{"text_format":"1","workbook":"xlsx","n_sheets":37,"sheets":["Cessation-Self Help","Cover","Evidence map","FULL MAP","Cessation","Cessation-Pharma&Guidance","Cessation-Bupropion","Cessation-Varenicline","Cessation-NRT","Cessation-ENDS","Cessation-OtherPharma","Cessation-Psycho&Guidance","Cessation-CBT","Cessation-BehSupport","Cessation-MI","Cessation-OtherPsycho","Cessation-Univer","Cessation-Multicomp","Prevention","Prevention-Pharma","Prevention-Psycho","Prevention-Univer","Prevention-MultiComp","Denormalisation","Denorm-Pharma","Denorm-Psycho","Denorm-Univer","Denorm-MultiComp","Adults","Adolescents","Pregnant & Postpartum women","Pre-existing health condition","Primary Care","Secondary & Tertiary Care","Educational institutes","Workplace","Sheet1"],"not_rendered":{"charts":0,"images":1,"macros":1,"external_links":0,"defined_names":0,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

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[null,"SYSTEMATIC REVIEWS - Self-help materials"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Moyo, F et al. Effectiveness of decision aids for smoking cessation in adults: a quantitative systematic review, JBI Database of Systematic Reviews and Implementation Reports: September 2018 - Volume 16 - Issue 9 - p 1791-1822 doi: 10.11124/JBISRIR-2017-003698\nAvailable here\n","Adults, 18 years and over, who smoke tobacco products.","Eight papers representing seven unique studies evaluating smoking cessation decision aids were included. Decision aids may be in the form of pamphlets, brochures, cards, DVDs, audio tapes, videos or web-based applications.\nOf the six studies that measured abstinence, only two had positive findings, with one reaching statistical significance. The fours studies that measured quit attempts all demonstrated a trend toward an increase in the number of quit attempts, with one study reaching statistical significance. Four of the five studies that measured knowledge reported an initial increase in the knowledge of smoking cessation methods, with two studies reaching statistical significance. Two of the three studies that measured decisional quality showed an improvement in decisional quality after use of the decision aid, with one study reaching statistical significance.","The evidence suggests that decision aids may be effective in increasing smoking cessation knowledge and decisional quality while increasing quit attempts. There is, however, inconclusive evidence to support the definitive effectiveness of decision aids for long term and sustained smoking cessation.\n"]

