95, 1.66]
Figuras y tablas -
Comparison 1. Behavioural interventions grouped by delivery method
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Comparison 2. Comparison of theoretical basis of behavioural interventions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Stage of Change models vs control Show forest plot

6

3282

Risk Ratio (Fixed, 95% CI)

1.06 [0.85, 1.31]

2 Motivational interviewing vs control Show forest plot

10

1752

Risk Ratio (Fixed, 95% CI)

1.11 [0.90, 1.36]

3 Social cognitive theory vs control Show forest plot

6

3667

Risk Ratio (Fixed, 95% CI)

1.16 [0.88, 1.51]

4 Complex theoretical model with stage of change, motivational interviewing, cognitive behavioural therapy and/or social cognitive theory vs control Show forest plot

9

2827

Risk Ratio (Fixed, 95% CI)

1.40 [1.14, 1.74]
Figuras y tablas -
Comparison 2. Comparison of theoretical basis of behavioural interventions
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Comparison 3. Pharmacological interventions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Nicotine replacement therapy vs placebo Show forest plot

2

385

Risk Ratio (IV, Fixed, 95% CI)

1.11 [0.48, 2.58]

1.1 Nicotine patch vs placebo

2

319

Risk Ratio (IV, Fixed, 95% CI)

1.02 [0.41, 2.56]

1.2 Nicotine gum vs placebo

1

66

Risk Ratio (IV, Fixed, 95% CI)

1.74 [0.21, 14.60]

2 Bupropion vs placebo Show forest plot

1

Risk Ratio (IV, Fixed, 95% CI)

Totals not selected

3 Nicotine patch + bupropion vs nicotine patch + placebo Show forest plot

1

Risk Ratio (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 3. Pharmacological interventions
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Comparison 4. Project EX interventions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Project EX vs control Show forest plot

4

1215

Risk Ratio (Fixed, 95% CI)

1.48 [1.05, 2.10]
Figuras y tablas -
Comparison 4. Project EX interventions
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