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[null,"GUIDANCE- FULL EVIDENCE MAP"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering advice or education to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering behavioural support to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for signposting and referral to other services and support. NG102. London: NICE; 2018. Available here.","This guideline is for:\n- Community pharmacies, local pharmaceutical committees and pharmacy organisations\n- Commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England\n- Local professional networks (hosted by NHS England)\n- Health and wellbeing boards.","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n"]
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[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\nThis guideline was checked in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines (Expected publication date: 18 January 2021)."]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2019.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","This guideline covers the care that healthy women and their babies should be offered during pregnancy. It aims to ensure that pregnant women are offered regular check-ups, information and support.\n\nIt provides the following guidance:\n- Woman‑centred care and informed decision‑making \n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\nLast updated: 04 February 2019"]
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[null,"National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people. PH14. London: NICE; 2008.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nWoolfall K et al. The prevention of uptake of smoking by children and young people, with reference to the areas of mass media and the sale of tobacco products: findings from a multi-method primary research study. \nAvailable here.\n\nRichardson et al. NICE Rapid review: Interventions to Prevent the Uptake of Smoking in  Children and Young People. British Columbia: Centre of Excellence for Women's Health; 2008. Available here.","This guideline is for: \n- NHS, local authorities, the criminal justice system and others working in the public, voluntary and community sectors\n- Retailers\n- Mass-media services\n- Children, young people and their carers and other members of the public","This guideline covers anti-smoking mass-media campaigns, for example, on TV, in newspapers and online. It also covers measures to prevent tobacco being sold to children and young people. The aim is to help prevent children and young people from taking up smoking.\n\nIt makes recommendations on:\n- Mass-media campaigns, including how to develop them and the type of messages to put across\n- Illegal sales and how to prevent them\n\nThis guideline was checked in November 2014."]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]
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[null,"SYSTEMATIC REVIEWS - FULL MAP"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Lindson N, et al. Strategies to improve smoking cessation rates in primary care. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD011556. DOI: 10.1002/14651858.CD011556.pub2.\nAvailable here\n","Adult primary healthcare patients. For the purposes of this review, primary care was defined as family medicine or general medical practice. ","This review assesses the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings.\n\nThe authors identified moderate‐certainty evidence, limited by inconsistency, that the provision of adjunctive counselling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost‐free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. \n\nThere was also moderate‐certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow‐up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants).\n\nThere was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies the authors judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty.\n","There is moderate‐certainty evidence that providing adjunctive counselling by an allied health professional, cost‐free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. \n\nThere is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, the authors rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. \n\nFurther studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting.\n\n"]
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[null,"Petkovic  J et al. Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.: CD012932. DOI: 10.1002/14651858.CD012932.pub2.\nAvailable here\n","Adults","This Cochrane review aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects.\nThe authors compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. They found a range of effects on health behaviours, such as tobacco use and attitudes to tobacco. When looking at tobacco use in terms of any interactive social media intervention compared to a non-interactive social media control, the authors found a small effect favouring the non-interactive control (4 studies, 7302 participants, 95% CI 0.98 [0.74 , 1.29]).\nWhen looking at tobacco attitudes in terms of interactive social media intervention compared to non-interactive social media, the authors found a small effect favouring interactive social media (1 study, 315 participants, 95% CI 1.10 [-3.38 , 5.58]). \n","Compared with non-interactive programmes, social media programmes may show little to no effect on health behaviours such as better diet or reducing tobacco use (evidence from 54 studies in 20,139 people).\nWhile the authors assessed many outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of the included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase understanding of the potential effect of these interventions on reducing health inequities.\n"]
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[null,"Hartmann-Boyce  J, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub6.\nAvailable here","People defined as currently smoking cigarettes at enrolment into the studies. Participants could be motivated or unmotivated to quit.","There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than inthose randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies,1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6).\nThere was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of Adverse Effects (AEs) was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). Serious Adverse Events (SAEs) were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.44, 95% CI 0.94 to 2.19: I2 = 0; 3 studies, 1183 participants).\nThere was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC thanto non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additionalseven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). \n\nThere was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.95, 95% CI 0.52 to 1.72; I2 = 0; 6 studies, 1033 participants).\nCompared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However,this finding was of very low certainty, due to issues with imprecision and risk of bias. \nThere was some evidence that non-serious AEs weremore common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), andagain, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies,1303 participants).\n","There is moderate-certainty evidence that Electronic Cigarettes (ECs) with nicotine increase quit rates compared to NRT and compared to ECs without nicotine.\nEvidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. \nConfidence intervals were for the most part wide for data on Adverse Effects (AEs), SAEs and other safety markers, with no difference in AEsbetween nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. \n\nThe authors did not detect evidence of harm from nicotine EC, but longest follow-up was two years and the number of studies was small.\nThe main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway.\n\nTo ensure the review continues to provide up-to-date information, this review is now a living systematic review. The authors run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status."]
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[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.\n","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.\n","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. \nThere is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. \nFurther evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. \nFuture studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. \nThere was insufficient evidence that interventions affected oral health."]
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[null,"Vijayaraghavan  M, et al. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013413. DOI: 10.1002/14651858.CD013413.pub2. \nAvailable here","Participants were tobacco smokers, aged 18 years or older, and had experienced homelessness","This Cochrane review aimed to assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence.\nThe authors identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing.\nThey identified low‐certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). \nThey identified very low‐certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six‐month follow‐up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). \nThere was low‐certainty evidence, limited by bias and imprecision, that multi‐issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change their interpretation of these data. \nSingle studies that examined the effects of text‐messaging support, e‐cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results.","There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. \n\nAlthough there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, their certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. \n\nAlthough there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high‐quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long‐term follow‐up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness."]
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[null,"Howes  S, Hartmann‐Boyce  J, Livingstone‐Banks  J, Hong  B, Lindson  N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub5.\nAvailable here\n","Adult smokers","There was high‐certainty evidence that bupropion increased long‐term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate‐certainty evidence, downgraded one level due to imprecision). They found high‐certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants).\nMeta‐analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). \nThe authors also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. \n","There is high‐certainty evidence that bupropion can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. Due to the high‐certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change their interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front‐line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly."]
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[null,"Claire  R, Chamberlain  C, Davey  MA, Cooper  SE, Berlin  I, Leonardi‐Bee  J, Coleman  T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub3.\nAvailable here\n","Pregnant women","Compared to placebo and non‐placebo (behavioural support only) controls, there was low‐certainty evidence that NRT increased the likelihood of smoking abstinence in later pregnancy (RR 1.37, 95% CI 1.08 to 1.74; I² = 34%, 9 studies, 2336 women). However, in subgroup analysis by comparator type, there was a subgroup difference between placebo‐controlled and non‐placebo controlled RCTs (test for subgroup differences P = 0.008). There was unclear evidence of an effect in placebo‐controlled RCTs (RR 1.21, 95% CI 0.95 to 1.55; I² = 0%, 6 studies, 2063 women), whereas non‐placebo‐controlled trials showed clearer evidence of a benefit (RR 8.55, 95% CI 2.05 to 35.71; I² = 0%, 3 studies, 273 women). An additional subgroup analysis in which studies were grouped by the type of NRT used found no difference in the effectiveness of NRT in those using patches or fast‐acting NRT (test for subgroup differences P = 0.08). \nThere was no evidence of a difference between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities, or neonatal death. In one study infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' at two years of age compared to the placebo group. Non‐serious adverse effects observed with NRT included headache, nausea, and local reactions (e.g. skin irritation from patches or foul taste from gum), but data could not be pooled. Adherence to NRT treatment regimens was generally low. \nThe authors identified low‐certainty evidence that there was no difference in smoking abstinence rates observed in later pregnancy in women using bupropion when compared to placebo control (RR 0.74, 95% CI 0.21 to 2.64; I² = 0%, 2 studies, 76 women). Evidence investigating the safety outcomes of bupropion use was sparse, but the existing evidence showed no difference between the bupropion and control group. \n","NRT used for smoking cessation in pregnancy may increase smoking cessation rates in late pregnancy. However, this evidence is of low certainty, as the effect was not evident when potentially biased, non‐placebo‐controlled RCTs were excluded from the analysis. Future studies may therefore change this conclusion. The authors found no evidence that NRT has either positive or negative impacts on birth outcomes; however, the evidence for some of these outcomes was also judged to be of low certainty due to imprecision and inconsistency. They found no evidence that bupropion may be an effective aid for smoking cessation during pregnancy, and there was little evidence evaluating its safety in this population. Further research evidence on the efficacy and safety of pharmacotherapy and EC use for smoking cessation in pregnancy is needed, ideally from placebo‐controlled RCTs that achieve higher adherence rates and that monitor infants' outcomes into childhood. Future RCTs of NRT should investigate higher doses than those tested in the studies included in this review."]
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[null,"Non-pharmacological and Pharmacological Intervention for Smoking Cessation Programs in Youth: A Review of Clinical Effectiveness and Guidelines.\nOttawa: CADTH; 2020 Feb. (CADTH rapid response report: summary with critical appraisal).\nAvailable here\n","Adolescents","Regarding the clinical effectiveness for pharmacological and non-pharmacological smoking cessation interventions, one RCT was identified in the search. Evidence from this RCT suggested that there were no significant differences in smoking cessation or smoking frequency outcomes when comparing a multicomponent intervention group (brief advice, nicotine patch therapy and a 6-week text messaging intervention) to brief advice and nicotine patch therapy alone.\nThree SRs and eight RCTs addressed the clinical effectiveness of non-pharmacological smoking cessation interventions research question, and the results were mixed. Evidence from the SRs did not reveal improved smoking cessation outcomes for most comparisons; two MAs did find improved smoking cessation outcomes in favour of the intervention. Of the seven RCTs that examined smoking cessation outcomes, three studies found reductions in favour of the smoking cessation intervention, three did not find differences between groups, and one study found improvements at 3 months in favour of the intervention but not at 6-month follow-up.","It may be early to draw conclusions about pharmacological and non-pharmacological smoking cessation interventions for youth given the mixed findings identified in this report. Larger, sufficiently powered comparative studies evaluating pharmacological and non-pharmacological smoking cessation interventions may help reduce this uncertainty."]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","General population","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Matkin  W, Ordóñez‐Mena  JM, Hartmann‐Boyce  J. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub4.\nAvailable here","Mostly adult smokers from the general population, but some studies also looked at teenagers, pregnant women, and people with long‐term or mental health conditions. ","The authors identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long‐term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms. \n\nAmong trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self‐help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, the reviewers downgraded the certainty of the evidence to moderate. \n\nIn studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, the authors downgraded the certainty of the evidence to moderate. In subgroup analysis, they found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta‐regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self‐help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). \n","There is moderate‐certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate‐certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. \n\nThere is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. \n\nEvidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention. "]
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[null,"Whittaker  R, McRobbie  H, Bullen  C, Rodgers  A, Gu  Y, Dobson  R. Mobile phone text messaging and app‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub5.\nAvailable here.","Adults\nAdolescents","This review includes 26 studies (33,849 participants). Overall, the authors judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high‐income countries. \nThere was moderate‐certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate‐certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). \nTwo studies comparing text messaging with other smoking cessation interventions, and three studies comparing high‐ and low‐intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. \nFive studies compared a smoking cessation smartphone app with lower‐intensity smoking cessation support (either a lower‐intensity app or non‐app minimal support). The authors pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so the authors did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. ","There is moderate‐certainty evidence that automated text message‐based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. \nThere is moderate‐certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. \nThe evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions."]
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[null,"Tzelepis  F, Paul  CL, Williams  CM, Gilligan  C, Regan  T, Daly  J, Hodder  RK, Byrnes  E, Byaruhanga  J, McFadyen  T, Wiggers  J. Real‐time video counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD012659. DOI: 10.1002/14651858.CD012659.pub2.\nAvailable here.","Adults\nAdults with pre-existing health conditions: women with HIV.\n","The authors included two randomised trials with 615 participants. Both studies delivered real‐time video counselling for smoking cessation individually, compared with telephone counselling. They judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow‐up) across the two included studies when real‐time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). The authors judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real‐time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI –0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD –0.20, 95% CI –0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI –0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between‐group differences on satisfaction score (MD 0.70, 95% CI –1.16 to 2.56; 1 study, 29 participants). ","There is very little evidence about the effectiveness of real‐time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. \nHigh‐quality randomised trials comparing real‐time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real‐time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation. "]
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[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Carson‐Chahhoud  KV, Livingstone‐Banks  J, Sharrad  KJ, Kopsaftis  Z, Brinn  MP, To‐A‐Nan  R, Bond  CM. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003698. DOI: 10.1002/14651858.CD003698.pub3.\nAvailable here.","Adults","The authors identified seven studies including 1774 participants. They judged three studies to be at high risk of bias and four to be at unclear risk.\nEach study provided face‐to‐face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards.\nComparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one‐off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. \n All studies took place in high‐income countries, and recruited participants visiting pharmacies.\nThe authors pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow‐up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low‐certainty evidence). ","Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low‐certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion. "]
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[null,"Lindson  N, Klemperer  E, Hong  B, Ordóñez‐Mena  JM, Aveyard  P. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2.\nAvailable here.","Adults","The authors identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. The authors judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. \n\nThe authors identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects. \n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. ","The authors concluded that:\n-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 another. Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty.\n-There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence).\n-Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms."]
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[null,"Ussher  MH, Faulkner  GEJ, Angus  K, Hartmann‐Boyce  J, Taylor  AH. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub6.\nAvailable here. ","Adults","The authors identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group‐based cardiovascular‐type exercise supplemented by a home‐based exercise programme and combined with a multi‐session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi‐session cognitive behavioural smoking cessation programme alone. Overall, they judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. \n\nAmong the 21 studies analysed, the authors found low‐certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). They excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular‐type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular‐type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when the authors excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, they found very low‐certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long‐term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). \n","There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions. "]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Hollands  GJ et al. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD009164. DOI: 10.1002/14651858.CD009164.pub3.\nAvailable here. ","Adults","The reviewer's identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.\n\nMeta‐analysis of all 10 included studies (12 comparisons) provided moderate‐certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI –0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI –0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant‐centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician‐centred may not (SMD 0.09, 95% CI –0.05 to 0.23; I² = 0%; n = 864).\n\nFive studies assessed short‐term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long‐term smoking abstinence of six months or more. Meta‐analyses resulted in low‐certainty evidence that adherence interventions may slightly increase short‐term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long‐term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self‐efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit.","The authors concluded that:\n- In people who are stopping smoking and receiving behavioural support, there is moderate‐certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence\n- There is only low‐certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer‐term\n- Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both\n- However, there is currently insufficient evidence to confirm which approach is more effective\n- There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support\n\n"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Barnes  J et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008.pub3. \nAvailable here. ","Adults","The reviewers included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta‐analysis was not possible. They judged only one study to be at low risk of bias overall; they judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations. \n\nPooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention‐matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity. \n\nMost studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event ‘index’ between hypnotherapy and relaxation. \n","The authors concluded that:\n- There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting\n- If a benefit is present, current evidence suggests the benefit is small at most\n- There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does\n- Further large, high‐quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic"]
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[null,"Zeng  L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub3. \nAvailable here. ","Adults with Pre-existing health condition: Lung cancer","The reviewers identified no randomised controlled trials (RCTs) RCTs that met their inclusion criteria. Among the 1817 records retrieved using their search strategy, they retrieved 19 studies for further investigation. They excluded 15 trials: ten trials because they could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. They excluded one trial because, though it was completed in 2004, no results are available. They assessed four ongoing trials for inclusion when data become available. \n","The authors concluded that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n- This systematic review identified a need for RCTs to explore these "]
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[null,"Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308. \nAvailable here. ","Adults","This Cochrane review aimed to determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation, compared to one another.\n\nThe reviewers identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. The reviewers judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high‐certainty evidence that combination NRT (fast‐acting form + patch) results in higher long‐term quit rates than single form (Risk ratio (RR) 1.25, 95% Confidence Interval (CI) 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). \n\nModerate‐certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate‐certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate‐certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High‐certainty evidence from eight studies suggests that using either a form of fast‐acting NRT or a nicotine patch results in similar long‐term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low‐certainty evidence); 16‐hour versus 24‐hour daily patch use; duration of combination NRT use (low‐ and very low‐certainty evidence); tapering of patch dose versus abrupt patch cessation; fast‐acting NRT type (very low‐certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast‐acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant‐ versus clinician‐selected NRT. However, in most cases these findings are based on very low‐ or low‐certainty evidence, and are the findings from single studies. \n\nAdverse events, serious adverse events and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low‐ or very low‐certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac adverse events, serious adverse events or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). \n","The authors concluded that:\n- There is high‐certainty evidence that using combination NRT versus single‐form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking\n- For patch dose comparisons, evidence was of moderate certainty, due to imprecision: 21 mg patches resulted in higher quit rates than 14 mg (24‐hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16‐hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24‐hour) patches\n- Using a fast‐acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches\n- There is moderate‐certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding\n- Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty\n- New studies should ensure that adverse events, serious adverse events and withdrawals due to treatment are both measured and reported"]
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[null,"Clair C et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub5. \nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking‐related diseases in helping them to quit smoking. \n\nThe reviwers included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking‐related disease risk (five studies); and feedback on smoking‐related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking‐related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking‐related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). ","The authors concluded that:\n- There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation\n- The most promising results relate to spirometry and carotid ultrasound, where moderate‐certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but CIs very narrowly missed one, and the point estimate favoured the intervention\n- A sensitivity analysis removing those studies at high risk of bias did detect a benefit\n- Moderate‐certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring\n- Low‐certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking‐related risk by genetic marker testing\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. The authors also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were randomised controlled trials (RCTs), and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Roelsgaard  IK et al. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012958. DOI: 10.1002/14651858.CD012958.pub2. \nAvailable here.","Adults with Pre-existing health conditions: Inflammatory joint diseases","This Cochrane review aimed to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with inflammatory joint diseases.\n\nThe reviewers included two studies with 57 smokers with a diagnosis of rheumatoid arthritis. They identified no studies including other inflammtry joint diseases. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight‐week cognitive‐behavioural patient education intervention on CVD risk for people with rheumatoid arthritis and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta‐analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non‐serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. They assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE.","The authors concluded that:\n\n- They found very little research investigating the efficacy of smoking cessation intervention specifically in people with inflammatory joint diseases\n- Included studies are limited by imprecision, risk of bias, and indirectness\n- Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with inflammatory joint diseases\n- High‐quality, adequately powered studies are warranted\n- In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long‐term smoking cessation"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacist-Led Interventions for Tobacco Smoking Cessation: A Review of the Clinical Effectiveness and Cost-Effectiveness. Ottawa: CADTH; 2019.\nAvailable here.","Adults","This CADTH rapid response review aimed to answer the following research questions:\n\n1. What is the clinical effectiveness of pharmacist-led tobacco smoking cessation interventions?\n2. What is the cost-effectiveness of pharmacist-led tobacco smoking cessation interventions versus self-directed smoking cessation interventions?\n\nA total of 458 citations were identified in the literature search. Following screening of titles and abstracts, 413 citations were excluded and 45 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 47 publications were excluded for various reasons, and four publications met the inclusion criteria and were included in this report. These comprised four SRs. Of the excluded studies, one was an overview of reviews\nthat met the inclusion criteria for this report; however, only one of the included SRs was relevant to this report, and because it was captured by the search and contained more comprehensive information, the SR was retained directly and the overview was excluded. Two other SRs met the inclusion criteria but were excluded for having overlapping primary studies with more comprehensive SRs included in this report. ","This rapid response review concluded that:\n- The overall quality of evidence was low, and high heterogeneity existed between the included studies, making it difficult to determine the overall effectiveness of these interventions\n- Very low- to moderate-quality evidence from three systematic reviews suggested that pharmacist-led smoking cessation interventions may lead to higher rates or no difference in rates of smoking cessation, as compared to usual care or no intervention, although there was a high degree of uncertainty in these findings\n- No other clinical effectiveness outcomes, including adverse events, were reported\n- Evidence of unknown quality from one very low-quality systematic review suggested that pharmacist-led smoking cessation interventions were cost-effective in Europe\n- Given the limited availability and low quality of evidence, the clinical effectiveness and cost-effectiveness of pharmacist-led interventions for smoking cessation remain uncertain\n"]
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[null,"Community Preventive Services Task Force. (2019). Tobacco Use and Secondhand Smoke Exposure: Internet-based Interventions to Increase Tobacco Use Cessation. USA.Gov. Available here.\n\nUnderpinning evidence review:\nMcCrabb et al, Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis. Annals of Behavioral Medicine 2019:53(2):180-95. Available here. ","This guidance is for:\nAdolescents and Young Adults\nAdults\nOlder Adults\nParents/Caregivers","The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The underpinning review (McCrabb et al) was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation. The review included 45 studies. The CPSTF examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.\n\nThe CPSTF findings are based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.\n\nFindings\n-Internet-based interventions increased tobacco use cessation rates by a median of 1.2 percentage points overall (31 studies).\n-Differences in cessation rates were slightly larger when internet-based interventions were compared to no intervention, usual care, printed materials, or basic website content (median increase of 1.3 percentage points; 17 studies).\n-Differences in cessation rates were smaller when internet-based interventions were compared to other interventions that provided interactive content, cessation counseling, or evidence-based cessation medications (median increase of 0.8 percentage points; 14 studies).\n-Most studies provided internet, cessation counseling, or medication interventions to participants in the comparison group.\n-Participants in both intervention and comparison groups quit at meaningful rates, which minimized differences.\n","Recommendation\nThe Community Preventive Services Task Force (CPSTF) recommends internet-based cessation interventions based on sufficient evidence of effectiveness in increasing tobacco use cessation among adult tobacco users. Systematic review evidence showed meaningful improvements in tobacco cessation outcomes when measured six or more months following intervention. "]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of NRT, including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Faseru B et al. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD002928. DOI: 10.1002/14651858.CD002928.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component. \n\nIt identified 465 citations, which were assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n =  3370). \nThe definition of partner varied among the studies.  The reviewers compared partner support versus control interventions at six‐ to nine‐month follow‐up and at 12 or more months follow‐up. They also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self‐reported smoking cessation rates, with limited biochemical verification of abstinence. \n\nThe pooled RR for abstinence was 0.97 (95% CI 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post‐treatment. \n\nOf the 11 studies that measured partner support at follow‐up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. The reviewers judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system the reviewers rated the overall quality of the evidence for the two primary outcomes as low. They downgraded due to the risk of bias, as they judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. They also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. ","The authors concluded that:\n- Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation\n- Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified"]
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[null,"Moyo, F et al. Effectiveness of decision aids for smoking cessation in adults: a quantitative systematic review, JBI Database of Systematic Reviews and Implementation Reports: September 2018 - Volume 16 - Issue 9 - p 1791-1822 doi: 10.11124/JBISRIR-2017-003698\nAvailable here\n","Adults, 18 years and over, who smoke tobacco products.","Eight papers representing seven unique studies evaluating smoking cessation decision aids were included. Of the six studies that measured abstinence, only two had positive findings, with one reaching statistical significance. The fours studies that measured quit attempts all demonstrated a trend toward an increase in the number of quit attempts, with one study reaching statistical significance. Four of the five studies that measured knowledge reported an initial increase in the knowledge of smoking cessation methods, with two studies reaching statistical significance. Two of the three studies that measured decisional quality showed an improvement in decisional quality after use of the decision aid, with one study reaching statistical significance.","The evidence suggests that decision aids may be effective in increasing smoking cessation knowledge and decisional quality while increasing quit attempts. There is, however, inconclusive evidence to support the definitive effectiveness of decision aids for long term and sustained smoking cessation."]
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[null,"Health Technology Assessment (HTA) of smoking cessation interventions. 22 March 2017. Health Information and Quality Authority Ireland. \nAvailable here\n","Those interested in smoking cessation across public, private and voluntary sectors. ","Cessation interventions that were evaluated in this HTA include both pharmacological and non-pharmacological interventions. The pharmacological interventions assessed were: nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes), antidepressants (specifically bupropion) and nicotine receptor partial agonists (NRPAs). The non-pharmacological interventions assessed were: acupuncture, and a range of behavioural interventions including motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. Financial incentives for pregnant women to quit were also evaluated. The effectiveness and safety of these interventions is reviewed in detail in Chapters 4 and 5.","Key points/Conclusions\nReducing the prevalence of smoking is a key priority within the public health system. \nA diverse range of smoking cessation interventions is available in Ireland. \nPharmacological interventions include nicotine replacement therapy (NRT), electronic cigarettes, antidepressants (specifically bupropion) and nicotine receptor partial agonists (varenicline and cytisine).\nPrescribed nicotine replacement therapy (NRT), varenicline and bupropion are currently reimbursed through the Primary Care Reimbursement Service (PCRS), although reimbursement of NRT is limited to Medical Card holders only. \nNeither varenicline nor bupropion are indicated for use in pregnant women in Ireland.\nBupropion is contraindicated in certain patient groups, including those at increased risk of seizures and those with bipolar affective disorder. \nWarnings cautioning the use of varenicline in patients with pre-existing psychiatric conditions were lifted in May 2016 following publication of safety and efficacy data from the EAGLES trial. The study did not show a significant increase in neuropsychiatric adverse events that could be attributed to varenicline or bupropion relative to nicotine patch or placebo in patients with or without pre-existing psychiatric disorders. \nElectronic cigarettes, also known as e-cigarettes, are not currently advocated by the HSE as a means of quitting due to lack of long-term data on their safety. However, support is provided by HSE smoking cessation services to smokers who choose to use e-cigarettes in their quit attempt. \nNon-pharmacological interventions include acupuncture, motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. \nThe absence of standard definitions for behavioural interventions, including the choice of treatment provider and the intensity of the intervention (influenced by duration, number and frequency of sessions), adds complexity to their analysis. In addition, there may be substantial overlap between these interventions. Often more than one intervention is simultaneously provided, and they may be provided with or without adjunct pharmacological therapy.\n"]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of NRT compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Adolescents and\nYoung children (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Stead LF, Carroll AJ and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub3.\nAvailable here.","Adults","This Cochrane review aimed to determine the effect of group‐delivered behavioural interventions in achieving long‐term smoking cessation. \n\nThe reviewers identified sixty‐six trials to meet their inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self‐help programme; there was an increase in cessation with the use of a group programme (n =  4395, RR 1.88, 95% CI 1.52 to 2.33, I² = 0%). They judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (n =  7286, RR 1.22, 95% CI 1.03 to 1.43, I² = 59%). They judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. \n\nThere was also low quality evidence of benefit of a group programme compared to no‐intervention controls, (9 trials, n =  1098, RR 2.60, 95% CI 1.80 to 3.76 I² = 55%). They did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, n =  980, RR 0.99, 95% CI 0.76 to 1.28, I² = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same‐length or shorter programmes without these components. ","The authors conclulded that:\n- Group therapy is better for helping people stop smoking than self‐help, and other less intensive interventions\n- There is not enough evidence to evaluate whether groups are more effective, or cost‐effective, than intensive individual counselling\n- There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included "]
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[null,"Taylor GMJ et al. Internet‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858.CD007078.pub5.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to determine the effectiveness of Internet‐based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. \n\nThe reviewers  identified 67 RCTs, including data from over 110,000 participants. They pooled data from 35,969 participants. There were only four RCTs conducted in adolescence or young adults that were eligible for meta‐analysis. \n\nResults for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non‐active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n =   6786). However, statistical heterogeneity was high (I² = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n =   3806, I² = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non‐active control (n =   2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I² = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n =  2769, I² = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n =   14,623, I² = 0%); GRADE rating was moderate. Three studies compared tailored with non‐tailored Internet‐based messages, compared to non‐tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n =  4040), and there was evidence of unexplained substantial statistical heterogeneity (I² = 57%); GRADE rating was low. \n\nResults should be interpreted with caution as the reviewers judged some of the included studies to be at high risk of bias. ","The authors concluded that:\n- The evidence from trials in adults suggests that interactive and tailored Internet‐based interventions with or without additional behavioural support are moderately more effective than non‐active controls at six months or longer\n- There was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity\n- Treatment effectiveness in younger people is unknown "]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I² = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I² = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I² = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"Thomas D et al. System change interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD010742. DOI: 10.1002/14651858.CD010742.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.\n\nThe reviewers included seven cluster‐randomised controlled studies in this review. They rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow‐up (four studies), and for the secondary outcome ‘prescribing of smoking cessation medications' (two studies). \n\nFour studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. ","The authors concluded that:\n- The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services\n- The available research is limited, therefore it was not feasible to draw strong conclusions\n- There is a need for additional high‐quality research to explore the impact of system change interventions on both cessation and system‐level outcomes"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Reduction and Cessation Interventions for Pregnant Women and Mothers of Infants: A Review of the Clinical Effectiveness. Ottawa: CADTH; 2017a.\nAvailable here.","Pregnant women and Women in post partum period","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of smoking reduction programs for Pregnant women or mothers of infants? \n2. What is the clinical effectiveness of smoking cessation interventions for Pregnant women or mothers of infants? \n\nA total of 492 citations were identified in the literature search. Following screening of titles and abstracts, 443 citations were excluded and 49 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search. Of these potentially relevant articles, 44 publications were excluded for various reasons, while seven publications, including two SRs and five RCTs, met the inclusion criteria and were included in this report. \n\n","The rapid response review concluded that:\n- Evidence on the effectiveness of smoking reduction interventions was limited\n- Psychosocial interventions for smoking cessation appeared to be effective, while the effect of health education and social support was less certain\n- The results suggest that psychosocial interventions reduced the risk of infants born with low birthweight, increased the mean birthweight, and decreased the risk of neonatal intensive care unit admission\n- Pharmacological interventions appeared to be effective during treatment or at the end of pregnancy\n- NRT did not seem to have any positive or negative effects on infant outcomes, while the safety of bupropion was inconclusive"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Cessation Interventions for Patients with Severe Mental Illnesses: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2017b.\nAvailable here.","Adults with Pre-existing health condition: Severe mental illness","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical evidence regarding the effectiveness of smoking cessation interventions for patients with severe mental illnesses? \n2. What are the evidence-based guidelines regarding smoking cessation interventions for patients with severe mental illnesses?\n\nThis report made use of a previous Rapid Response (Smoking cessation interventions for patients with severe mental illnesses: clinical effectiveness and guidelines) on the same subject to identify studies, which was supplemented by an updated search. The original search, which was completed in July 2016, identified 325 citations, of which 25 were ordered for full-text screening. A total of 86 additional citations were identified in the literature search update. Following screening of titles and abstracts of the 86 new citations, 65 citations were excluded and 21 potentially relevant reports from the electronic search were retrieved for full-text review. Forty-five potentially relevant publications were retrieved from the grey literature search and, in addition to the 25 from the previous reference list on the topic and the 21 added in the update, 91 full texts were reviewed. Of these potentially relevant articles, 68 publications were excluded for various reasons, while 23 publications met the inclusion criteria and were included in this report. \n\nWhile concerns about safety may prevent pharmacological options from being used more often among people with severe illness, the current review did not find evidence for an increased risk of adverse events compared to the general population, or worsening of psychiatric symptoms when using NRT, varenicline or bupropion with people with severe mental illness.  \n\nAll three interventions were found to improve smoking cessation rates compared to placebo or no treatment, varenicline and bupropion may be more effective than NRT, and additional psychosocial support may enhance success. Nausea and sleep disturbances were common when using varenicline, but peaked and declined with time. Sustained effects beyond the treatment period were not generally measured, nor were varying dosages except for one study which found higher NRT dose did not improve outcomes.\n\nIn general, the quality of studies was low and sample sizes small, suggesting the need for better reporting across these studies and more adequately powered analyses.","This rapid response review concluded that:\n- NRT, varenicline and bupropion were all generally found to improve smoking cessation rates, most commonly measured as 7-day point prevalence abstinence against placebo, among people with severe mental illness\n- Varenicline and bupropion may be more effective than NRT\n- The longest follow up duration on treatment was six months, and sustained effects beyond this were unclear, except in one study that did not find an increase in suicide attempts/behaviours after one year\n- There was no evidence that adverse events occurred more often than in those without mental illness, or that psychiatric symptoms worsened\n- Nausea and sleep disturbances were common with varenicline\n- All studies included some form of psychosocial support in addition to the pharmacological intervention, and only one study considered randomizing different dosages for NRT, and did not find a difference\n- In general, the quality of studies was low and sample sizes small\n- One guideline was found, which did not favour any treatment, but suggested considering NRT, varenicline or bupropion for patients with severe mental illness, with safety caveats for the latter two that may require closer patient monitoring"]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here\n","Adults","Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.\n","Community pharmacy interventions are effective for smoking cessation.\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I² = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I² = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Jeyashree K et al. Smoking cessation interventions for pulmonary tuberculosis treatment outcomes. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011125. DOI: 10.1002/14651858.CD011125.pub2.\nAvailable here.","Adults with Pre-existing health condition: Tuberculosis","This Cochrane review aimed to analyse the effect of tobacco smoking cessation interventions on the treatment outcomes of people with adult pulmonary tuberculosis (TB).\n\nThere were no RCTs that met the eligibility criteria. A number of potentially eligible studies are underway, and the reviewers will assess them for inclusion in the next update of this review. ","The authors concluded that:\n- There is a lack of high‐quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes\n- There is a need for good‐quality RCTs that assess the effect of smoking cessation interventions on TB treatment outcomes in both the short and long term\n- Establishing such an evidence base would be an essential step towards the implementation of smoking cessation interventions in TB control programmes worldwide"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I² = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I² = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Cahill K, Hartmann‐Boyce J and Perera R. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub5.\nAvailable here.","Adults\nPregnant women and Women in post partum period\n","This Cochrane review aimed to determine whether incentives and contingency management programmes lead to higher long‐term quit rates. \n\nTwenty‐one mixed‐population studies met the inclusion criteria, covering more than 8400 participants. Ten studies were set in clinics or health centres, one in Thai villages served by community health workers, two in academic institutions, and the rest in worksites. All but six of the trials were run in the USA. The incentives included lottery tickets or prize draws, cash payments, vouchers for goods and groceries, and in six trials the recovery of money deposited by those taking part. The OR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.42 (95% CI 1.19 to 1.69; 17 trials, [20 comparisons], 7715 participants). Only three studies demonstrated significantly higher quit rates for the incentives group than for the control group at or beyond the six‐month assessment: One five‐arm USA trial compared rewards‐ and deposit‐based interventions at individual and group level, with incentives available up to $800 per quitter, and demonstrated a quit rate in the rewards groups of 8.1% at 12 months, compared with 4.7% in the deposits groups. A direct comparison between the rewards‐based and the deposit‐based groups found a benefit for the rewards arms, with an OR at 12 months of 1.76 (95% CI 1.22 to 2.53; 2070 participants). Although more people in this trial accepted the rewards programmes than the deposit programmes, the proportion of quitters in each group favoured the deposit‐refund programme. Another USA study rewarded both participation and quitting up to $750, and achieved sustained quit rates of 9.4% in the incentives group compared with 3.6% for the controls. A deposit‐refund trial in Thailand also achieved significantly higher quit rates in the intervention group (44.2%) compared with the control group (18.8%), but uptake was relatively low, at 10.5%. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. The reviewers rated the overall quality of the older studies as low, but with later trials (post‐2000) more likely to meet current standards of methodology and reporting.\n \nEight of nine trials with usable data in pregnant smokers (seven conducted in the USA and one in the UK) delivered an adjusted OR at longest follow‐up (up to 24 weeks post‐partum) of 3.60 (95% CI 2.39 to 5.43; 1295 participants, moderate‐quality studies) in favour of incentives. Three of the trials demonstrated a clear benefit for contingent rewards; one delivered monthly vouchers to confirmed quitters and to their designated 'significant other supporter', achieving a quit rate in the intervention group of 21.4% at two months post‐partum, compared with 5.9% among the controls. Another trial offered a scaled programme of rewards for the %age of smoking reduction achieved over the course of the 12‐week intervention, and achieved an intervention quit rate of 31% at six weeks post‐partum, compared with no quitters in the control group. The largest (UK‐based) trial provided intervention quitters with up to £400‐worth of vouchers, and achieved a quit rate of 15.4% at longest follow‐up, compared to the control quit rate of 4%. Four trials confirmed that payments made to reward a successful quit attempt (i.e. contingent), compared to fixed payments for attending the antenatal appointment (non‐contingent), resulted in higher quit rates. Front‐loading of rewards to counteract early withdrawal symptoms made little difference to quit rates. ","The authors included that:\n- Incentives appear to boost cessation rates while they are in place. \n- The two trials recruiting from work sites that achieved sustained success rates beyond the reward schedule concentrated their resources into substantial cash payments for abstinence but such an approach may only be feasible where independently‐funded smoking cessation programmes are already available, and within a relatively affluent and educated population\n- Deposit‐refund trials can suffer from relatively low rates of uptake, but those who do sign up and contribute their own money may achieve higher quit rates than reward‐only participants\n- Incentive schemes conducted among pregnant smokers improved the cessation rates, both at the end‐of‐pregnancy and post‐partum assessments\n- Current and future research might continue to explore the scale, loading and longevity of possible cash or voucher reward schedules, within a variety of smoking populations"]
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[null,"Lindson‐Hawley N, Thompson TP and Begh R. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub3.\nAvailable here.","Adults","This Cocrane review aimed to determine whether or not motivational interviewing (MI) promotes smoking cessation.\n\nThe reviewers  identified 28 studies published between 1997 and 2014, involving over 16,000 participants. MI was conducted in one to six sessions, with the duration of each session ranging from 10 to 60 minutes. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. The meta‐analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.26; 95% CI 1.16 to 1.36; 28 studies; n =   16,803). Subgroup analyses found that MI delivered by primary care physicians resulted in an RR of 3.49 (95% CI 1.53 to 7.94; 2 trials; n =  736). When delivered by counsellors the RR was smaller (1.25; 95% CI 1.15 to 1.63; 22 trials; n =   13,593) but MI still resulted in higher quit rates than brief advice or usual care. When we compared MI interventions conducted through shorter sessions (less than 20 minutes per session) to controls, this resulted in an RR of 1.69 (95% CI 1.34 to 2.12; 9 trials; n =   3651). Single‐session treatments might increase the likelihood of quitting over multiple sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow‐up calls. \n\nThere was variation across the trials in treatment fidelity. All trials used some variant of MI. Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports.   ","The authors concluded that:\n- MI may assist people to quit smoking\n- The results of this review should be interpreted with caution, due to variations in study quality, treatment fidelity, between‐study heterogeneity and the possibility of publication or selective reporting bias"]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Adolescents and children (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"Barth J, Jacob T, Daha  I and Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD006886. DOI: 10.1002/14651858.CD006886.pub2.\nAvailable here.","Adults with Pre-existing health condition: Coronary heart disease (CHD)","This Cochrane review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with CHD in short‐term (6 to 12 month follow‐up) and long‐term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification.\n\nThe reviewers found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long‐term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self‐help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction. \n\nAfter an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (RR 1.22, 95% CI 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow‐up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non‐validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self‐help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow‐up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow‐up, one or more contacts in total over an hour with no follow‐up or any initial contact plus follow‐up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long‐term follow‐up (over 12 months), and did not show any benefits. \n\nAdverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). ","The authors concluded that:\n- Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration\n- After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost‐effectiveness analyses are needed\n- Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. NRT) compared with pharmacological treatment alone and investigate economic outcomes"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth Delivery of Group Smoking Cessation Programs for Adolescents and Young Adults: Clinical Effectiveness. Ottawa: CADTH; 2015a.\nAvailable here.","Adolescents and young adults (age not specified)","This CADTH rapid response review aimed to answer the following research question:\nWhat is the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults? \n\nNo relevant HTAs, SRs, meta-analyses, RCTs, or non-randomised studies were identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults. ","This rapid response review reported that:\n- No relevant literature was identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adult "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Mindfulness Interventions for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Use Disorders: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015b.\nAvailable here.","Adults with Pre-existing health condition and other populatiion: Post traumatic stress disorder, generalised anxiety disorder and depression","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders? \n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, depression, or substance use disorders? \n\nFor the purposes of this map, data relevant to the map has only been presented here.\n  \nOne SR and one RCT assessing mindfulness interventions in patients with substance use disorder were identified. The SR was conducted in Italy and included 24 studies (14 RCTs and ten non-RCTs). Twelve studies focused on alcohol and/or heterogeneous substance use, four on cigarette smoking, three on opiate use, one on marijuana use, and one on metamphetamine use. Eight studies focused on mindfulness-based stress reduction or related mindfulness-based interventions, five on acceptance and commitment therapy, three on Spiritual self-schema therapy , two on Dialectical behavioral therapy, one study focused on a Vipassana meditation (where individuals assume a seated position and focus their attention onto the breath), one study focused on goal management training in adjunct to mindfulness meditation, and one study focused on a motivational intervention in adjunct to mindfulness meditation. Ten of the included studies compared mindfulness-based interventions to a waiting list, eight compared it with an active treatment, two compared it with non-specific educational interventions designed to be structurally its equivalent. One study included adult patients enrolled in a substance abuse aftercare program. Mindfulness-based relapse prevention was compared to relapse prevention or treatment as usual in this RCT. Relapse to drug use and heavy drinking frequency of substance use in the past 90 days was assessed. \n \nThe evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited, where only one RCT was identified which concluded that the mindfulness intervention was more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. The only SR for substance use disorders included in this report concluded a lack of randomisation or of randomisation details, objective measures of drug use, and of information for treatment adherence, as well as small sample sizes, and raised concerns as to whether observed findings were actually due to the delivered interventions or are more properly attributable to methodological biases of included studies. \n\nSix evidence-based guidelines considered the use of mindfulness in clinical practice, of which one suggested  that Mindfulness-Based Stress Reduction can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals. ","This rapid response review reported that:\n- One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking\n- One evidence-based guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals \n "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"White AR et al. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000009. DOI: 10.1002/14651858.CD000009.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation in smoking cessation, in comparison with no intervention, sham treatment, or other interventions. \n\nThe reviewers included 38 studies. Based on three studies, acupuncture was not shown to be more effective than a waiting list control for long‐term abstinence, with wide CIs and evidence of heterogeneity (n =  393, RR 1.79, 95% CI 0.98 to 3.28, I² = 57%). Compared with sham acupuncture, the RR for the short‐term effect of acupuncture was 1.22 (95% CI 1.08 to 1.38), and for the long‐term effect was 1.10 (95% CI 0.86 to 1.40). The studies were not judged to be free from bias, and there was evidence of funnel plot asymmetry with larger studies showing smaller effects. The heterogeneity between studies was not explained by the technique used. Acupuncture was less effective than NRT. \n\nThere was no evidence that acupuncture is superior to psychological interventions in the short‐ or long‐term. There is limited evidence that acupressure is superior to sham acupressure for short‐term outcomes (3 trials, n =  325, RR 2.54, 95% CI 1.27 to 5.08), but no trials reported long‐term effects. The pooled estimate for studies testing an intervention that included continuous auricular stimulation suggested a short‐term benefit compared to sham stimulation (14 trials, n =  1155, RR 1.69, 95% CI 1.32 to 2.16); subgroup analysis showed an effect for continuous acupressure (7 studies, n =  496, RR 2.73, 95% CI 1.78 to 4.18) but not acupuncture with indwelling needles (6 studies, n =  659, RR 1.24, 95% CI 0.91 to 1.69). At longer follow‐up the CIs did not exclude no effect (5 trials, n =  570, RR 1.47, 95% CI 0.79 to 2.74). The evidence from two trials using laser stimulation was inconsistent and could not be combined. The combined evidence on electrostimulation suggests it is not superior to sham electrostimulation (short‐term abstinence: 6 trials, n =  634, RR 1.13, 95% CI 0.87 to 1.46; long‐term abstinence: 2 trials, n =  405, RR 0.87, 95% CI 0.61 to 1.23). ","The authors concluded that:\n- Although pooled estimates suggest possible short‐term effects there is no consistent, bias‐free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for six months or more; lack of evidence and methodological problems mean that no firm conclusions can be drawn\n- Electrostimulation is not effective for smoking cessation\n- Well‐designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence‐based interventions"]
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[null,"Cahill K and Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4. \nAvailable here.","Adults","This Cochrane review aimed to firstly, categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking; and secondly, to collect and evaluate data on costs and cost effectiveness associated with workplace interventions. \n\nThe reviewers included 57 studies (61 comparisons) in this updated review. They found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, NRT, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (OR for cessation 1.71, 95% CI 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. ","The authors reported that:\n- They found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere\n- Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low\n- They failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data\n- There was limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates \n- Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced "]
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[null,"Leaviss J, Sullivan W, Ren S, Everson-Hock E, Stevenson M, Stevens J, et al. What is the clinical effectiveness and cost effectiveness of cytisine compared with varenicline for smoking cessation: a systematic review and economic evaluation?. Health Technology Assessment 2014;18(33)\nAvailable here\n","Adult smokers","Twenty-three (RCTs) were included in the systematic review, comprising a total of 10,610 participants. Twenty-one trials of varenicline of differing dosing schedules and two trials of cytisine at standard dose met the inclusion criteria. No head-to-head trials comparing varenicline with cytisine were identified. Cytisine was more efficacious than placebo [hazard ratio (HR) 4.27, 95% credible interval (CrI) 2.05 to 10.05], as was standard-dose varenicline (HR 2.58, 95% Crl 2.16 to 3.15). Standard-dose varenicline treatment was associated with significantly higher rates of headache, insomnia and nausea than placebo; there was no significant difference in the rates of abnormal dreams. There were no significant differences in the rates of headache or nausea between cytisine and placebo; data were identified for neither abnormal dreams nor insomnia. Using expected values, cytisine is anticipated to dominate varenicline, in that it produces more quality-adjusted life-years at a lower associated cost. This occurred in approximately 90% of the scenarios performed. However, owing to the large number of people who wish to quit smoking (estimated to be 3 million over a 10-year period), the implications of making an incorrect decision is large. The expected value of sample information indicated that conducting a head-to-head trial of cytisine and varenicline was worthwhile, and that 1000 smokers per arm was an appropriate number to recruit.","On the basis of the evidence included in this review, varenicline and cytisine are both effective interventions to aid smoking cessation when compared with placebo. Cytisine is estimated to be both more clinically effective and cost-effective than varenicline. However, there is uncertainty in the decision, and a head-to-head trial of cytisine and varenicline would appear to be an effective use of resources."]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Young people (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence. Ottawa: CADTH; 2014.\nAvailable here.","Not specified","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of newer nicotine replacement products (Nicorette Quick Mist, Nicorette Combo Quit, Nicorette Mini Lozenges) for smoking cessation?\n2. What is the clinical evidence for the use of supratherapeutic doses of NRT?\n3. What is the clinical evidence for the use of nicotine replacement products to reduce smoking for those who do not quit?\n\nThe literature search identified 303 citations, with no additional articles identified from other sources. After screening the abstracts, 13 were deemed potentially relevant and 9 met the criteria for inclusion in this review: 3 SRs and 6 RCTs.\n\nNo clinical evidence was identified for the NRT products specifically termed as the Nicorette Quick Mist, Nicorette Combo Quit, or Nicorette Mini Lozenges. Limited evidence showed that nicotine mouth spray or the combination of nicotine patch plus gum achieved higher smoking cessation than placebo. Modestly higher smoking cessation rates were observed with high doses nicotine patch compared with standard nicotine patch dose. NRT appears effective in reduction of smoking for those who did not want to quit. However, findings reported in this review should be interpreted with caution due to the potential methodological limitations and clinical heterogeneity of the body evidence. Better designed RCTs in Canadian settings are needed to determine the clinical effectiveness of the newer NRT products or the use of high doses of NRT for smoking cessation, as well as the role of NRT in smoking reduction.","This rapid response review reported that:\n- No evidence was found specific to the new products Nicorette QuickMist, Nicorette ComboQuit, and Nicorette mini lozenges\n- Limited evidence shows a higher quit rate with: nicotine mouth spray, as compared with placebo; the combination of nicotine patch plus gum, as compared with placebo; and\nhigh-dose nicotine patch, as compared with standard-dose nicotine patch\n- NRT appears effective in the reduction of smoking for those who do not want to quit\n- These findings should be interpreted with caution because of limitations of the evidence"]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"Chen Y, Madan J, Welton N, Yahaya I, Aveyard P. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment 2012;16(38)\nAvailable here\n","Adults","This effectiveness review included 60 RCTs/quasi-RCTs reported in 77 publications. Pooled estimate for prolonged abstinence [relative risk (RR) = 1.32, 95% confidence interval (CI) 1.21 to 1.45] and point prevalence abstinence (RR = 1.14, 95% CI 1.07 to 1.22) suggested that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials. There was no significant difference in effect sizes between aid to cessation studies (which provide support to smokers who are ready to quit) and cessation induction studies (which attempt to encourage a cessation attempt in smokers who are not yet ready to quit). Results from MTC also showed small but significant intervention effect (time to relapse, mean hazard ratio 0.87, 95% credible interval 0.83 to 0.92).","The effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. The cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost-effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counselling. The key source of uncertainty is that around the comparative effectiveness of different types of electronic interventions. The review suggests that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on the relationship between involving users in the design of interventions and the impact this has on effectiveness, and finally on how electronic aids developed and tested in research settings are applied in routine practice and in the community."]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Quitline interventions. Atlanta: CPTSF; 2012c. \nAvailable here.","Adults","This CPSTF finding on quitline effectiveness is based on evidence from an SR published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up.This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.\n\nEvidence of effectiveness for quitline promotional efforts is based on an SR of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).\n\nThe SRs were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nThe Task Force recommendation is based on evidence from 71 studies that evaluated effectiveness of proactive telephone counseling. Twelve studies evaluated treatment effectiveness for callers to quitlines available to the general public and observed a median absolute %age point increase in tobacco cessation of 3.1 %age points (interquartile interval [IQI]: 0.5 to 3.3 %age points). Fifty-one studies evaluated interventions for clients in clinical and research settings and observed a median absolute %age point increase in tobacco cessation of 1.7 %age points (IQI: 0.0 to 8.5 %age points). \n\nOnly six of 77 included studies provided evidence on effectiveness of reactive (caller initiated) quitline counseling. Three of these studies evaluated effectiveness of counseling for a single quitline contact and overall findings were inconsistent. The other three studies evaluated effectiveness of offering tobacco users access to quitline services, and similarly, overall results were inconsistent.","The CPSTF concluded that:\n- Quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting are recommended\n- Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions\n- Three interventions effective at increasing use of quitlines are mass-reach health communication interventions that combine cessation messages with a quitline number, provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting, and quitline referral interventions for health care systems and providers\n- Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence-based cessation treatments. Atlanta: CPTSF; 2012d. \nAvailable here.","Adults","This CPSTF is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al, 5 studies, search period 1980-2000) combined with more recent evidence (13 studies, search period January 2000July 2012). Based on this updated review, the Task Force recommendation was changed from sufficient evidence to strong evidence of effectiveness. \n\nPrimary evidence for the finding comes from 14 of these 18 studies that evaluated the effectiveness of reducing out-of-pocket costs for cessation treatments on rates of tobacco cessation, total number of tobacco users who quit, or the prevalence of tobacco use in defined populations. Twelve of the 14 studies provided measurements of change in quit rates and observed a median absolute % increase of 4.3 %age points (IQI: + 0.2 to +6.0 %age points) with follow-up periods of 3.5 months or longer. The two remaining studies observed decreases in smoking prevalence over two years in populations provided with a new tobacco cessation benefit. \n\nThe included studies also provided measurements of change in use of the covered cessation treatments, and in overall quit attempts. Fifteen studies examined changes in the use of cessation treatments, of which 11 reported differences in the rate of use and observed a median absolute % increase of 7.0 %age points (IQI: +1.4 to +18.3 %age points). Seven studies examined changes in overall quit attempts, with six studies reporting a median absolute % difference in quit attempt rates of +2.8 %age points (IQI: -0.6 to +9.1 %age points). \n\nEvidence-based treatments considered in the Task Force recommendation were based on the findings of Treating Tobacco Use and Dependence: 2008 update (Fiore et al., 2008) a series of recent systematic reviews conducted to document the evidence of effectiveness of clinical interventions and cessation treatments to reduce tobacco use among patients in health care settings and systems. Cessation treatments described in the included studies for this review were categorised for description and analysis as cessation counseling and cessation medications. The evidence-based treatments provided at reduced out-of-pocket costs in 13 of the 18 studies included both medications and counseling. Five studies assessed the effectiveness of reducing out-of-pocket costs for cessation medications only, and observed results similar to the overall body of evidence. Only one study assessed the effectiveness of reduced out-of-pocket costs only for cessation counseling, so the effectiveness of this benefits approach remains unclear. ","The CPSTF concluded that:\n- Policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit, are recommended\n- Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications\n- Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions"]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Rigotti NA, Clair C, Munafò MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3. \nAvailable here.","Adults with\nPre-existing health condition: Hospitalised patients\n","This Cochrane review aimed to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. \n\nFifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (RR 1.37, 95% CI 1.27 to 1.48; 25 trials). A specific benefit for post‐discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post‐discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. \n\nAdding NRT to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non‐significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow‐up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilisation endpoints, and found significant reductions in all‐cause mortality and hospital readmission rates over a two‐year follow‐up period. These trials were all conducted in acute care hospitals. \n\nA comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). ","The authors concluded that:\n- High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\n- The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals\n- There was no evidence of effect for interventions of lower intensity or shorter duration\n- This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone\n- There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone"]
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[null,"Bize R et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. \n\nThe reviewers  included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested carbon monoxide feedback alone and carbon monoxide combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used carbon monoxide measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of carbon monoxide and spirometry feedback in different settings. ","The authors concluded that:\n- There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation\n- Of the fifteen included studies, only two detected a significant effect of the intervention\n- Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal\n- A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect\n- Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta‐analyses; neither of these found evidence of an effect\n- Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"Lancaster  T and Stead  LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000191. DOI: 10.1002/14651858.CD000191.pub2. \nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. \n\nTwo studies provided long‐term follow‐up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled RR for quitting for silver acetate vs placebo was 1.04 (95% CI 0.69 to 1.57). ","The authors concluded that:\n- Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation\n- The CI for the ratio are quite wide but the upper limit of the CI for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%\n- Any effect of this agent is therefore likely to be smaller than NRT\n- The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Hartmann‐Boyce  J, Cahill  K, Hatsukami  D and Cornuz  J. Nicotine vaccines for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007072. DOI: 10.1002/14651858.CD007072.pub2. \nAvailable here.","Adults","This Cochrane review aimed to assess the efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type of adverse events associated with the use of nicotine vaccines. \n\nThere are no nicotine vaccines currently licensed for public use, but there are a number in development. The reviewers found four trials which met their inclusion criteria, three comparing NicVAX to placebo and one comparing NIC002 (formerly NicQbeta) to placebo. All were smoking cessation trials conducted by pharmaceutical companies as part of the drug development process, and all trials were judged to be at high or unclear risk of bias in at least one domain. Overall, 2642 smokers participated in the included studies in this review. None of the four included studies detected a statistically significant difference in long‐term cessation between participants receiving vaccine and those receiving placebo. The RR for 12 month cessation in active and placebo groups was 1.35 (95% CI 0.82 to 2.22) in the trial of NIC002 and 1.74 (95% CI 0.73 to 4.18) in one NicVAX trial. Two Phase III NicVAX trials, for which full results were not available, reported similar quit rates of approximately 11% in both groups. In the two studies with full results available, post hoc analyses detected higher cessation rates in participants with higher levels of nicotine antibodies, but these findings are not readily generalisable. The two studies with full results showed nicotine vaccines to be well tolerated, with the majority of adverse events classified as mild or moderate. In the study of NIC002, participants receiving the vaccine were more likely to report mild to moderate adverse events, most commonly flu‐like symptoms, whereas in the study of NicVAX there was no significant difference between the two arms. Information on adverse events was not available for the large Phase III trials of NicVAX. \n\nVaccine candidates are likely to undergo significant changes before becoming available to the general public, and those included in this review may not be the first to reach market; this limits the external validity of the results reported in this review in terms of both effectiveness and tolerability. ","The authors concluded that:\n- There is currently no evidence that nicotine vaccines enhance long‐term smoking cessation\n- Rates of serious adverse events recorded in the two trials with full data available were low, and the majority of adverse events reported were at mild to moderate levels\n- The evidence available suggests nicotine vaccines do not induce compensatory smoking or affect withdrawal symptoms\n- No nicotine vaccines are currently licensed for use in any country but a number are under development\n- Further trials of nicotine vaccines are needed, comparing vaccines with placebo for smoking cessation\n- Further trials are also needed to explore the potential of nicotine vaccines to prevent relapse. Results from past, current and future research should be reported in full. Adverse events and serious adverse events should continue to be carefully monitored and thoroughly reported"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacologic-Based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses. Ottawa: CADTH; 2012.\nAvailable here.","Adults","This CADTH HTA report aimed to compare the pharmacological agents (drug-based smoking cessation aids) to determine which of these works best (clinical effectiveness) at six months and 12 months after patients attempt to quit smoking. It also aimed to perform an economic analysis to determine which smoking cessation\ntherapy was the most cost-effective for patients, drug plans, and the Canadian health care system.\n\nEighty-one trials (from August 1982 to June 2009) were identified, involving a total of 40,317 participants. Varenicline, bupropion, and all six NRTs (patch, gum, lozenge, inhaler, spray, and sublingual) were found to be more efficacious than placebo after six months and one year of follow-up. Use of NRTs (OR 1.89, CredI 95% 1.63 to 2.18) or use of bupropion (OR 1.95, CredI 95% 1.58 to 2.41) was found to approximately double the odds of quitting successfully and maintaining abstinence for at least 12 months compared with placebo. Use of varenicline (OR 2.78, CredI 95% 2.17 to 3.57) also improved the odds of success between two- and three-fold. The use of mixed treatment comparisons in the review found varenicline to be superior to conventional NRT use and bupropion. There were no differences in efficacy between bupropion and NRT or between the various forms of NRT alternatives.\n\nNicotine gum, nicotine patch, and bupropion were shown to be superior compared with placebo at 12 months of follow-up in five trials (n = 1,673) assessing five different interventions for smoking cessation in smokers with cardiovascular or smoking-related diseases. For patients with chronic obstructive pulmonary disease, nicotine sublingual (one trial, n = 370) and bupropion (two trials, n = 579) were superior to placebo.\n\nThere were few RCTs of combined therapy versus monotherapy. The addition of nicotine gum to nicotine patch was superior compared with nicotine patch alone for the six-month continuous abstinence rate, but not at one year of follow-up (one RCT, n = 374). The combined therapies of nicotine patch and inhaler or bupropion and NRT did not provide an added effect compared with monotherapy (four RCTs). Thus, combined therapy should be prescribed with caution because the evidence is scarce and the adverse effects unknown.\n\nA review of existing economic analyses showed that varenicline (with or without behavioural interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results should be interpreted with caution because most of the studies comparing varenicline with bupropion or NRT were funded by the manufacturer of varenicline.\n\nThe economic analyses targeting a general population showed that, for all ages and gender, bupropion and varenicline dominated (i.e., cost less and was more effective) nicotine gum, patch, lozenge, and inhaler. If providers' willingness to pay was greater than $10,000 per QALY, then varenicline was preferred.","Based on the included evidence, this HTA report cnsludes that:\n- All pharmacotherapies under review (NRT, bupropion, and varenicline) are efficacious in helping the general population (relatively healthy smokers) quit smoking for at least six to 12 months and therefore, could all be used as aids for smoking cessation in the general population of smokers\n- Bupropion or NRT were found to be effective for those with cardiovascular disease or chronic obstructive pulmonary disease who wanted to quit smoking\n- For pharmacological interventions targeting a general population, bupropion and varenicline were dominating options (cost less and were more effective) over nicotine gum, patch, lozenge, and inhaler. If a provider's willingness to pay was greater than $10,000 per QALY gained, varenicline was the optimal treatment choice compared with NRT and bupropion"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions. Atlanta: CPTSF; 2011a. \nAvailable here.","Adolescents (age not specified)\nAdults \n","The CPSTF finding is based on evidence published in 2009 (Whittaker et al., search period through December 2008) combined with more recent evidence (search period December 2008–August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. \n\nPrimary evidence for the Task Force finding comes from six studies that evaluated the effectiveness of interventions using automated text messages for recruited participants willing to make a quit attempt. Studies were conducted in Norway, New Zealand, and the United Kingdom. All six included studies were RCTs and assessed self-reported (4 studies) or biochemically verified (2 studies) cessation outcomes at 6- or 12-month follow-up. The median loss to follow-up rate was 10%. One study included NRT, which was provided to participants in both the intervention and comparison groups.\n\nIn three studies, mobile phone text messaging was the primary cessation support intervention. The median difference in cessation rates at 6 months was an improvement of 2.9 %age points (range of values: +1.7 %age points to +4.9 %age points). In the other three studies, mobile phone messages were complemented by Internet-based components. The median difference in cessation rates at 6 months or longer was an improvement of 9 %age points (range of values: -1.2 %age points to +13.3 %age points). Only one study included NRT, which was provided to participants in both the intervention and comparison groups. ","The CPSTF concluded that:\n- Mobile phone-based interventions for tobacco cessation are recommended to increase tobacco use abstinence among people who want to quit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Internet-Based Cessation Interventions. Atlanta: CPTSF; 2011b. \nAvailable here.","Adolescents (age not specified)\nAdults","The CPSTF finding is based on evidence from SR published in 2010 (Civljak et al., search period through June 2010) combined with more recent evidence (search period June 2010-August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nPrimary evidence for the Task Force finding comes from 24 studies that evaluated the effectiveness of Internet-based interventions, implemented alone or in combination with additional interventions designed to increase tobacco cessation. As defined in the 2010 SR, the studies included in the present review were organised and considered for each comparison evaluated. Thirteen studies provided a comparison of an Internet-based intervention with usual care or a non-Internet-based intervention. Across the body of evidence, the effect estimates from these studies were inconsistent. A subset of seven of these studies targeted adult tobacco users and observed a median absolute %age point change in tobacco cessation of 3.2 %age points (IQI: -1.7 %age points to 12.5 %age points). Eleven of the 24 studies provided comparisons of one Internet-based intervention with a different Internet-based intervention. Effect estimates from these studies were inconsistent, and the examined comparisons were of limited use to the Task Force’s assessment of effectiveness.  \n\nAn additional analysis examined ten of the 24 studies that compared Internet-based interventions that provided tailored and interactive content with non-tailored-Internet or no-Internet interventions. Effect estimates from these studies were inconsistent, with a median absolute %age point increase in tobacco cessation of 2.1 %age points (IQI: 0.1 %age points to 12.5 %age points). ","The CPSTF concluded that:\n- There is insufficient evidence to determine whether internet-based interventions increase tobacco use cessation\n- Studies included in the review reported inconsistent effects, and interpretation was complicated by differences in internet-based content, components, and interactions; frequent provision of evidence-based interventions to comparison groups; and moderate to high rates of loss to follow-up"]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]
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[null,"Carr S, et al. An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 2011; 15(9).\nAvailable here.","Adults","This review aimed to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK.\nFour studies were identified that examined the impact of LAs in smoking cessation. All of the interventions were delivered on a one-to-one basis. The support was delivered via telephone or face-to-face meetings in addition to telephone calls. The contacts were supported with videos and pamphlets and access to free NRT.\nTwo studies West (1998) and May (2006) used the intervention of buddy groups, allocating a partner and encouraging exchange of telephone numbers. Financial incentives were also sued in both studies. Woodruff (2002) reviewed past quit attempts, discussed the pros and cons of smoking and quitting, discussed self-monitoring to identify smoking patterns, identified potential reinforcements and substitute behaviours and discussed appropriate coping strategies, set a quit date, discussed experiences while quitting and relapse prevention, and talked about overall lifestyle change. Emmons (2005) emphasised the smoker’s choice, personal responsibility for change and enhancement of self-efficacy. The calls were tailored to the participants’ stage of readiness to quit smoking and interest in other health topics and goals. Nicotine replacement therapy (NRT) was discussed, and was made available without cost to the intervention group’s participants and their spouses/partners who indicated in the counselling calls that they were ready to make a serious quit attempt.\nSignificantly more remained abstinent from smoking in the buddy support group after 4 weeks [15% difference, effect size 2.79 (95% CI 1.26 to 6.22)] in West 1998 but not in May 2006 (adjusted OR 1.16, 95% CI 0.76 to 1.78). Woodruff 2002120 reports that 20.3% of the intervention group had quit at 3 months compared with 8.7% of the comparison group. However, these results are based on a per-protocol analysis that ignores differential attrition in the intervention arm. Applying an intention-to-treat analysis, and assuming that all of those lost to follow-up have relapsed, gives a quit rate of 17.3% in the intervention group and 8.3% in the control group. Emmons 2005 reported that the quit rate was significantly higher in the peer counselling group than the control group (16.8% vs 8.5%, p < 0.0003) at 8 months. This difference was maintained at the 12-month follow-up (15% vs 9%, p < 0.01). Controlling for baseline self-efficacy and depression, the peer counselling group was more likely to quit smoking by the 12-month follow-up compared with the control group (12-month OR 1.99, 95% CI 1.27 to 3.14)\n\nOverall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL). The buddy schemes explored in these studies have much to offer to an analysis of intervention components and may still offer potential as a practice model.","Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. \n\nReporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions.\n \nA future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence. "]

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[null,"GUIDANCE - PHARMACOTHERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here.\n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here.\n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\nThis guideline was checked in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines (Expected publication date: 16 January 2020)."]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2008.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","The ethos of this guideline is that pregnancy is a normal physiological process and that, as such, any interventions offered should have known benefits and be acceptable to pregnant women. The guideline has been developed with the following aims: to offer information on best practice for baseline clinical care of all pregnancies and comprehensive information on the antenatal care of the healthy woman with an uncomplicated singleton pregnancy. It provides evidence‑based information for use by clinicians and pregnant women to make decisions about appropriate treatment in specific circumstances. \n\nIt provides the following guidance:\n- Woman‑centred care and informed decision‑making \n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\nThis guideline is currently being updated."]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]

{"sheet":"Cessation-Bupropion","index":6,"n_rows":502,"n_cols":5,"rows_kept":502,"cut":false,"hidden":false,"merged":[[10,1,52,1],[10,2,52,2],[10,3,52,3],[10,4,52,4],[8,1,8,4],[131,1,169,1],[131,3,169,3],[131,4,169,4],[170,1,191,1],[170,2,195,2],[170,3,197,3],[170,4,197,4],[97,1,130,1],[97,2,130,2],[97,3,130,3],[97,4,130,4],[53,1,96,1],[53,2,96,2],[53,3,96,3],[53,4,96,4],[198,1,238,1],[198,2,238,2],[198,3,238,3],[198,4,238,4],[239,1,287,1],[239,2,287,2],[239,3,287,3],[239,4,287,4],[362,1,389,1],[362,2,389,2],[362,3,389,3],[362,4,389,4],[288,1,331,1],[288,2,331,2],[288,3,331,3],[288,4,331,4],[332,1,361,1],[332,2,361,2],[332,3,361,3],[332,4,361,4],[390,1,424,1],[390,2,424,2],[390,3,424,3],[390,4,424,4],[425,1,452,1],[425,2,452,2],[425,3,452,3],[425,4,452,4],[453,1,500,1],[453,2,500,2],[453,3,500,3],[453,4,500,4],[501,1,516,1],[501,2,516,2],[501,3,516,3],[501,4,516,4]]}
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[null,"SYSTEMATIC REVIEWS: BUPROPION"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.\n","Adolescents; general adult population; pregnant women.","This is an update of 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. Results were mixed on smoking cessation effectiveness at 6 to 12 months among smokers intending to quit when compared with placebo devices or NRT.","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Howes  S, Hartmann‐Boyce  J, Livingstone‐Banks  J, Hong  B, Lindson  N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub5.\nAvailable here\n","Adult smokers","There was high‐certainty evidence that bupropion increased long‐term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate‐certainty evidence, downgraded one level due to imprecision). They found high‐certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants).\nMeta‐analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). \nThe authors also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. \n","There is high certainty evidence that bupropion can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. \nDue to the high‐certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change their interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front‐line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly."]
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[null,"Claire  R, Chamberlain  C, Davey  MA, Cooper  SE, Berlin  I, Leonardi‐Bee  J, Coleman  T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub3.\nAvailable here\n","Pregnant women","Compared to placebo and non‐placebo (behavioural support only) controls, there was low‐certainty evidence that NRT increased the likelihood of smoking abstinence in later pregnancy (RR 1.37, 95% CI 1.08 to 1.74; I² = 34%, 9 studies, 2336 women). However, in subgroup analysis by comparator type, there was a subgroup difference between placebo‐controlled and non‐placebo controlled RCTs (test for subgroup differences P = 0.008). There was unclear evidence of an effect in placebo‐controlled RCTs (RR 1.21, 95% CI 0.95 to 1.55; I² = 0%, 6 studies, 2063 women), whereas non‐placebo‐controlled trials showed clearer evidence of a benefit (RR 8.55, 95% CI 2.05 to 35.71; I² = 0%, 3 studies, 273 women). An additional subgroup analysis in which studies were grouped by the type of NRT used found no difference in the effectiveness of NRT in those using patches or fast‐acting NRT (test for subgroup differences P = 0.08). \nThere was no evidence of a difference between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities, or neonatal death. In one study infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' at two years of age compared to the placebo group. Non‐serious adverse effects observed with NRT included headache, nausea, and local reactions (e.g. skin irritation from patches or foul taste from gum), but data could not be pooled. Adherence to NRT treatment regimens was generally low. \nThe authors identified low‐certainty evidence that there was no difference in smoking abstinence rates observed in later pregnancy in women using bupropion when compared to placebo control (RR 0.74, 95% CI 0.21 to 2.64; I² = 0%, 2 studies, 76 women). Evidence investigating the safety outcomes of bupropion use was sparse, but the existing evidence showed no difference between the bupropion and control group. \n","NRT used for smoking cessation in pregnancy may increase smoking cessation rates in late pregnancy. However, this evidence is of low certainty, as the effect was not evident when potentially biased, non‐placebo‐controlled RCTs were excluded from the analysis. Future studies may therefore change this conclusion. The authors found no evidence that NRT has either positive or negative impacts on birth outcomes; however, the evidence for some of these outcomes was also judged to be of low certainty due to imprecision and inconsistency. They found no evidence that bupropion may be an effective aid for smoking cessation during pregnancy, and there was little evidence evaluating its safety in this population. Further research evidence on the efficacy and safety of pharmacotherapy and EC use for smoking cessation in pregnancy is needed, ideally from placebo‐controlled RCTs that achieve higher adherence rates and that monitor infants' outcomes into childhood. Future RCTs of NRT should investigate higher doses than those tested in the studies included in this review."]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of NRT compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Cessation Interventions for Patients with Severe Mental Illnesses: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2017b.\nAvailable here.","Adults with Pre-existing health condition: Severe mental illness","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical evidence regarding the effectiveness of smoking cessation interventions for patients with severe mental illnesses? \n2. What are the evidence-based guidelines regarding smoking cessation interventions for patients with severe mental illnesses?\n\nThis report made use of a previous Rapid Response (Smoking cessation interventions for patients with severe mental illnesses: clinical effectiveness and guidelines) on the same subject to identify studies, which was supplemented by an updated search. The original search, which was completed in July 2016, identified 325 citations, of which 25 were ordered for full-text screening. A total of 86 additional citations were identified in the literature search update. Following screening of titles and abstracts of the 86 new citations, 65 citations were excluded and 21 potentially relevant reports from the electronic search were retrieved for full-text review. Forty-five potentially relevant publications were retrieved from the grey literature search and, in addition to the 25 from the previous reference list on the topic and the 21 added in the update, 91 full texts were reviewed. Of these potentially relevant articles, 68 publications were excluded for various reasons, while 23 publications met the inclusion criteria and were included in this report. \n\nWhile concerns about safety may prevent pharmacological options from being used more often among people with severe illness, the current review did not find evidence for an increased risk of adverse events compared to the general population, or worsening of psychiatric symptoms when using NRT, varenicline or bupropion with people with severe mental illness.  \n\nAll three interventions were found to improve smoking cessation rates compared to placebo or no treatment, varenicline and bupropion may be more effective than NRT, and additional psychosocial support may enhance success. Nausea and sleep disturbances were common when using varenicline, but peaked and declined with time. Sustained effects beyond the treatment period were not generally measured, nor were varying dosages except for one study which found higher NRT dose did not improve outcomes.\n\nIn general, the quality of studies was low and sample sizes small, suggesting the need for better reporting across these studies and more adequately powered analyses.","This rapid response review concluded that:\n- NRT, varenicline and bupropion were all generally found to improve smoking cessation rates, most commonly measured as 7-day point prevalence abstinence against placebo, among people with severe mental illness\n- Varenicline and bupropion may be more effective than NRT\n- The longest follow up duration on treatment was six months, and sustained effects beyond this were unclear, except in one study that did not find an increase in suicide attempts/behaviours after one year\n- There was no evidence that adverse events occurred more often than in those without mental illness, or that psychiatric symptoms worsened\n- Nausea and sleep disturbances were common with varenicline\n- All studies included some form of psychosocial support in addition to the pharmacological intervention, and only one study considered randomizing different dosages for NRT, and did not find a difference\n- In general, the quality of studies was low and sample sizes small\n- One guideline was found, which did not favour any treatment, but suggested considering NRT, varenicline or bupropion for patients with severe mental illness, with safety caveats for the latter two that may require closer patient monitoring"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Coleman T et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub2.\nAvailable here.","Pregnant women ","This Cochrane review aimed to determine the efficacy and safety of smoking cessation pharmacotherapies (including NRT, varenicline and bupropion), other medications, or electronic nicotine delivery systems when used for smoking cessation in pregnancy. \n\nThis review includes a total of nine trials which enrolled 2210 pregnant smokers: eight trials of NRT and one trial of bupropion as adjuncts to behavioural support/cognitive behavioural therapy (CBT). The risk of bias was generally low across trials with virtually all domains of the 'Risk of bias' assessment tool being satisfied for the majority of studies. The reviewers found no trials investigating varenicline or electronic nicotine delivery systems. Compared to placebo and non‐placebo controls, there was a difference in smoking rates observed in later pregnancy favouring use of NRT (RR 1.41, 95% CI 1.03 to 1.93, eight studies, 2199 women).  However, subgroup analysis of placebo‐RCTs provided a lower RR in favour of NRT (RR 1.28, 95% CI 0.99 to 1.66, five studies, 1926 women), whereas within the two non‐placebo RCTs there was a strong positive effect of NRT, (RR 8.51, 95% CI 2.05 to 35.28, three studies, 273 women; P value for random‐effects subgroup interaction test = 0.01). There were no differences between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities or neonatal death. Compared to placebo group infants, at two years of age, infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' (one trial). Generally, adherence with trial NRT regimens was low. Non‐serious side effects observed with NRT included headache, nausea and local reactions (e.g. skin irritation from patches or foul taste from gum), but these data could not be pooled. ","The authors concluded that:\n- NRT used in pregnancy for smoking cessation increases smoking cessation rates measured in late pregnancy by approximately 40%\n- There is evidence, suggesting that when potentially‐biased, non‐placebo RCTs are excluded from analyses, NRT is no more effective than placebo\n- There is no evidence that NRT used for smoking cessation in pregnancy has either positive or negative impacts on birth outcomes\n- Evidence from the only trial to have followed up infants after birth, suggests use of NRT promotes healthy developmental outcomes in infants\n- Further research evidence on NRT efficacy and safety is needed, ideally from placebo‐controlled RCTs which achieve higher adherence rates and which monitor infants' outcomes into childhood\n- Accruing data suggests that it would be ethical for future RCTs to investigate higher doses of NRT than those tested in the included studies "]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and SAEs compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]

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[null,"SYSTEMATIC REVIEWS - VARENICLINE"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Health Technology Assessment (HTA) of smoking cessation interventions. 22 March 2017. Health Information and Quality Authority Ireland. \nAvailable here\n","Those interested in smoking cessation across public, private and voluntary sectors. ","Cessation interventions that were evaluated in this HTA include both pharmacological and non-pharmacological interventions. The pharmacological interventions assessed were: nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes), antidepressants (specifically bupropion) and nicotine receptor partial agonists (NRPAs). The non-pharmacological interventions assessed were: acupuncture, and a range of behavioural interventions including motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. Financial incentives for pregnant women to quit were also evaluated. The effectiveness and safety of these interventions is reviewed in detail in Chapters 4 and 5.","Key points/Conclusions\nReducing the prevalence of smoking is a key priority within the public health system. \nA diverse range of smoking cessation interventions is available in Ireland. \nPharmacological interventions include nicotine replacement therapy (NRT), electronic cigarettes, antidepressants (specifically bupropion) and nicotine receptor partial agonists (varenicline and cytisine).\nPrescribed nicotine replacement therapy (NRT), varenicline and bupropion are currently reimbursed through the Primary Care Reimbursement Service (PCRS), although reimbursement of NRT is limited to Medical Card holders only. \nNeither varenicline nor bupropion are indicated for use in pregnant women in Ireland.\nBupropion is contraindicated in certain patient groups, including those at increased risk of seizures and those with bipolar affective disorder. \nWarnings cautioning the use of varenicline in patients with pre-existing psychiatric conditions were lifted in May 2016 following publication of safety and efficacy data from the EAGLES trial. The study did not show a significant increase in neuropsychiatric adverse events that could be attributed to varenicline or bupropion relative to nicotine patch or placebo in patients with or without pre-existing psychiatric disorders. \nElectronic cigarettes, also known as e-cigarettes, are not currently advocated by the HSE as a means of quitting due to lack of long-term data on their safety. However, support is provided by HSE smoking cessation services to smokers who choose to use e-cigarettes in their quit attempt. \nNon-pharmacological interventions include acupuncture, motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. \nThe absence of standard definitions for behavioural interventions, including the choice of treatment provider and the intensity of the intervention (influenced by duration, number and frequency of sessions), adds complexity to their analysis. In addition, there may be substantial overlap between these interventions. Often more than one intervention is simultaneously provided, and they may be provided with or without adjunct pharmacological therapy.\n"]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of nicotine replacement therapy (NRT) compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Cessation Interventions for Patients with Severe Mental Illnesses: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2017b.\nAvailable here.","Adults with Pre-existing health condition: Severe mental illness","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical evidence regarding the effectiveness of smoking cessation interventions for patients with severe mental illnesses? \n2. What are the evidence-based guidelines regarding smoking cessation interventions for patients with severe mental illnesses?\n\nThis report made use of a previous Rapid Response (Smoking cessation interventions for patients with severe mental illnesses: clinical effectiveness and guidelines) on the same subject to identify studies, which was supplemented by an updated search. The original search, which was completed in July 2016, identified 325 citations, of which 25 were ordered for full-text screening. A total of 86 additional citations were identified in the literature search update. Following screening of titles and abstracts of the 86 new citations, 65 citations were excluded and 21 potentially relevant reports from the electronic search were retrieved for full-text review. Forty-five potentially relevant publications were retrieved from the grey literature search and, in addition to the 25 from the previous reference list on the topic and the 21 added in the update, 91 full texts were reviewed. Of these potentially relevant articles, 68 publications were excluded for various reasons, while 23 publications met the inclusion criteria and were included in this report. \n\nWhile concerns about safety may prevent pharmacological options from being used more often among people with severe illness, the current review did not find evidence for an increased risk of adverse events compared to the general population, or worsening of psychiatric symptoms when using NRT, varenicline or bupropion with people with severe mental illness.  \n\nAll three interventions were found to improve smoking cessation rates compared to placebo or no treatment, varenicline and bupropion may be more effective than NRT, and additional psychosocial support may enhance success. Nausea and sleep disturbances were common when using varenicline, but peaked and declined with time. Sustained effects beyond the treatment period were not generally measured, nor were varying dosages except for one study which found higher NRT dose did not improve outcomes.\n\nIn general, the quality of studies was low and sample sizes small, suggesting the need for better reporting across these studies and more adequately powered analyses.","This rapid response review concluded that:\n- NRT, varenicline and bupropion were all generally found to improve smoking cessation rates, most commonly measured as 7-day point prevalence abstinence against placebo, among people with severe mental illness\n- Varenicline and bupropion may be more effective than NRT\n- The longest follow up duration on treatment was six months, and sustained effects beyond this were unclear, except in one study that did not find an increase in suicide attempts/behaviours after one year\n- There was no evidence that adverse events occurred more often than in those without mental illness, or that psychiatric symptoms worsened\n- Nausea and sleep disturbances were common with varenicline\n- All studies included some form of psychosocial support in addition to the pharmacological intervention, and only one study considered randomizing different dosages for NRT, and did not find a difference\n- In general, the quality of studies was low and sample sizes small\n- One guideline was found, which did not favour any treatment, but suggested considering NRT, varenicline or bupropion for patients with severe mental illness, with safety caveats for the latter two that may require closer patient monitoring"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Leaviss J, Sullivan W, Ren S, Everson-Hock E, Stevenson M, Stevens J, et al. What is the clinical effectiveness and cost effectiveness of cytisine compared with varenicline for smoking cessation: a systematic review and economic evaluation?. Health Technology Assessment 2014;18(33)\nAvailable here\n","Adult smokers","Twenty-three (RCTs) were included in the systematic review, comprising a total of 10,610 participants. Twenty-one trials of varenicline of differing dosing schedules and two trials of cytisine at standard dose met the inclusion criteria. No head-to-head trials comparing varenicline with cytisine were identified. Cytisine was more efficacious than placebo [hazard ratio (HR) 4.27, 95% credible interval (CrI) 2.05 to 10.05], as was standard-dose varenicline (HR 2.58, 95% Crl 2.16 to 3.15). Standard-dose varenicline treatment was associated with significantly higher rates of headache, insomnia and nausea than placebo; there was no significant difference in the rates of abnormal dreams. There were no significant differences in the rates of headache or nausea between cytisine and placebo; data were identified for neither abnormal dreams nor insomnia. Using expected values, cytisine is anticipated to dominate varenicline, in that it produces more quality-adjusted life-years at a lower associated cost. This occurred in approximately 90% of the scenarios performed. However, owing to the large number of people who wish to quit smoking (estimated to be 3 million over a 10-year period), the implications of making an incorrect decision is large. The expected value of sample information indicated that conducting a head-to-head trial of cytisine and varenicline was worthwhile, and that 1000 smokers per arm was an appropriate number to recruit.\n","On the basis of the evidence included in this review, varenicline and cytisine are both effective interventions to aid smoking cessation when compared with placebo. Cytisine is estimated to be both more clinically effective and cost-effective than varenicline. However, there is uncertainty in the decision, and a head-to-head trial of cytisine and varenicline would appear to be an effective use of resources."]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]

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[null,"SYSTEMATIC REVIEW SECTION - NICOTINE REPLACEMENT THERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. \nThere is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. \nFurther evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. \nFuture studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. \nThere is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. \nThere was insufficient evidence that interventions affected oral health."]
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[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.","Adolescents; general adult population; pregnant women.","This is an update of a 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. Results were mixed on smoking cessation effectiveness at 6 to 12 months among smokers intending to quit when compared with placebo devices or NRT.","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. Available here.","Children and adolescents up to 18 years of age for cessation and 25 years of age for prevention.","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Behavioural interventions included motivational interviewing.  Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.\n","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed.\n"]
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[null,"Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308. \nAvailable here. ","Adults","This Cochrane review aimed to determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation, compared to one another.\n\nThe reviewers identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. The reviewers judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high‐certainty evidence that combination NRT (fast‐acting form + patch) results in higher long‐term quit rates than single form (Risk ratio (RR) 1.25, 95% Confidence Interval (CI) 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). \n\nModerate‐certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate‐certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate‐certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High‐certainty evidence from eight studies suggests that using either a form of fast‐acting NRT or a nicotine patch results in similar long‐term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low‐certainty evidence); 16‐hour versus 24‐hour daily patch use; duration of combination NRT use (low‐ and very low‐certainty evidence); tapering of patch dose versus abrupt patch cessation; fast‐acting NRT type (very low‐certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast‐acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant‐ versus clinician‐selected NRT. However, in most cases these findings are based on very low‐ or low‐certainty evidence, and are the findings from single studies. \n\nAdverse events, serious adverse events and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low‐ or very low‐certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac adverse events, serious adverse events or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). \n","The authors concluded that:\n- There is high‐certainty evidence that using combination NRT versus single‐form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking\n- For patch dose comparisons, evidence was of moderate certainty, due to imprecision: 21 mg patches resulted in higher quit rates than 14 mg (24‐hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16‐hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24‐hour) patches\n- Using a fast‐acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches\n- There is moderate‐certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding\n- Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty\n- New studies should ensure that adverse events, serious adverse events and withdrawals due to treatment are both measured and reported"]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of nicotine replacement therapy (NRT) compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Reduction and Cessation Interventions for Pregnant Women and Mothers of Infants: A Review of the Clinical Effectiveness. Ottawa: CADTH; 2017a.\nAvailable here.","Pregnant women and Women in post partum period","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of smoking reduction programs for Pregnant women or mothers of infants? \n2. What is the clinical effectiveness of smoking cessation interventions for Pregnant women or mothers of infants? \n\nA total of 492 citations were identified in the literature search. Following screening of titles and abstracts, 443 citations were excluded and 49 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search. Of these potentially relevant articles, 44 publications were excluded for various reasons, while seven publications, including two SRs and five RCTs, met the inclusion criteria and were included in this report. \n\n","The rapid response review concluded that:\n- Evidence on the effectiveness of smoking reduction interventions was limited\n- Psychosocial interventions for smoking cessation appeared to be effective, while the effect of health education and social support was less certain\n- The results suggest that psychosocial interventions reduced the risk of infants born with low birthweight, increased the mean birthweight, and decreased the risk of neonatal intensive care unit admission\n- Pharmacological interventions appeared to be effective during treatment or at the end of pregnancy\n- NRT did not seem to have any positive or negative effects on infant outcomes, while the safety of bupropion was inconclusive"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Cessation Interventions for Patients with Severe Mental Illnesses: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2017b.\nAvailable here.","Adults with Pre-existing health condition: Severe mental illness","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical evidence regarding the effectiveness of smoking cessation interventions for patients with severe mental illnesses? \n2. What are the evidence-based guidelines regarding smoking cessation interventions for patients with severe mental illnesses?\n\nThis report made use of a previous Rapid Response (Smoking cessation interventions for patients with severe mental illnesses: clinical effectiveness and guidelines) on the same subject to identify studies, which was supplemented by an updated search. The original search, which was completed in July 2016, identified 325 citations, of which 25 were ordered for full-text screening. A total of 86 additional citations were identified in the literature search update. Following screening of titles and abstracts of the 86 new citations, 65 citations were excluded and 21 potentially relevant reports from the electronic search were retrieved for full-text review. Forty-five potentially relevant publications were retrieved from the grey literature search and, in addition to the 25 from the previous reference list on the topic and the 21 added in the update, 91 full texts were reviewed. Of these potentially relevant articles, 68 publications were excluded for various reasons, while 23 publications met the inclusion criteria and were included in this report. \n\nWhile concerns about safety may prevent pharmacological options from being used more often among people with severe illness, the current review did not find evidence for an increased risk of adverse events compared to the general population, or worsening of psychiatric symptoms when using NRT, varenicline or bupropion with people with severe mental illness.  \n\nAll three interventions were found to improve smoking cessation rates compared to placebo or no treatment, varenicline and bupropion may be more effective than NRT, and additional psychosocial support may enhance success. Nausea and sleep disturbances were common when using varenicline, but peaked and declined with time. Sustained effects beyond the treatment period were not generally measured, nor were varying dosages except for one study which found higher NRT dose did not improve outcomes.\n\nIn general, the quality of studies was low and sample sizes small, suggesting the need for better reporting across these studies and more adequately powered analyses.","This rapid response review concluded that:\n- NRT, varenicline and bupropion were all generally found to improve smoking cessation rates, most commonly measured as 7-day point prevalence abstinence against placebo, among people with severe mental illness\n- Varenicline and bupropion may be more effective than NRT\n- The longest follow up duration on treatment was six months, and sustained effects beyond this were unclear, except in one study that did not find an increase in suicide attempts/behaviours after one year\n- There was no evidence that adverse events occurred more often than in those without mental illness, or that psychiatric symptoms worsened\n- Nausea and sleep disturbances were common with varenicline\n- All studies included some form of psychosocial support in addition to the pharmacological intervention, and only one study considered randomizing different dosages for NRT, and did not find a difference\n- In general, the quality of studies was low and sample sizes small\n- One guideline was found, which did not favour any treatment, but suggested considering NRT, varenicline or bupropion for patients with severe mental illness, with safety caveats for the latter two that may require closer patient monitoring"]
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[null,"Health Technology Assessment (HTA) of smoking cessation interventions. 22 March 2017. Health Information and Quality Authority Ireland. \nAvailable here\n","Those interested in smoking cessation across public, private and voluntary sectors. ","Cessation interventions that were evaluated in this HTA include both pharmacological and non-pharmacological interventions. The pharmacological interventions assessed were: nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes), antidepressants (specifically bupropion) and nicotine receptor partial agonists (NRPAs). The non-pharmacological interventions assessed were: acupuncture, and a range of behavioural interventions including motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. Financial incentives for pregnant women to quit were also evaluated. The effectiveness and safety of these interventions is reviewed in detail in Chapters 4 and 5.","Key points/Conclusions\nReducing the prevalence of smoking is a key priority within the public health system. \nA diverse range of smoking cessation interventions is available in Ireland. \nPharmacological interventions include nicotine replacement therapy (NRT), electronic cigarettes, antidepressants (specifically bupropion) and nicotine receptor partial agonists (varenicline and cytisine).\nPrescribed nicotine replacement therapy (NRT), varenicline and bupropion are currently reimbursed through the Primary Care Reimbursement Service (PCRS), although reimbursement of NRT is limited to Medical Card holders only. \nNeither varenicline nor bupropion are indicated for use in pregnant women in Ireland.\nBupropion is contraindicated in certain patient groups, including those at increased risk of seizures and those with bipolar affective disorder. \nWarnings cautioning the use of varenicline in patients with pre-existing psychiatric conditions were lifted in May 2016 following publication of safety and efficacy data from the EAGLES trial. The study did not show a significant increase in neuropsychiatric adverse events that could be attributed to varenicline or bupropion relative to nicotine patch or placebo in patients with or without pre-existing psychiatric disorders. \nElectronic cigarettes, also known as e-cigarettes, are not currently advocated by the HSE as a means of quitting due to lack of long-term data on their safety. However, support is provided by HSE smoking cessation services to smokers who choose to use e-cigarettes in their quit attempt. \nNon-pharmacological interventions include acupuncture, motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. \nThe absence of standard definitions for behavioural interventions, including the choice of treatment provider and the intensity of the intervention (influenced by duration, number and frequency of sessions), adds complexity to their analysis. In addition, there may be substantial overlap between these interventions. Often more than one intervention is simultaneously provided, and they may be provided with or without adjunct pharmacological therapy.\n"]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here\n","Adults","Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. \nThe evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Community pharmacy interventions are effective for smoking cessation.\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I² = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I² = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"Cahill K and Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4. \nAvailable here.","Adults","This Cochrane review aimed to firstly, categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking; and secondly, to collect and evaluate data on costs and cost effectiveness associated with workplace interventions. \n\nThe reviewers included 57 studies (61 comparisons) in this updated review. They found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, NRT, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (odds ratio (OR) for cessation 1.71, 95% CI 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. ","The authors reported that:\n- They found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere\n- Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low\n- They failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data\n- There was limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates\n- Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced"]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence. Ottawa: CADTH; 2014.\nAvailable here.","Not specified","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of newer nicotine replacement products (Nicorette Quick Mist, Nicorette Combo Quit, Nicorette Mini Lozenges) for smoking cessation?\n2. What is the clinical evidence for the use of supratherapeutic doses of NRT?\n3. What is the clinical evidence for the use of nicotine replacement products to reduce smoking for those who do not quit?\n\nThe literature search identified 303 citations, with no additional articles identified from other sources. After screening the abstracts, 13 were deemed potentially relevant and 9 met the criteria for inclusion in this review: 3 SRs and 6 RCTs.\n\nNo clinical evidence was identified for the NRT products specifically termed as the Nicorette Quick Mist, Nicorette Combo Quit, or Nicorette Mini Lozenges. Limited evidence showed that nicotine mouth spray or the combination of nicotine patch plus gum achieved higher smoking cessation than placebo. Modestly higher smoking cessation rates were observed with high doses nicotine patch compared with standard nicotine patch dose. NRT appears effective in reduction of smoking for those who did not want to quit. However, findings reported in this review should be interpreted with caution due to the potential methodological limitations and clinical heterogeneity of the body evidence. Better designed RCTs in Canadian settings are needed to determine the clinical effectiveness of the newer NRT products or the use of high doses of NRT for smoking cessation, as well as the role of NRT in smoking reduction.","This rapid response review reported that:\n- No evidence was found specific to the new products Nicorette QuickMist, Nicorette ComboQuit, and Nicorette mini lozenges\n- Limited evidence shows a higher quit rate with: nicotine mouth spray, as compared with placebo; the combination of nicotine patch plus gum, as compared with placebo; and\nhigh-dose nicotine patch, as compared with standard-dose nicotine patch\n- NRT appears effective in the reduction of smoking for those who do not want to quit\n- These findings should be interpreted with caution because of limitations of the evidence"]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and SAEs compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacologic-Based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses. Ottawa: CADTH; 2012.\nAvailable here.","Adults","This CADTH HTA report aimed to compare the pharmacological agents (drug-based smoking cessation aids) to determine which of these works best (clinical effectiveness) at six months and 12 months after patients attempt to quit smoking. It also aimed to perform an economic analysis to determine which smoking cessation\ntherapy was the most cost-effective for patients, drug plans, and the Canadian health care system.\n\nEighty-one trials (from August 1982 to June 2009) were identified, involving a total of 40,317 participants. Varenicline, bupropion, and all six NRTs (patch, gum, lozenge, inhaler, spray, and sublingual) were found to be more efficacious than placebo after six months and one year of follow-up. Use of NRTs (OR 1.89, CredI 95% 1.63 to 2.18) or use of bupropion (OR 1.95, CredI 95% 1.58 to 2.41) was found to approximately double the odds of quitting successfully and maintaining abstinence for at least 12 months compared with placebo. Use of varenicline (OR 2.78, CredI 95% 2.17 to 3.57) also improved the odds of success between two- and three-fold. The use of mixed treatment comparisons in the review found varenicline to be superior to conventional NRT use and bupropion. There were no differences in efficacy between bupropion and NRT or between the various forms of NRT alternatives.\n\nNicotine gum, nicotine patch, and bupropion were shown to be superior compared with placebo at 12 months of follow-up in five trials (n = 1,673) assessing five different interventions for smoking cessation in smokers with cardiovascular or smoking-related diseases. For patients with chronic obstructive pulmonary disease, nicotine sublingual (one trial, n = 370) and bupropion (two trials, n = 579) were superior to placebo.\n\nThere were few RCTs of combined therapy versus monotherapy. The addition of nicotine gum to nicotine patch was superior compared with nicotine patch alone for the six-month continuous abstinence rate, but not at one year of follow-up (one RCT, n = 374). The combined therapies of nicotine patch and inhaler or bupropion and NRT did not provide an added effect compared with monotherapy (four RCTs). Thus, combined therapy should be prescribed with caution because the evidence is scarce and the adverse effects unknown.\n\nA review of existing economic analyses showed that varenicline (with or without behavioural interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results should be interpreted with caution because most of the studies comparing varenicline with bupropion or NRT were funded by the manufacturer of varenicline.\n\nThe economic analyses targeting a general population showed that, for all ages and gender, bupropion and varenicline dominated (i.e., cost less and was more effective) nicotine gum, patch, lozenge, and inhaler. If providers' willingness to pay was greater than $10,000 per QALY, then varenicline was preferred.","Based on the included evidence, this HTA report cnsludes that:\n- All pharmacotherapies under review (NRT, bupropion, and varenicline) are efficacious in helping the general population (relatively healthy smokers) quit smoking for at least six to 12 months and therefore, could all be used as aids for smoking cessation in the general population of smokers\n- Bupropion or NRT were found to be effective for those with cardiovascular disease or chronic obstructive pulmonary disease who wanted to quit smoking\n- For pharmacological interventions targeting a general population, bupropion and varenicline were dominating options (cost less and were more effective) over nicotine gum, patch, lozenge, and inhaler. If a provider's willingness to pay was greater than $10,000 per QALY gained, varenicline was the optimal treatment choice compared with NRT and bupropion"]

{"sheet":"Cessation-ENDS","index":9,"n_rows":206,"n_cols":5,"rows_kept":206,"cut":false,"hidden":false,"merged":[[10,4,49,4],[8,1,8,4],[79,1,155,1],[79,2,155,2],[79,3,155,3],[79,4,155,4],[50,1,78,1],[50,2,78,2],[50,3,78,3],[50,4,78,4],[10,1,49,1],[10,2,49,2],[10,3,49,3],[156,1,204,1],[156,2,204,2],[156,3,204,3],[156,4,204,4],[205,1,234,1],[205,2,234,2],[205,3,234,3],[205,4,234,4]]}
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[null,"SYSTEMATIC REVIEWS- ELECTRONIC NICOTINE DELIVERY SYSTEMS AND E-CIGARETTES"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Hartmann-Boyce  J et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub5.\nAvailable here.\n","People defined as currently smoking cigarettes at enrolment into the studies. Participants could be motivated or unmotivated to quit.","There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than inthose randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies,1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6).\nThere was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of Adverse Effects (AEs) was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). Serious Adverse Events (SAEs) were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.44, 95% CI 0.94 to 2.19: I2 = 0; 3 studies, 1183 participants).\nThere was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC thanto non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additionalseven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). \n\nThere was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.95, 95% CI 0.52 to 1.72; I2 = 0; 6 studies, 1033 participants).\nCompared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However,this finding was of very low certainty, due to issues with imprecision and risk of bias. \nThere was some evidence that non-serious AEs weremore common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), andagain, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies,1303 participants).\n","There is moderate-certainty evidence that Electronic Cigarettes (ECs) with nicotine increase quit rates compared to NRT and compared to ECs without nicotine.\nEvidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. \nConfidence intervals were for the most part wide for data on Adverse Effects (AEs), SAEs and other safety markers, with no difference in AEsbetween nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. \n\nThe authors did not detect evidence of harm from nicotine EC, but longest follow-up was two years and the number of studies was small.\nThe main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway.\n\nTo ensure the review continues to provide up-to-date information, this review is now a living systematic review. The authors run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status."]
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[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. \nThere is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. \nFurther evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. \nThere was insufficient evidence that interventions affected oral health."]
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[null,"Health Technology Assessment (HTA) of smoking cessation interventions. 22 March 2017. Health Information and Quality Authority Ireland. \nAvailable here","Those interested in smoking cessation across public, private and voluntary sectors.","Cessation interventions that were evaluated in this HTA include both pharmacological and non-pharmacological interventions. The pharmacological interventions assessed were: nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes), antidepressants (specifically bupropion) and nicotine receptor partial agonists (NRPAs). The non-pharmacological interventions assessed were: acupuncture, and a range of behavioural interventions including motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. Financial incentives for pregnant women to quit were also evaluated. The effectiveness and safety of these interventions is reviewed in detail in Chapters 4 and 5.\n","Key points/Conclusions\nReducing the prevalence of smoking is a key priority within the public health system. \nA diverse range of smoking cessation interventions is available in Ireland. \nPharmacological interventions include nicotine replacement therapy (NRT), electronic cigarettes, antidepressants (specifically bupropion) and nicotine receptor partial agonists (varenicline and cytisine).\nPrescribed nicotine replacement therapy (NRT), varenicline and bupropion are currently reimbursed through the Primary Care Reimbursement Service (PCRS), although reimbursement of NRT is limited to Medical Card holders only. \nNeither varenicline nor bupropion are indicated for use in pregnant women in Ireland.\nBupropion is contraindicated in certain patient groups, including those at increased risk of seizures and those with bipolar affective disorder. \nWarnings cautioning the use of varenicline in patients with pre-existing psychiatric conditions were lifted in May 2016 following publication of safety and efficacy data from the EAGLES trial. The study did not show a significant increase in neuropsychiatric adverse events that could be attributed to varenicline or bupropion relative to nicotine patch or placebo in patients with or without pre-existing psychiatric disorders. \nElectronic cigarettes, also known as e-cigarettes, are not currently advocated by the HSE as a means of quitting due to lack of long-term data on their safety. However, support is provided by HSE smoking cessation services to smokers who choose to use e-cigarettes in their quit attempt. \nNon-pharmacological interventions include acupuncture, motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. \nThe absence of standard definitions for behavioural interventions, including the choice of treatment provider and the intensity of the intervention (influenced by duration, number and frequency of sessions), adds complexity to their analysis. In addition, there may be substantial overlap between these interventions. Often more than one intervention is simultaneously provided, and they may be provided with or without adjunct pharmacological therapy.\n"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Coleman T et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub2.\nAvailable here.","Pregnant women ","This Cochrane review aimed to determine the efficacy and safety of smoking cessation pharmacotherapies (including NRT, varenicline and bupropion), other medications, or electronic nicotine delivery systems when used for smoking cessation in pregnancy. \n\nThis review includes a total of nine trials which enrolled 2210 pregnant smokers: eight trials of NRT and one trial of bupropion as adjuncts to behavioural support/cognitive behavioural therapy (CBT). The risk of bias was generally low across trials with virtually all domains of the 'Risk of bias' assessment tool being satisfied for the majority of studies. The reviewers found no trials investigating varenicline or electronic nicotine delivery systems. Compared to placebo and non‐placebo controls, there was a difference in smoking rates observed in later pregnancy favouring use of NRT (RR 1.41, 95% CI 1.03 to 1.93, eight studies, 2199 women).  However, subgroup analysis of placebo‐RCTs provided a lower RR in favour of NRT (RR 1.28, 95% CI 0.99 to 1.66, five studies, 1926 women), whereas within the two non‐placebo RCTs there was a strong positive effect of NRT, (RR 8.51, 95% CI 2.05 to 35.28, three studies, 273 women; P value for random‐effects subgroup interaction test = 0.01). There were no differences between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities or neonatal death. Compared to placebo group infants, at two years of age, infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' (one trial). Generally, adherence with trial NRT regimens was low. Non‐serious side effects observed with NRT included headache, nausea and local reactions (e.g. skin irritation from patches or foul taste from gum), but these data could not be pooled. ","The authors concluded that:\n- NRT used in pregnancy for smoking cessation increases smoking cessation rates measured in late pregnancy by approximately 40%\n- There is evidence, suggesting that when potentially‐biased, non‐placebo RCTs are excluded from analyses, NRT is no more effective than placebo\n- There is no evidence that NRT used for smoking cessation in pregnancy has either positive or negative impacts on birth outcomes\n- Evidence from the only trial to have followed up infants after birth, suggests use of NRT promotes healthy developmental outcomes in infants\n- Further research evidence on NRT efficacy and safety is needed, ideally from placebo‐controlled RCTs which achieve higher adherence rates and which monitor infants' outcomes into childhood\n- Accruing data suggests that it would be ethical for future RCTs to investigate higher doses of NRT than those tested in the included studies "]

{"sheet":"Cessation-OtherPharma","index":10,"n_rows":213,"n_cols":5,"rows_kept":213,"cut":false,"hidden":false,"merged":[[8,1,8,4],[48,1,67,1],[48,2,67,2],[48,3,67,3],[48,4,67,4],[10,1,47,1],[10,2,47,2],[10,3,47,3],[10,4,47,4],[148,1,163,1],[148,2,163,2],[148,3,163,3],[148,4,163,4],[212,1,222,1],[212,2,222,2],[212,3,222,3],[212,4,222,4],[164,1,180,1],[164,2,180,2],[164,3,180,3],[164,4,180,4],[181,1,211,1],[181,3,211,3],[181,4,211,4],[68,1,130,1],[68,2,130,2],[68,3,130,3],[68,4,130,4],[131,1,147,1],[131,2,147,2],[131,3,147,3],[131,4,147,4]]}
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[null,"SYSTEMATIC REVIEWS - OTHER PHARMACOTHERAPIES"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Howes  S, Hartmann‐Boyce  J, Livingstone‐Banks  J, Hong  B, Lindson  N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub5.\nAvailable here\n","Adult Smokers","There was high‐certainty evidence that bupropion increased long‐term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate‐certainty evidence, downgraded one level due to imprecision). They found high‐certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants).\nMeta‐analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). \nThe authors also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. ","There is high‐certainty evidence that bupropion can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. \nDue to the high‐certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change their interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front‐line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly."]
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[null,"Zeng  L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub3. \nAvailable here. ","Adults with Pre-existing health condition: Lung cancer","The reviewers identified no randomised controlled trials (RCTs) RCTs that met their inclusion criteria. Among the 1817 records retrieved using their search strategy, they retrieved 19 studies for further investigation. They excluded 15 trials: ten trials because they could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. They excluded one trial because, though it was completed in 2004, no results are available. They assessed four ongoing trials for inclusion when data become available. \n","The authors concluded that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n- This systematic review identified a need for RCTs to explore these "]
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[null,"Health Technology Assessment (HTA) of smoking cessation interventions. 22 March 2017. Health Information and Quality Authority Ireland. \nAvailable here","Those interested in smoking cessation across public, private and voluntary sectors.","Cessation interventions that were evaluated in this HTA include both pharmacological and non-pharmacological interventions. The pharmacological interventions assessed were: nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes), antidepressants (specifically bupropion) and nicotine receptor partial agonists (NRPAs). The non-pharmacological interventions assessed were: acupuncture, and a range of behavioural interventions including motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. Financial incentives for pregnant women to quit were also evaluated. The effectiveness and safety of these interventions is reviewed in detail in Chapters 4 and 5.\n","Key points/Conclusions\nReducing the prevalence of smoking is a key priority within the public health system. \nA diverse range of smoking cessation interventions is available in Ireland. \nPharmacological interventions include nicotine replacement therapy (NRT), electronic cigarettes, antidepressants (specifically bupropion) and nicotine receptor partial agonists (varenicline and cytisine).\nPrescribed nicotine replacement therapy (NRT), varenicline and bupropion are currently reimbursed through the Primary Care Reimbursement Service (PCRS), although reimbursement of NRT is limited to Medical Card holders only. \nNeither varenicline nor bupropion are indicated for use in pregnant women in Ireland.\nBupropion is contraindicated in certain patient groups, including those at increased risk of seizures and those with bipolar affective disorder. \nWarnings cautioning the use of varenicline in patients with pre-existing psychiatric conditions were lifted in May 2016 following publication of safety and efficacy data from the EAGLES trial. The study did not show a significant increase in neuropsychiatric adverse events that could be attributed to varenicline or bupropion relative to nicotine patch or placebo in patients with or without pre-existing psychiatric disorders. \nElectronic cigarettes, also known as e-cigarettes, are not currently advocated by the HSE as a means of quitting due to lack of long-term data on their safety. However, support is provided by HSE smoking cessation services to smokers who choose to use e-cigarettes in their quit attempt. \nNon-pharmacological interventions include acupuncture, motivational interviewing, brief advice, telephone-based interventions, Internet-based interventions, mobile phone-based interventions, individual behavioural counselling, group behaviour therapy and the Allen Carr method. \nThe absence of standard definitions for behavioural interventions, including the choice of treatment provider and the intensity of the intervention (influenced by duration, number and frequency of sessions), adds complexity to their analysis. In addition, there may be substantial overlap between these interventions. Often more than one intervention is simultaneously provided, and they may be provided with or without adjunct pharmacological therapy.\n"]
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[null,"Leaviss J, Sullivan W, Ren S, Everson-Hock E, Stevenson M, Stevens J, et al. What is the clinical effectiveness and cost effectiveness of cytisine compared with varenicline for smoking cessation: a systematic review and economic evaluation?. Health Technology Assessment 2014;18(33)\nAvailable here","Adult smokers","Twenty-three (RCTs) were included in the systematic review, comprising a total of 10,610 participants. Twenty-one trials of varenicline of differing dosing schedules and two trials of cytisine at standard dose met the inclusion criteria. No head-to-head trials comparing varenicline with cytisine were identified. Cytisine was more efficacious than placebo [hazard ratio (HR) 4.27, 95% credible interval (CrI) 2.05 to 10.05], as was standard-dose varenicline (HR 2.58, 95% Crl 2.16 to 3.15). Standard-dose varenicline treatment was associated with significantly higher rates of headache, insomnia and nausea than placebo; there was no significant difference in the rates of abnormal dreams. There were no significant differences in the rates of headache or nausea between cytisine and placebo; data were identified for neither abnormal dreams nor insomnia. Using expected values, cytisine is anticipated to dominate varenicline, in that it produces more quality-adjusted life-years at a lower associated cost. This occurred in approximately 90% of the scenarios performed. However, owing to the large number of people who wish to quit smoking (estimated to be 3 million over a 10-year period), the implications of making an incorrect decision is large. The expected value of sample information indicated that conducting a head-to-head trial of cytisine and varenicline was worthwhile, and that 1000 smokers per arm was an appropriate number to recruit.\n","On the basis of the evidence included in this review, varenicline and cytisine are both effective interventions to aid smoking cessation when compared with placebo. Cytisine is estimated to be both more clinically effective and cost-effective than varenicline. However, there is uncertainty in the decision, and a head-to-head trial of cytisine and varenicline would appear to be an effective use of resources."]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Lancaster  T and Stead  LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000191. DOI: 10.1002/14651858.CD000191.pub2. \nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. \n\nTwo studies provided long‐term follow‐up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled RR for quitting for silver acetate vs placebo was 1.04 (95% CI 0.69 to 1.57). ","The authors concluded that:\n- Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation\n- The CI for the ratio are quite wide but the upper limit of the CI for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%\n- Any effect of this agent is therefore likely to be smaller than NRT\n- The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus "]
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[null,"Hartmann‐Boyce  J, Cahill  K, Hatsukami  D and Cornuz  J. Nicotine vaccines for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007072. DOI: 10.1002/14651858.CD007072.pub2. \nAvailable here.","Adults","This Cochrane review aimed to assess the efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type of adverse events associated with the use of nicotine vaccines. \n\nThere are no nicotine vaccines currently licensed for public use, but there are a number in development. The reviewers found four trials which met their inclusion criteria, three comparing NicVAX to placebo and one comparing NIC002 (formerly NicQbeta) to placebo. All were smoking cessation trials conducted by pharmaceutical companies as part of the drug development process, and all trials were judged to be at high or unclear risk of bias in at least one domain. Overall, 2642 smokers participated in the included studies in this review. None of the four included studies detected a statistically significant difference in long‐term cessation between participants receiving vaccine and those receiving placebo. The RR for 12 month cessation in active and placebo groups was 1.35 (95% CI 0.82 to 2.22) in the trial of NIC002 and 1.74 (95% CI 0.73 to 4.18) in one NicVAX trial. Two Phase III NicVAX trials, for which full results were not available, reported similar quit rates of approximately 11% in both groups. In the two studies with full results available, post hoc analyses detected higher cessation rates in participants with higher levels of nicotine antibodies, but these findings are not readily generalisable. The two studies with full results showed nicotine vaccines to be well tolerated, with the majority of adverse events classified as mild or moderate. In the study of NIC002, participants receiving the vaccine were more likely to report mild to moderate adverse events, most commonly flu‐like symptoms, whereas in the study of NicVAX there was no significant difference between the two arms. Information on adverse events was not available for the large Phase III trials of NicVAX. \n\nVaccine candidates are likely to undergo significant changes before becoming available to the general public, and those included in this review may not be the first to reach market; this limits the external validity of the results reported in this review in terms of both effectiveness and tolerability. ","The authors concluded that:\n- There is currently no evidence that nicotine vaccines enhance long‐term smoking cessation\n- Rates of serious adverse events recorded in the two trials with full data available were low, and the majority of adverse events reported were at mild to moderate levels\n- The evidence available suggests nicotine vaccines do not induce compensatory smoking or affect withdrawal symptoms\n- No nicotine vaccines are currently licensed for use in any country but a number are under development\n- Further trials of nicotine vaccines are needed, comparing vaccines with placebo for smoking cessation\n- Further trials are also needed to explore the potential of nicotine vaccines to prevent relapse. Results from past, current and future research should be reported in full. Adverse events and serious adverse events should continue to be carefully monitored and thoroughly reported"]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]

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[null,"GUIDANCE - PSYCHOSOCIAL THERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering advice or education to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering behavioural support to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for signposting and referral to other services and support. NG102. London: NICE; 2018. Available here.","This guideline is for:\n- Community pharmacies, local pharmaceutical committees and pharmacy organisations\n- Commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England\n- Local professional networks (hosted by NHS England)\n- Health and wellbeing boards.","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n"]
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[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\nThis guideline was checked in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines (Expected publication date: 16 January 2020)."]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2008.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","The ethos of this guideline is that pregnancy is a normal physiological process and that, as such, any interventions offered should have known benefits and be acceptable to pregnant women. The guideline has been developed with the following aims: to offer information on best practice for baseline clinical care of all pregnancies and comprehensive information on the antenatal care of the healthy woman with an uncomplicated singleton pregnancy. It provides evidence‑based information for use by clinicians and pregnant women to make decisions about appropriate treatment in specific circumstances. \n\nIt provides the following guidance:\n- Woman‑centred care and informed decision‑making \n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\nThis guideline is currently being updated."]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]

{"sheet":"Cessation-CBT","index":12,"n_rows":36,"n_cols":5,"rows_kept":36,"cut":false,"hidden":false,"merged":[[8,1,8,4],[35,1,94,1],[35,2,39,2],[35,3,114,3],[35,4,114,4],[10,1,34,1],[10,2,34,2],[10,3,34,3],[10,4,34,4]]}
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[null,"SYSTEMATIC REVIEWS - COGNITIVE BEHAVIOURAL THERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Roelsgaard  IK et al. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012958. DOI: 10.1002/14651858.CD012958.pub2. \nAvailable here.","Adults with Pre-existing health conditions: Inflammatory joint diseases","This Cochrane review aimed to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with inflammatory joint diseases.\n\nThe reviewers included two studies with 57 smokers with a diagnosis of rheumatoid arthritis. They identified no studies including other inflammtry joint diseases. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight‐week cognitive‐behavioural patient education intervention on CVD risk for people with rheumatoid arthritis and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta‐analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non‐serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. They assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE.","The authors concluded that:\n\n- They found very little research investigating the efficacy of smoking cessation intervention specifically in people with inflammatory joint diseases\n- Included studies are limited by imprecision, risk of bias, and indirectness\n- Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with inflammatory joint diseases\n- High‐quality, adequately powered studies are warranted\n- In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long‐term smoking cessation."]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]

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[null,"SYSTEMATIC REVIEWS - BEHAVIOUR SUPPORT"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.\n","Adolescents; general adult population; pregnant women.","This is an update of a 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. \n","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and adolescents up to 18 years of age for cessation and 25 years of age for prevention.","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Whittaker  R, McRobbie  H, Bullen  C, Rodgers  A, Gu  Y, Dobson  R. Mobile phone text messaging and app‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub5.\nAvailable here.","Adults\nAdolescents","This review includes 26 studies (33,849 participants). Overall, the authors judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high‐income countries. \nThere was moderate‐certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate‐certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). \nTwo studies comparing text messaging with other smoking cessation interventions, and three studies comparing high‐ and low‐intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. \nFive studies compared a smoking cessation smartphone app with lower‐intensity smoking cessation support (either a lower‐intensity app or non‐app minimal support). The authors pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so the authors did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. ","There is moderate‐certainty evidence that automated text message‐based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. \nThere is moderate‐certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. \nThe evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions."]
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[null,"Tzelepis  F, Paul  CL, Williams  CM, Gilligan  C, Regan  T, Daly  J, Hodder  RK, Byrnes  E, Byaruhanga  J, McFadyen  T, Wiggers  J. Real‐time video counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD012659. DOI: 10.1002/14651858.CD012659.pub2.\nAvailable here.","Adults\nAdults with pre-existing health conditions: women with HIV.","The authors included two randomised trials with 615 participants. Both studies delivered real‐time video counselling for smoking cessation individually, compared with telephone counselling. They judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow‐up) across the two included studies when real‐time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). The authors judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real‐time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI –0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD –0.20, 95% CI –0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI –0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between‐group differences on satisfaction score (MD 0.70, 95% CI –1.16 to 2.56; 1 study, 29 participants). ","There is very little evidence about the effectiveness of real‐time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. \nHigh‐quality randomised trials comparing real‐time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real‐time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation. "]
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[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Carson‐Chahhoud  KV, Livingstone‐Banks  J, Sharrad  KJ, Kopsaftis  Z, Brinn  MP, To‐A‐Nan  R, Bond  CM. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003698. DOI: 10.1002/14651858.CD003698.pub3.\nAvailable here.","Adults","The authors identified seven studies including 1774 participants. They judged three studies to be at high risk of bias and four to be at unclear risk.\nEach study provided face‐to‐face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards.\nComparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one‐off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. \n All studies took place in high‐income countries, and recruited participants visiting pharmacies.\nThe authors pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow‐up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low‐certainty evidence). ","Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low‐certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion. "]
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[null,"Lindson  N, Klemperer  E, Hong  B, Ordóñez‐Mena  JM, Aveyard  P. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2.\nAvailable here.",null,"The authors identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. The authors judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. \n\nThe authors identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects. \n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. \n","The authors concluded that:\n-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 another. Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty.\n-There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence).\n-Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms."]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I² = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I² = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I² = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here\n","Adults","Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. \nThere is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Community pharmacy interventions are effective for smoking cessation.\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Jeyashree K et al. Smoking cessation interventions for pulmonary tuberculosis treatment outcomes. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011125. DOI: 10.1002/14651858.CD011125.pub2.\nAvailable here.","Adults with Pre-existing health condition: Tuberculosis","This Cochrane review aimed to analyse the effect of tobacco smoking cessation interventions on the treatment outcomes of people with adult pulmonary tuberculosis (TB).\n\nThere were no RCTs that met the eligibility criteria. A number of potentially eligible studies are underway, and the reviewers will assess them for inclusion in the next update of this review. ","The authors concluded that:\n- There is a lack of high‐quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes\n- There is a need for good‐quality RCTs that assess the effect of smoking cessation interventions on TB treatment outcomes in both the short and long term\n- Establishing such an evidence base would be an essential step towards the implementation of smoking cessation interventions in TB control programmes worldwide"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I² = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I² = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"Barth J, Jacob T, Daha  I and Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD006886. DOI: 10.1002/14651858.CD006886.pub2.\nAvailable here.","Adults with Pre-existing health condition: Coronary heart disease (CHD)","This Cochrane review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with CHD in short‐term (6 to 12 month follow‐up) and long‐term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification.\n\nThe reviewers found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long‐term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self‐help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction. \n\nAfter an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (RR 1.22, 95% CI 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow‐up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non‐validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self‐help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow‐up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow‐up, one or more contacts in total over an hour with no follow‐up or any initial contact plus follow‐up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long‐term follow‐up (over 12 months), and did not show any benefits. \n\nAdverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). ","The authors concluded that:\n- Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration\n- After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost‐effectiveness analyses are needed\n- Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. NRT) compared with pharmacological treatment alone and investigate economic outcomes"]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Rigotti NA, Clair C, Munafò MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3. \nAvailable here.","Adults with\nPre-existing health condition: Hospitalised patients\n","This Cochrane review aimed to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. \n\nFifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (RR 1.37, 95% CI 1.27 to 1.48; 25 trials). A specific benefit for post‐discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post‐discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. \n\nAdding NRT to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non‐significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow‐up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilisation endpoints, and found significant reductions in all‐cause mortality and hospital readmission rates over a two‐year follow‐up period. These trials were all conducted in acute care hospitals. \n\nA comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). ","The authors concluded that:\n- High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\n- The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals\n- There was no evidence of effect for interventions of lower intensity or shorter duration\n- This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone\n- There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone"]

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[null,"SYSTEMATIC REVIEWS - MOTIVATIONAL INTERVIEWING"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.\n","Adolescents; general adult population; pregnant women.","This is an update of a 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. ","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020. Available here.","Children and adolescents up to 18 years of age for cessation and 25 years of age for prevention.","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Behavioural interventions included motivational interviewing.  Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.\n","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed.\n"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacist-Led Interventions for Tobacco Smoking Cessation: A Review of the Clinical Effectiveness and Cost-Effectiveness. Ottawa: CADTH; 2019.\nAvailable here.","Adults","This CADTH rapid response review aimed to answer the following research questions:\n\n1. What is the clinical effectiveness of pharmacist-led tobacco smoking cessation interventions?\n2. What is the cost-effectiveness of pharmacist-led tobacco smoking cessation interventions versus self-directed smoking cessation interventions?\n\nA total of 458 citations were identified in the literature search. Following screening of titles and abstracts, 413 citations were excluded and 45 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 47 publications were excluded for various reasons, and four publications met the inclusion criteria and were included in this report. These comprised four SRs. Of the excluded studies, one was an overview of reviews\nthat met the inclusion criteria for this report; however, only one of the included SRs was relevant to this report, and because it was captured by the search and contained more comprehensive information, the SR was retained directly and the overview was excluded. Two other SRs met the inclusion criteria but were excluded for having overlapping primary studies with more comprehensive SRs included in this report. ","This rapid response review concluded that:\n- The overall quality of evidence was low, and high heterogeneity existed between the included studies, making it difficult to determine the overall effectiveness of these interventions\n- Very low- to moderate-quality evidence from three systematic reviews suggested that pharmacist-led smoking cessation interventions may lead to higher rates or no difference in rates of smoking cessation, as compared to usual care or no intervention, although there was a high degree of uncertainty in these findings\n- No other clinical effectiveness outcomes, including adverse events, were reported\n- Evidence of unknown quality from one very low-quality systematic review suggested that pharmacist-led smoking cessation interventions were cost-effective in Europe\n- Given the limited availability and low quality of evidence, the clinical effectiveness and cost-effectiveness of pharmacist-led interventions for smoking cessation remain uncertain\n"]

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[null,"SYSTEMATIC REVIEWS - OTHER PSYCHOSOCIAL THERAPIES"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Matkin  W, Ordóñez‐Mena  JM, Hartmann‐Boyce  J. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub4.\nAvailable here","Mostly adult smokers from the general population, but some studies also looked at teenagers, pregnant women, and people with long‐term or mental health conditions. ","The authors identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long‐term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms. \n\nAmong trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self‐help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, the reviewers downgraded the certainty of the evidence to moderate. \n\nIn studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, the authors downgraded the certainty of the evidence to moderate. In subgroup analysis, they found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta‐regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self‐help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). ","There is moderate‐certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate‐certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. \n\nThere is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. \n\nEvidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention. "]
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[null,"Ussher  MH, Faulkner  GEJ, Angus  K, Hartmann‐Boyce  J, Taylor  AH. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub6.\nAvailable here. ","Adults","The authors identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group‐based cardiovascular‐type exercise supplemented by a home‐based exercise programme and combined with a multi‐session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi‐session cognitive behavioural smoking cessation programme alone. Overall, they judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. \n\nAmong the 21 studies analysed, the authors found low‐certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). They excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular‐type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular‐type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when the authors excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, they found very low‐certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long‐term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). \n","There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions. "]
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[null,"Zeng  L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub3. \nAvailable here. ","Adults with Pre-existing health condition: Lung cancer","The reviewers identified no randomised controlled trials (RCTs) RCTs that met their inclusion criteria. Among the 1817 records retrieved using their search strategy, they retrieved 19 studies for further investigation. They excluded 15 trials: ten trials because they could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. They excluded one trial because, though it was completed in 2004, no results are available. They assessed four ongoing trials for inclusion when data become available. \n","The authors concluded that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n- This systematic review identified a need for RCTs to explore these "]
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[null,"Barnes  J et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008.pub3. \nAvailable here. ","Adults","The reviewers included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta‐analysis was not possible. They judged only one study to be at low risk of bias overall; they judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations. \n\nPooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention‐matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity. \n\nMost studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event ‘index’ between hypnotherapy and relaxation. \n","The authors concluded that:\n- There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting\n- If a benefit is present, current evidence suggests the benefit is small at most\n- There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does\n- Further large, high‐quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacist-Led Interventions for Tobacco Smoking Cessation: A Review of the Clinical Effectiveness and Cost-Effectiveness. Ottawa: CADTH; 2019.\nAvailable here.","Adults","This CADTH rapid response review aimed to answer the following research questions:\n\n1. What is the clinical effectiveness of pharmacist-led tobacco smoking cessation interventions?\n2. What is the cost-effectiveness of pharmacist-led tobacco smoking cessation interventions versus self-directed smoking cessation interventions?\n\nA total of 458 citations were identified in the literature search. Following screening of titles and abstracts, 413 citations were excluded and 45 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 47 publications were excluded for various reasons, and four publications met the inclusion criteria and were included in this report. These comprised four SRs. Of the excluded studies, one was an overview of reviews\nthat met the inclusion criteria for this report; however, only one of the included SRs was relevant to this report, and because it was captured by the search and contained more comprehensive information, the SR was retained directly and the overview was excluded. Two other SRs met the inclusion criteria but were excluded for having overlapping primary studies with more comprehensive SRs included in this report. ","This rapid response review concluded that:\n- The overall quality of evidence was low, and high heterogeneity existed between the included studies, making it difficult to determine the overall effectiveness of these interventions\n- Very low- to moderate-quality evidence from three systematic reviews suggested that pharmacist-led smoking cessation interventions may lead to higher rates or no difference in rates of smoking cessation, as compared to usual care or no intervention, although there was a high degree of uncertainty in these findings\n- No other clinical effectiveness outcomes, including adverse events, were reported\n- Evidence of unknown quality from one very low-quality systematic review suggested that pharmacist-led smoking cessation interventions were cost-effective in Europe\n- Given the limited availability and low quality of evidence, the clinical effectiveness and cost-effectiveness of pharmacist-led interventions for smoking cessation remain uncertain\n"]
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[null,"Faseru B et al. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD002928. DOI: 10.1002/14651858.CD002928.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component. \n\nIt identified 465 citations, which were assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n =  3370). \nThe definition of partner varied among the studies.  The reviewers compared partner support versus control interventions at six‐ to nine‐month follow‐up and at 12 or more months follow‐up. They also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self‐reported smoking cessation rates, with limited biochemical verification of abstinence. \n\nThe pooled RR for abstinence was 0.97 (95% CI 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post‐treatment. \n\nOf the 11 studies that measured partner support at follow‐up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. The reviewers judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system the reviewers rated the overall quality of the evidence for the two primary outcomes as low. They downgraded due to the risk of bias, as they judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. They also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. ","The authors concluded that:\n- Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation\n- Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified"]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Stead LF, Carroll AJ and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub3.\nAvailable here.","Adults","This Cochrane review aimed to determine the effect of group‐delivered behavioural interventions in achieving long‐term smoking cessation. \n\nThe reviewers identified sixty‐six trials to meet their inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self‐help programme; there was an increase in cessation with the use of a group programme (n =  4395, RR 1.88, 95% CI 1.52 to 2.33, I² = 0%). They judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (n =  7286, RR 1.22, 95% CI 1.03 to 1.43, I² = 59%). They judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. \n\nThere was also low quality evidence of benefit of a group programme compared to no‐intervention controls, (9 trials, n =  1098, RR 2.60, 95% CI 1.80 to 3.76 I² = 55%). They did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, n =  980, RR 0.99, 95% CI 0.76 to 1.28, I² = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same‐length or shorter programmes without these components. ","The authors conclulded that:\n- Group therapy is better for helping people stop smoking than self‐help, and other less intensive interventions\n- There is not enough evidence to evaluate whether groups are more effective, or cost‐effective, than intensive individual counselling\n- There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Reduction and Cessation Interventions for Pregnant Women and Mothers of Infants: A Review of the Clinical Effectiveness. Ottawa: CADTH; 2017a.\nAvailable here.","Pregnant women and Women in post partum period","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of smoking reduction programs for Pregnant women or mothers of infants? \n2. What is the clinical effectiveness of smoking cessation interventions for Pregnant women or mothers of infants? \n\nA total of 492 citations were identified in the literature search. Following screening of titles and abstracts, 443 citations were excluded and 49 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search. Of these potentially relevant articles, 44 publications were excluded for various reasons, while seven publications, including two SRs and five RCTs, met the inclusion criteria and were included in this report. \n\n","The rapid response review concluded that:\n- Evidence on the effectiveness of smoking reduction interventions was limited\n- Psychosocial interventions for smoking cessation appeared to be effective, while the effect of health education and social support was less certain\n- The results suggest that psychosocial interventions reduced the risk of infants born with low birthweight, increased the mean birthweight, and decreased the risk of neonatal intensive care unit admission\n- Pharmacological interventions appeared to be effective during treatment or at the end of pregnancy\n- NRT did not seem to have any positive or negative effects on infant outcomes, while the safety of bupropion was inconclusive"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Mindfulness Interventions for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Use Disorders: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015.\nAvailable here.","Adults with Pre-existing health condition and other populatiion: Post traumatic stress disorder, generalised anxiety disorder and depression","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders? \n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, depression, or substance use disorders? \n\nFor the purposes of this map, data relevant to the map has only been presented here.\n  \nOne SR and one RCT assessing mindfulness interventions in patients with substance use disorder were identified. The SR was conducted in Italy and included 24 studies (14 RCTs and ten non-RCTs). Twelve studies focused on alcohol and/or heterogeneous substance use, four on cigarette smoking, three on opiate use, one on marijuana use, and one on metamphetamine use. Eight studies focused on mindfulness-based stress reduction or related mindfulness-based interventions, five on acceptance and commitment therapy, three on Spiritual self-schema therapy , two on Dialectical behavioral therapy, one study focused on a Vipassana meditation (where individuals assume a seated position and focus their attention onto the breath), one study focused on goal management training in adjunct to mindfulness meditation, and one study focused on a motivational intervention in adjunct to mindfulness meditation. Ten of the included studies compared mindfulness-based interventions to a waiting list, eight compared it with an active treatment, two compared it with non-specific educational interventions designed to be structurally its equivalent. One study included adult patients enrolled in a substance abuse aftercare program. Mindfulness-based relapse prevention was compared to relapse prevention or treatment as usual in this RCT. Relapse to drug use and heavy drinking frequency of substance use in the past 90 days was assessed. \n \nThe evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited, where only one RCT was identified which concluded that the mindfulness intervention was more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. The only SR for substance use disorders included in this report concluded a lack of randomisation or of randomisation details, objective measures of drug use, and of information for treatment adherence, as well as small sample sizes, and raised concerns as to whether observed findings were actually due to the delivered interventions or are more properly attributable to methodological biases of included studies. \n\nSix evidence-based guidelines considered the use of mindfulness in clinical practice, of which one suggested  that Mindfulness-Based Stress Reduction can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals. ","This rapid response review reported that:\n- One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking\n- One evidence-based guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals \n "]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]

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[null,"GUIDANCE - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering advice or education to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering behavioural support to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for signposting and referral to other services and support. NG102. London: NICE; 2018. Available here.","This guideline is for:\n- Community pharmacies, local pharmaceutical committees and pharmacy organisations\n- Commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England\n- Local professional networks (hosted by NHS England)\n- Health and wellbeing boards.","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n"]
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[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\nThis guideline was checked in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines (Expected publication date: 16 January 2020)."]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"SYSTEMATIC REVIEWS - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Petkovic  J et al. Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.: CD012932. DOI: 10.1002/14651858.CD012932.pub2.\nAvailable here\n","Adults","This Cochrane review aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects.\nThe authors compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. They found a range of effects on health behaviours, such as tobacco use and attitudes to tobacco. When looking at tobacco use in terms of any interactive social media intervention compared to a non-interactive social media control, the authors found a small effect favouring the non-interactive control (4 studies, 7302 participants, 95% CI 0.98 [0.74 , 1.29]).\nWhen looking at tobacco attitudes in terms of interactive social media intervention compared to non-interactive social media, the authors found a small effect favouring interactive social media (1 study, 315 participants, 95% CI 1.10 [-3.38 , 5.58]). \n","Compared with non-interactive programmes, social media programmes may show little to no effect on health behaviours such as better diet or reducing tobacco use (evidence from 54 studies in 20,139 people).\nWhile the authors assessed many outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of the included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase understanding of the potential effect of these interventions on reducing health inequities.\n"]
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[null,"Community Preventive Services Task Force. (2019). Tobacco Use and Secondhand Smoke Exposure: Internet-based Interventions to Increase Tobacco Use Cessation. USA.Gov. Available here.\n\nUnderpinning evidence review:\nMcCrabb et al, Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis. Annals of Behavioral Medicine 2019:53(2):180-95. Available here. ","This guidance is for:\nAdolescents and Young Adults\nAdults\nOlder Adults\nParents/Caregivers","The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The underpinning review (McCrabb et al) was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation. The review included 45 studies. The CPSTF examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.\n\nThe CPSTF findings are based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.\n\nFindings\n-Internet-based interventions increased tobacco use cessation rates by a median of 1.2 percentage points overall (31 studies).\n-Differences in cessation rates were slightly larger when internet-based interventions were compared to no intervention, usual care, printed materials, or basic website content (median increase of 1.3 percentage points; 17 studies).\n-Differences in cessation rates were smaller when internet-based interventions were compared to other interventions that provided interactive content, cessation counseling, or evidence-based cessation medications (median increase of 0.8 percentage points; 14 studies).\n-Most studies provided internet, cessation counseling, or medication interventions to participants in the comparison group.\n-Participants in both intervention and comparison groups quit at meaningful rates, which minimized differences.","Recommendation\nThe Community Preventive Services Task Force (CPSTF) recommends internet-based cessation interventions based on sufficient evidence of effectiveness in increasing tobacco use cessation among adult tobacco users. Systematic review evidence showed meaningful improvements in tobacco cessation outcomes when measured six or more months following intervention. "]
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[null,"Matkin  W, Ordóñez‐Mena  JM, Hartmann‐Boyce  J. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub4.\nAvailable here","Mostly adult smokers from the general population, but some studies also looked at teenagers, pregnant women, and people with long‐term or mental health conditions. ","The authors identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long‐term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms. \n\nAmong trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self‐help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, the reviewers downgraded the certainty of the evidence to moderate. \n\nIn studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, the authors downgraded the certainty of the evidence to moderate. In subgroup analysis, they found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta‐regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self‐help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). ","There is moderate‐certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate‐certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. \n\nThere is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. \n\nEvidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention. "]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Clair C et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub5. \nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking‐related diseases in helping them to quit smoking. \n\nThe reviwers included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking‐related disease risk (five studies); and feedback on smoking‐related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking‐related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking‐related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). ","The authors concluded that:\n- There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation\n- The most promising results relate to spirometry and carotid ultrasound, where moderate‐certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but CIs very narrowly missed one, and the point estimate favoured the intervention\n- A sensitivity analysis removing those studies at high risk of bias did detect a benefit\n- Moderate‐certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring\n- Low‐certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking‐related risk by genetic marker testing\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Clair C et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub5. \nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking‐related diseases in helping them to quit smoking. \n\nThe reviwers included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking‐related disease risk (five studies); and feedback on smoking‐related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking‐related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking‐related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). ","The authors concluded that:\n- There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation\n- The most promising results relate to spirometry and carotid ultrasound, where moderate‐certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but CIs very narrowly missed one, and the point estimate favoured the intervention\n- A sensitivity analysis removing those studies at high risk of bias did detect a benefit\n- Moderate‐certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring\n- Low‐certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking‐related risk by genetic marker testing\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Taylor GMJ et al. Internet‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858.CD007078.pub5.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to determine the effectiveness of Internet‐based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. \n\nThe reviewers  identified 67 RCTs, including data from over 110,000 participants. They pooled data from 35,969 participants. There were only four RCTs conducted in adolescence or young adults that were eligible for meta‐analysis. \n\nResults for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non‐active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n =   6786). However, statistical heterogeneity was high (I² = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n =   3806, I² = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non‐active control (n =   2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I² = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n =  2769, I² = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n =   14,623, I² = 0%); GRADE rating was moderate. Three studies compared tailored with non‐tailored Internet‐based messages, compared to non‐tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n =  4040), and there was evidence of unexplained substantial statistical heterogeneity (I² = 57%); GRADE rating was low. \n\nResults should be interpreted with caution as the reviewers judged some of the included studies to be at high risk of bias. ","The authors concluded that:\n- The evidence from trials in adults suggests that interactive and tailored Internet‐based interventions with or without additional behavioural support are moderately more effective than non‐active controls at six months or longer\n- There was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity\n- Treatment effectiveness in younger people is unknown "]
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[null,"Thomas D et al. System change interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD010742. DOI: 10.1002/14651858.CD010742.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.\n\nThe reviewers included seven cluster‐randomised controlled studies in this review. They rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow‐up (four studies), and for the secondary outcome ‘prescribing of smoking cessation medications' (two studies). \n\nFour studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. ","The authors concluded that:\n- The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services\n- The available research is limited, therefore it was not feasible to draw strong conclusions\n- There is a need for additional high‐quality research to explore the impact of system change interventions on both cessation and system‐level outcomes"]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Reduction and Cessation Interventions for Pregnant Women and Mothers of Infants: A Review of the Clinical Effectiveness. Ottawa: CADTH; 2017a.\nAvailable here.","Pregnant women and Women in post partum period","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of smoking reduction programs for Pregnant women or mothers of infants? \n2. What is the clinical effectiveness of smoking cessation interventions for Pregnant women or mothers of infants? \n\nA total of 492 citations were identified in the literature search. Following screening of titles and abstracts, 443 citations were excluded and 49 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search. Of these potentially relevant articles, 44 publications were excluded for various reasons, while seven publications, including two SRs and five RCTs, met the inclusion criteria and were included in this report. \n\n","The rapid response review concluded that:\n- Evidence on the effectiveness of smoking reduction interventions was limited\n- Psychosocial interventions for smoking cessation appeared to be effective, while the effect of health education and social support was less certain\n- The results suggest that psychosocial interventions reduced the risk of infants born with low birthweight, increased the mean birthweight, and decreased the risk of neonatal intensive care unit admission\n- Pharmacological interventions appeared to be effective during treatment or at the end of pregnancy\n- NRT did not seem to have any positive or negative effects on infant outcomes, while the safety of bupropion was inconclusive"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Whittaker R et al. Mobile phone‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub4.\nAvailable here.","Adolescents\nAdults\n","This Cochrane review aimed to determine whether mobile phone‐based smoking cessation interventions increase smoking cessation in people who smoke and want to quit. \n\nThis updated search identified 12 studies with six‐month smoking cessation outcomes, including seven studies completed since the previous review. The interventions were predominantly text messaging‐based, although several paired text messaging with in‐person visits or initial assessments. Two studies gave pre‐paid mobile phones to low‐income human immunodeficiency virus (HIV) positive populations; one solely for phone counselling, the other also included text messaging. One study used text messages to link to video messages. Control programmes varied widely. Studies were pooled according to outcomes ‐ some providing measures of continuous abstinence or repeated measures of point prevalence; others only providing 7‐day point prevalence abstinence. All 12 studies pooled using their most rigorous 26‐week measures of abstinence provided an RR of 1.67 (95% CI 1.46 to 1.90; I² = 59%). Six studies verified quitting biochemically at six months (RR 1.83; 95% CI 1.54 to 2.19). ","The authors concluded that:\n- The current evidence supports a beneficial impact of mobile phone‐based smoking cessation interventions on six‐month cessation outcomes\n- While all studies were good quality, the fact that those studies with biochemical verification of quitting status demonstrated an even higher chance of quitting further supports the positive findings\n-  It should be noted that most included studies were of text message interventions in high‐income countries with good tobacco control policies\n- Caution should be taken in generalising these results outside of this type of intervention and context"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth Delivery of Group Smoking Cessation Programs for Adolescents and Young Adults: Clinical Effectiveness. Ottawa: CADTH; 2015.\nAvailable here.","Adolescents and young adults (age not specified)","This CADTH rapid response review aimed to answer the following research question:\nWhat is the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults? \n\nNo relevant HTAs, SRs, meta-analyses, RCTs, or non-randomised studies were identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults. ","This rapid response review reported that:\n- No relevant literature was identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adult "]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Chen Y, Madan J, Welton N, Yahaya I, Aveyard P. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment 2012;16(38)\nAvailable here\n","Adults","This effectiveness review included 60 RCTs/quasi-RCTs reported in 77 publications. Pooled estimate for prolonged abstinence [relative risk (RR) = 1.32, 95% confidence interval (CI) 1.21 to 1.45] and point prevalence abstinence (RR = 1.14, 95% CI 1.07 to 1.22) suggested that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials. There was no significant difference in effect sizes between aid to cessation studies (which provide support to smokers who are ready to quit) and cessation induction studies (which attempt to encourage a cessation attempt in smokers who are not yet ready to quit). Results from MTC also showed small but significant intervention effect (time to relapse, mean hazard ratio 0.87, 95% credible interval 0.83 to 0.92).","The effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. The cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost-effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counselling. The key source of uncertainty is that around the comparative effectiveness of different types of electronic interventions.\nThe review suggests that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on the relationship between involving users in the design of interventions and the impact this has on effectiveness, and finally on how electronic aids developed and tested in research settings are applied in routine practice and in the community."]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Quitline interventions. Atlanta: CPTSF; 2012c. \nAvailable here.","Adults","This CPSTF finding on quitline effectiveness is based on evidence from an SR published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up.This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.\n\nEvidence of effectiveness for quitline promotional efforts is based on an SR of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).\n\nThe SRs were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nThe Task Force recommendation is based on evidence from 71 studies that evaluated effectiveness of proactive telephone counseling. Twelve studies evaluated treatment effectiveness for callers to quitlines available to the general public and observed a median absolute %age point increase in tobacco cessation of 3.1 %age points (interquartile interval [IQI]: 0.5 to 3.3 %age points). Fifty-one studies evaluated interventions for clients in clinical and research settings and observed a median absolute %age point increase in tobacco cessation of 1.7 %age points (IQI: 0.0 to 8.5 %age points). \n\nOnly six of 77 included studies provided evidence on effectiveness of reactive (caller initiated) quitline counseling. Three of these studies evaluated effectiveness of counseling for a single quitline contact and overall findings were inconsistent. The other three studies evaluated effectiveness of offering tobacco users access to quitline services, and similarly, overall results were inconsistent.","The CPSTF concluded that:\n- Quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting are recommended\n- Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions\n- Three interventions effective at increasing use of quitlines are mass-reach health communication interventions that combine cessation messages with a quitline number, provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting, and quitline referral interventions for health care systems and providers\n- Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence-based cessation treatments. Atlanta: CPTSF; 2012d. \nAvailable here.","Adults","This CPSTF is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al, 5 studies, search period 1980-2000) combined with more recent evidence (13 studies, search period January 2000July 2012). Based on this updated review, the Task Force recommendation was changed from sufficient evidence to strong evidence of effectiveness. \n\nPrimary evidence for the finding comes from 14 of these 18 studies that evaluated the effectiveness of reducing out-of-pocket costs for cessation treatments on rates of tobacco cessation, total number of tobacco users who quit, or the prevalence of tobacco use in defined populations. Twelve of the 14 studies provided measurements of change in quit rates and observed a median absolute % increase of 4.3 %age points (IQI: + 0.2 to +6.0 %age points) with follow-up periods of 3.5 months or longer. The two remaining studies observed decreases in smoking prevalence over two years in populations provided with a new tobacco cessation benefit. \n\nThe included studies also provided measurements of change in use of the covered cessation treatments, and in overall quit attempts. Fifteen studies examined changes in the use of cessation treatments, of which 11 reported differences in the rate of use and observed a median absolute % increase of 7.0 %age points (IQI: +1.4 to +18.3 %age points). Seven studies examined changes in overall quit attempts, with six studies reporting a median absolute % difference in quit attempt rates of +2.8 %age points (IQI: -0.6 to +9.1 %age points). \n\nEvidence-based treatments considered in the Task Force recommendation were based on the findings of Treating Tobacco Use and Dependence: 2008 update (Fiore et al., 2008) a series of recent systematic reviews conducted to document the evidence of effectiveness of clinical interventions and cessation treatments to reduce tobacco use among patients in health care settings and systems. Cessation treatments described in the included studies for this review were categorised for description and analysis as cessation counseling and cessation medications. The evidence-based treatments provided at reduced out-of-pocket costs in 13 of the 18 studies included both medications and counseling. Five studies assessed the effectiveness of reducing out-of-pocket costs for cessation medications only, and observed results similar to the overall body of evidence. Only one study assessed the effectiveness of reduced out-of-pocket costs only for cessation counseling, so the effectiveness of this benefits approach remains unclear. ","The CPSTF concluded that:\n- Policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit, are recommended\n- Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications\n- Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]
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[null,"Bize R et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. \n\nThe reviewers  included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested carbon monoxide feedback alone and carbon monoxide combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used carbon monoxide measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of carbon monoxide and spirometry feedback in different settings. ","The authors concluded that:\n- There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation\n- Of the fifteen included studies, only two detected a significant effect of the intervention\n- Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal\n- A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect\n- Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta‐analyses; neither of these found evidence of an effect\n- Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions. Atlanta: CPTSF; 2011a. \nAvailable here.","Adolescents (age not specified)\nAdults \n","The CPSTF finding is based on evidence published in 2009 (Whittaker et al., search period through December 2008) combined with more recent evidence (search period December 2008–August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. \n\nPrimary evidence for the Task Force finding comes from six studies that evaluated the effectiveness of interventions using automated text messages for recruited participants willing to make a quit attempt. Studies were conducted in Norway, New Zealand, and the United Kingdom. All six included studies were RCTs and assessed self-reported (4 studies) or biochemically verified (2 studies) cessation outcomes at 6- or 12-month follow-up. The median loss to follow-up rate was 10%. One study included NRT, which was provided to participants in both the intervention and comparison groups.\n\nIn three studies, mobile phone text messaging was the primary cessation support intervention. The median difference in cessation rates at 6 months was an improvement of 2.9 %age points (range of values: +1.7 %age points to +4.9 %age points). In the other three studies, mobile phone messages were complemented by Internet-based components. The median difference in cessation rates at 6 months or longer was an improvement of 9 %age points (range of values: -1.2 %age points to +13.3 %age points). Only one study included NRT, which was provided to participants in both the intervention and comparison groups. ","The CPSTF concluded that:\n- Mobile phone-based interventions for tobacco cessation are recommended to increase tobacco use abstinence among people who want to quit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Internet-Based Cessation Interventions. Atlanta: CPTSF; 2011b. \nAvailable here.","Adolescents (age not specified)\nAdults","The CPSTF finding is based on evidence from SR published in 2010 (Civljak et al., search period through June 2010) combined with more recent evidence (search period June 2010-August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nPrimary evidence for the Task Force finding comes from 24 studies that evaluated the effectiveness of Internet-based interventions, implemented alone or in combination with additional interventions designed to increase tobacco cessation. As defined in the 2010 SR, the studies included in the present review were organised and considered for each comparison evaluated. Thirteen studies provided a comparison of an Internet-based intervention with usual care or a non-Internet-based intervention. Across the body of evidence, the effect estimates from these studies were inconsistent. A subset of seven of these studies targeted adult tobacco users and observed a median absolute %age point change in tobacco cessation of 3.2 %age points (IQI: -1.7 %age points to 12.5 %age points). Eleven of the 24 studies provided comparisons of one Internet-based intervention with a different Internet-based intervention. Effect estimates from these studies were inconsistent, and the examined comparisons were of limited use to the Task Force’s assessment of effectiveness.  \n\nAn additional analysis examined ten of the 24 studies that compared Internet-based interventions that provided tailored and interactive content with non-tailored-Internet or no-Internet interventions. Effect estimates from these studies were inconsistent, with a median absolute %age point increase in tobacco cessation of 2.1 %age points (IQI: 0.1 %age points to 12.5 %age points). ","The CPSTF concluded that:\n- There is insufficient evidence to determine whether internet-based interventions increase tobacco use cessation\n- Studies included in the review reported inconsistent effects, and interpretation was complicated by differences in internet-based content, components, and interactions; frequent provision of evidence-based interventions to comparison groups; and moderate to high rates of loss to follow-up"]

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[null,"GUIDANCE - MULTI-COMPONENT INTERVENTIONS"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2019.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","This guideline covers the care that healthy women and their babies should be offered during pregnancy. It aims to ensure that pregnant women are offered regular check-ups, information and support.\n\nIt provides the following guidance:\n\n- Woman‑centred care and informed decision‑making\n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\n\nLast updated: 04 February 2019fPH45"]
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[null,"SYSTEMATIC REVIEWS - MULTI-COMPONENT INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.","Adolescents; general adult population; pregnant women.","This is an update of a 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. ","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Vijayaraghavan  M, et al. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013413. DOI: 10.1002/14651858.CD013413.pub2. \nAvailable here","Participants were tobacco smokers, aged 18 years or older, and had experienced homelessness","This Cochrane review aimed to assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence.\nThe authors identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing.\nThey identified low‐certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). \nThey identified very low‐certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six‐month follow‐up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). \nThere was low‐certainty evidence, limited by bias and imprecision, that multi‐issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change their interpretation of these data. \nSingle studies that examined the effects of text‐messaging support, e‐cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results.","There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. \n\nAlthough there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, their certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. \n\nAlthough there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high‐quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long‐term follow‐up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness."]
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[null,"Non-pharmacological and Pharmacological Intervention for Smoking Cessation Programs in Youth: A Review of Clinical Effectiveness and Guidelines.\nOttawa: CADTH; 2020 Feb. (CADTH rapid response report: summary with critical appraisal).\nAvailable here\n","Adolescents","Regarding the clinical effectiveness for pharmacological and non-pharmacological smoking cessation interventions, one RCT was identified in the search. Evidence from this RCT suggested that there were no significant differences in smoking cessation or smoking frequency outcomes when comparing a multicomponent intervention group (brief advice, nicotine patch therapy and a 6-week text messaging intervention) to brief advice and nicotine patch therapy alone.\n\nThree SRs and eight RCTs addressed the clinical effectiveness of non-pharmacological smoking cessation interventions research question, and the results were mixed. Evidence from the SRs did not reveal improved smoking cessation outcomes for most comparisons; two MAs did find improved smoking cessation outcomes in favour of the intervention. Of the seven RCTs that examined smoking cessation outcomes, three studies found reductions in favour of the smoking cessation intervention, three did not find differences between groups, and one study found improvements at 3 months in favour of the intervention but not at 6-month follow-up.\n","It may be early to draw conclusions about pharmacological and non-pharmacological smoking cessation interventions for youth given the mixed findings identified in this report. Larger, sufficiently powered comparative studies evaluating pharmacological and non-pharmacological smoking cessation interventions may help reduce this uncertainty.\n"]
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[null,"Tzelepis  F, Paul  CL, Williams  CM, Gilligan  C, Regan  T, Daly  J, Hodder  RK, Byrnes  E, Byaruhanga  J, McFadyen  T, Wiggers  J. Real‐time video counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD012659. DOI: 10.1002/14651858.CD012659.pub2.\nAvailable here.","Adults\nAdults with pre-existing health conditions: women with HIV","The authors included two randomised trials with 615 participants. Both studies delivered real‐time video counselling for smoking cessation individually, compared with telephone counselling. They judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow‐up) across the two included studies when real‐time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). The authors judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real‐time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI –0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD –0.20, 95% CI –0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI –0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between‐group differences on satisfaction score (MD 0.70, 95% CI –1.16 to 2.56; 1 study, 29 participants). ","There is very little evidence about the effectiveness of real‐time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. \nHigh‐quality randomised trials comparing real‐time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real‐time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation. "]
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[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Carson‐Chahhoud  KV, Livingstone‐Banks  J, Sharrad  KJ, Kopsaftis  Z, Brinn  MP, To‐A‐Nan  R, Bond  CM. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003698. DOI: 10.1002/14651858.CD003698.pub3.\nAvailable here.","Adults","The authors identified seven studies including 1774 participants. They judged three studies to be at high risk of bias and four to be at unclear risk.\nEach study provided face‐to‐face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards.\nComparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one‐off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. \n All studies took place in high‐income countries, and recruited participants visiting pharmacies.\nThe authors pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow‐up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low‐certainty evidence). ","Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low‐certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion. "]
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[null,"Lindson  N, Klemperer  E, Hong  B, Ordóñez‐Mena  JM, Aveyard  P. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2.\nAvailable here.","Adults","The authors identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. The authors judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. \n\nThe authors identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects. \n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. \n","The authors concluded that:\n-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 another. Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty.\n-There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence).\n-Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms."]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Hollands  GJ et al. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD009164. DOI: 10.1002/14651858.CD009164.pub3.\nAvailable here. ","Adults","The reviewer's identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.\n\nMeta‐analysis of all 10 included studies (12 comparisons) provided moderate‐certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI –0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI –0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant‐centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician‐centred may not (SMD 0.09, 95% CI –0.05 to 0.23; I² = 0%; n = 864).\n\nFive studies assessed short‐term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long‐term smoking abstinence of six months or more. Meta‐analyses resulted in low‐certainty evidence that adherence interventions may slightly increase short‐term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long‐term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self‐efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit.","The authors concluded that:\n- In people who are stopping smoking and receiving behavioural support, there is moderate‐certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence\n- There is only low‐certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer‐term\n- Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both\n- However, there is currently insufficient evidence to confirm which approach is more effective\n- There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support\n\n"]
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[null,"Zeng  L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub3. \nAvailable here. ","Adults with Pre-existing health condition: Lung cancer","The reviewers identified no randomised controlled trials (RCTs) RCTs that met their inclusion criteria. Among the 1817 records retrieved using their search strategy, they retrieved 19 studies for further investigation. They excluded 15 trials: ten trials because they could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. They excluded one trial because, though it was completed in 2004, no results are available. They assessed four ongoing trials for inclusion when data become available. \n","The authors concluded that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n- This systematic review identified a need for RCTs to explore these "]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Livingstone‐Banks J, Ordóñez‐Mena JM and Hartmann‐Boyce J. Print‐based self‐help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD001118. DOI: 10.1002/14651858.CD001118.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. \n\nThe reviewers identified 75 studies that met their inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. They judged 30 studies (40%) to be at high risk of bias for one or more domains. \n\nThirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n =   13,241; RR 1.19, 95% CI 1.03 to 1.37; I² = 0%). The reviwers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n =   7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n =   2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n =   5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).  \n\nThirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n =   19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n =   14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n =   2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n =   1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n =   14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n =   11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). The reviewers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias. \n\nFive studies evaluated self‐help materials as an adjunct to NRT; pooling three of these provided no evidence of additional benefit (n =   1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower CI crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes. ","The authors concluded that:\n- Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention\n- When people receive advice from a health professional or are using NRT, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded\n- Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention\n- However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit\n- Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available\n- Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available"]
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[null,"Taylor GMJ et al. Internet‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858.CD007078.pub5.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to determine the effectiveness of Internet‐based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. \n\nThe reviewers  identified 67 RCTs, including data from over 110,000 participants. They pooled data from 35,969 participants. There were only four RCTs conducted in adolescence or young adults that were eligible for meta‐analysis. \n\nResults for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non‐active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n =   6786). However, statistical heterogeneity was high (I² = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n =   3806, I² = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non‐active control (n =   2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I² = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n =  2769, I² = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n =   14,623, I² = 0%); GRADE rating was moderate. Three studies compared tailored with non‐tailored Internet‐based messages, compared to non‐tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n =  4040), and there was evidence of unexplained substantial statistical heterogeneity (I² = 57%); GRADE rating was low. \n\nResults should be interpreted with caution as the reviewers judged some of the included studies to be at high risk of bias. ","The authors concluded that:\n- The evidence from trials in adults suggests that interactive and tailored Internet‐based interventions with or without additional behavioural support are moderately more effective than non‐active controls at six months or longer\n- There was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity\n- Treatment effectiveness in younger people is unknown "]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I² = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I² = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I² = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I² = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I² = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Jeyashree K et al. Smoking cessation interventions for pulmonary tuberculosis treatment outcomes. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011125. DOI: 10.1002/14651858.CD011125.pub2.\nAvailable here.","Adults with Pre-existing health condition: Tuberculosis","This Cochrane review aimed to analyse the effect of tobacco smoking cessation interventions on the treatment outcomes of people with adult pulmonary tuberculosis (TB).\n\nThere were no RCTs that met the eligibility criteria. A number of potentially eligible studies are underway, and the reviewers will assess them for inclusion in the next update of this review. ","The authors concluded that:\n- There is a lack of high‐quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes\n- There is a need for good‐quality RCTs that assess the effect of smoking cessation interventions on TB treatment outcomes in both the short and long term\n- Establishing such an evidence base would be an essential step towards the implementation of smoking cessation interventions in TB control programmes worldwide"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I² = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I² = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Patnode CP et al. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Evidence Synthesis No. 134. AHRQ Publication No. 14-05200-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2015.\nAvailable here.","Adults and\nPregnant women with or without Pre-existing health condition: Mental health conditions","This review of reviews aimed to systematically review evidence for the effectiveness and safety of pharmacotherapy and behavioral tobacco cessation interventions among adults, including Pregnant women and those with mental health conditions, and to conduct a de novo search for primary evidence related to electronic nicotine delivery systems for adults.\n\nThe reviewers included 54 SRs, 22 of which served as the basis for the primary findings. Among adults, nine reviews addressed the efficacy and/or harms of NRT, bupropion hydrochloride sustained release (bupropion SR), and/or varenicline. None of these reviews reported on health outcomes. All three medications were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months followup. The pooled RR for abstinence for NRT was 1.60 (95% CI, 1.53 to 1.68); for bupropion SR, RR 1.62 (95% CI, 1.49 to 1.76); and for varenicline, 2.27 (95% CI, 2.02 to 2.55). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect in pooled analysis (RR 1.34 [95% CI, 1.18 to 1.51]). \n\nNone of the drugs were associated with major cardiovascular adverse events, although NRT produced higher rates of all cardiovascular events (driven by minor events). \n\nOne review on combined pharmacotherapy and behavioral interventions reported a relative increase in quitting by 82 % versus nonpharmacotherapy usual care (RR 1.82 [95% CI, 1.66 to 2.00]). The reviewers included an additional 33 reviews that addressed behavioral tobacco cessation treatments among adults, including those that focused on specific subpopulations such as older adults. Compared with various controls, behavioral interventions such as in-person advice and support from clinicians, self-help materials, and telephone counseling had modest, but significantly increased, relative smoking cessation at 6 or more months (18% to 96%). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months followup. Only two trials addressed the efficacy and harms related to the use of ECs and these trials suggested no benefit on smoking cessation among smokers intending to quit. \n\nEight reviews focusing on Pregnant women found significant benefits for perinatal health, including increased birth weight and reduced preterm birth. These benefits were evident with behavioral interventions, and suggested by data from some of the NRT trials, although that evidence was limited. Cessation during late pregnancy was greater among women receiving any type of behavioral intervention, with evidence most clear for counseling. Rates of validated cessation among women allocated to NRT (5% to 24%) compared with placebo (0% to 15%) were not statistically different, although few studies contributed data. \n\nThe reviews among individuals with depression or schizophrenia provided limited trial evidence on the efficacy of pharmacotherapy or behavioral interventions. There was, however, some evidence of a benefit for bupropion among those with schizophrenia and the addition of a mood management component to behavioral interventions for smokers with depression.","The authors concluded that:\n- This review of reviews suggests that behavioral interventions and pharmacotherapy, alone or in combination, are effective in helping to reduce rates of smoking among the general adult population\n- Behavioral interventions, in particular, can assist Pregnant women to stop smoking\n- Data on the effectiveness and safety of electronic nicotine delivery systems are limited\n- Future research should focus on direct comparisons between different combinations and classes of drugs; the incidence of serious adverse events related to medications for cessation; the efficacy and safety of electronic nicotine delivery systems; and pharmacotherapies for pregnant women and those with mental health conditions including evidence on health outcomes"]
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[null,"Stead LF, Koilpillai P and Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the effect of increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. \n\nForty‐seven studies met the inclusion criteria with over 18,000 participants in the relevant arms. There was little evidence of statistical heterogeneity (I² = 18%) so the reviewers pooled all studies in the main analysis. There was evidence of a small but statistically significant benefit from more intensive support (RR 1.17, 95% CI 1.11 to 1.24) for abstinence at longest follow‐up. All but four of the included studies provided four or more sessions of support to the intervention group. Most trials used NRT. Significant effects for studies where the pharmacotherapy was nortriptyline (two trials) or varenicline (one trial) were not detected which reflects the absence of evidence. \n\nIn subgroup analyses, studies that provided at least four sessions of personal contact for the intervention and no personal contact for the control had slightly larger estimated effects (RR 1.25, 95% CI 1.08 to 1.45; 6 trials, 3762 participants), although a formal test for subgroup differences was not significant. Studies where all intervention counselling was via telephone (RR 1.28, 95% CI 1.17 to 1.41; 6 trials, 5311 participants) also had slightly larger effects, and the test for subgroup differences was significant, but this subgroup analysis was not prespecified. In this update, the benefit of providing additional behavioural support was similar for the subgroup of trials in which all participants, including controls, had at least 30 minutes of personal contact (RR 1.18, 95% CI 1.06 to 1.32; 21 trials, 5166 participants); previously the evidence of benefit in this subgroup had been weaker. This subgroup was not prespecified and a test for subgroup differences was not significant. The reviewers judged the quality of the evidence to be high, using the GRADE approach. They judged a small number of trials to be at high risk of bias on one or more domains, but findings were not sensitive to their exclusion. ","The authors concluded that:\n- Providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking has a small but important effect\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 25%, based on a pooled estimate from 47 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support"]
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[null,"Zeng L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub2.\nAvailable here.","Any age with Pre-existing health condition: Lung cancer","This Cochrane review aimed to determine the effectiveness of smoking cessation programmes for people with lung cancer. \n\nThe reviewers identified no RCTs that met their inclusion criteria. Among the 1052 records retrieved using our search strategy, they retrieved 13 studies for further investigation. They excluded 10 trials: five trials because we could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. One trial was excludedl because, though it was completed in 2004, no results are available. They assessed three ongoing trials for inclusion when data become available. ","The authors reported that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- Due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n\nThis systematic review identified a need for RCTs to explore these. "]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"Cahill K and Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4. \nAvailable here.","Adults","This Cochrane review aimed to firstly, categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking; and secondly, to collect and evaluate data on costs and cost effectiveness associated with workplace interventions. \n\nThe reviewers included 57 studies (61 comparisons) in this updated review. They found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, NRT, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (OR for cessation 1.71, 95% CI 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. ","The authors reported that:\n- They found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere\n- Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low\n- They failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data\n- There was limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates \n- Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced "]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Rigotti NA, Clair C, Munafò MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3. \nAvailable here.","Adults with\nPre-existing health condition: Hospitalised patients\n","This Cochrane review aimed to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. \n\nFifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (RR 1.37, 95% CI 1.27 to 1.48; 25 trials). A specific benefit for post‐discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post‐discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. \n\nAdding NRT to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non‐significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow‐up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilisation endpoints, and found significant reductions in all‐cause mortality and hospital readmission rates over a two‐year follow‐up period. These trials were all conducted in acute care hospitals. \n\nA comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). ","The authors concluded that:\n- High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\n- The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals\n- There was no evidence of effect for interventions of lower intensity or shorter duration\n- This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone\n- There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone"]
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[null,"Carr S, et al. An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 2011; 15(9).\nAvailable here.","General adult population","This review aimed to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK.\nFour studies were identified that examined the impact of LAs in smoking cessation. All of the interventions were delivered on a one-to-one basis. The support was delivered via telephone or face-to-face meetings in addition to telephone calls. The contacts were supported with videos and pamphlets and access to free NRT.\nTwo studies West (1998) and May (2006) used the intervention of buddy groups, allocating a partner and encouraging exchange of telephone numbers. Financial incentives were also sued in both studies. Woodruff 2002 reviewed past quit attempts, discussed the pros and cons of smoking and quitting, discussed self-monitoring to identify smoking patterns, identified potential reinforcements and substitute behaviours and discussed appropriate coping strategies, set a quit date, discussed experiences while quitting and relapse prevention, and talked about overall lifestyle change. Emmons (2005) emphasised the smoker’s choice, personal responsibility for change and enhancement of self-efficacy. The calls were tailored to the participants’ stage of readiness to quit smoking and interest in other health topics and goals. Nicotine replacement therapy (NRT) was discussed, and was made available without cost to the intervention group’s participants and their spouses/partners who indicated in the counselling calls that they were ready to make a serious quit attempt.\nSignificantly more remained abstinent from smoking in the buddy support group after 4 weeks [15% difference, effect size 2.79 (95% CI 1.26 to 6.22)] in West 1998 but not in May 2006 (adjusted OR 1.16, 95% CI 0.76 to 1.78). Woodruff 2002120 reports that 20.3% of the intervention group had quit at 3 months compared with 8.7% of the comparison group. However, these results are based on a per-protocol analysis that ignores differential attrition in the intervention arm. Applying an intention-to-treat analysis, and assuming that all of those lost to follow-up have relapsed, gives a quit rate of 17.3% in the intervention group and 8.3% in the control group. Emmons 2005 reported that the quit rate was significantly higher in the peer counselling group than the control group (16.8% vs 8.5%, p < 0.0003) at 8 months. This difference was maintained at the 12-month follow-up (15% vs 9%, p < 0.01). Controlling for baseline self-efficacy and depression, the peer counselling group was more likely to quit smoking by the 12-month follow-up compared with the control group (12-month OR 1.99, 95% CI 1.27 to 3.14)\n\nOverall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL). The buddy schemes explored in these studies have much to offer to an analysis of intervention components and may still offer potential as a practice model.\n","Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. \n\nReporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions.\n \nA future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence. "]

{"sheet":"Prevention","index":18,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Prevention-Pharma","index":19,"n_rows":82,"n_cols":5,"rows_kept":82,"cut":false,"hidden":false,"merged":[[32,1,63,1],[32,2,63,2],[32,3,63,3],[32,4,63,4],[8,1,8,4],[10,1,28,1],[10,2,28,2],[10,3,28,4],[30,1,30,4],[64,1,80,1],[64,2,80,2],[64,3,80,3],[64,4,80,4],[81,1,101,1],[81,2,101,2],[81,3,101,3],[81,4,101,4]]}
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[null,"GUIDANCE- PHARMACOTHERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"SYSTEMATIC REVIEWS- PHARMACOTHERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Livingstone‐Banks J et al. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub5.\nAvailable here.","Adults\nPregnant Women ","This Cochrane review aimed to assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking.\n\nThe reviewers included 77 studies (67,285 participants), 15 of which are new to this update. They judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty‐eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe reviewers focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, RR 1.23, 95% CI 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and NRT in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide CIs with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population.","The authors concluded that:\n- Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means they are only moderately certain of this\n- In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard\n- Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity\n- Moderate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though CIs mean they could not rule out a clinically important benefit at this stage\n- Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with NRT in preventing relapse in assisted abstainers\n-  More research is needed in this area, especially as the evidence for extended NRT in unassisted abstainers did suggest a benefit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Patnode CD et al. Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 97. AHRQ Publication No. 12-05175-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.\nAvailable here.","Adolescents and Young children (age not specified)","This review aimed to systematically review evidence for the efficacy and harms of primary care interventions to prevent tobacco initiation and encourage tobacco cessation among children and adolescents.\n\nThe reviewers included 24 articles representing 19 unique studies. None of the studies examined childhood or longer-term health outcomes (e.g., respiratory health or adult smoking). Seven trials evaluating combined prevention and cessation interventions were mainly rated as fair quality and included a diverse mix of intervention components and approaches. Pooled analyses of six of the combined trials (n =  8,749) resulted in a nonstatistically significant difference in the smoking prevalence among the intervention group compared with the control group at 6- to 12-months followup. Pooled analyses across all of the prevention trials suggested a small reduction in smoking initiation at 6- to 12-months followup among intervention participants compared with control group participants (RR 0.81, 95% CI 0.70 to 0.93]; k=9; n =  26,624). Meta-analyses of the behavior-based cessation trials (k=7; n =  2,328) and the medication (bupropion) cessation trials (k=2; n =  256) did not show a statistically significant effect on self-reported smoking status among baseline smokers at 6- to 12-months followup. \n\nNo trials evaluating behavior-based interventions (both prevention and cessation) reported possible harms from interventions. Some trials, however, reported a higher absolute prevalence of smoking in the intervention groups compared with the control groups, although none were statistically significant. Three studies were included that examined adverse effects related to bupropion use, and findings were mixed.","The authors concluded that:\n- Interventions designed to reduce the prevalence of tobacco use among children and adolescents represent a clinically and methodologically heterogeneous body of literature\n- Overall, methodological differences between the included trials limits their ability to determine if the relatively small effect found on smoking initiation in this subset of trials represents true benefit across this body of literature\n- In particular, the measurement of smoking status, including what constituted smoking initiation and cessation, varied across all studies\n- In addition, the diversity of both the components and the intensity of the interventions limits their ability to draw conclusions about common efficacious elements"]

{"sheet":"Prevention-Psycho","index":20,"n_rows":153,"n_cols":5,"rows_kept":153,"cut":false,"hidden":false,"merged":[[75,1,111,1],[75,2,111,2],[75,3,111,3],[75,4,111,4],[8,1,8,4],[10,1,31,1],[10,2,31,2],[10,3,31,4],[32,1,51,1],[32,2,51,2],[32,3,51,4],[53,1,53,4],[55,1,74,1],[55,2,74,2],[55,3,74,3],[55,4,74,4],[152,1,180,1],[152,2,180,2],[152,3,180,3],[152,4,180,4],[112,1,151,1],[112,2,151,2],[112,3,151,3],[112,4,151,4]]}
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[null,"GUIDANCE - PSYCHOSOCIAL THERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"SYSTEMATIC REVIEWS - PSYCHOSOCIAL THERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and adolescents up to 18 years of age for cessation and 25 years of age for prevention.","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Adolescents and children (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012b, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]

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[null,"GUIDANCE - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people. PH14. London: NICE; 2008.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nWoolfall K et al. The prevention of uptake of smoking by children and young people, with reference to the areas of mass media and the sale of tobacco products: findings from a multi-method primary research study. \nAvailable here.\n\nRichardson et al. NICE Rapid review: Interventions to Prevent the Uptake of Smoking in  Children and Young People. British Columbia: Centre of Excellence for Women's Health; 2008. Available here.","This guideline is for: \n- NHS, local authorities, the criminal justice system and others working in the public, voluntary and community sectors\n- Retailers\n- Mass-media services\n- Children, young people and their carers and other members of the public","This guideline covers anti-smoking mass-media campaigns, for example, on TV, in newspapers and online. It also covers measures to prevent tobacco being sold to children and young people. The aim is to help prevent children and young people from taking up smoking.\n\nIt makes recommendations on:\n- Mass-media campaigns, including how to develop them and the type of messages to put across\n- Illegal sales and how to prevent them\n\nThis guideline was checked in November 2014."]
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[null,"SYSTEMATIC REVIEWS - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here\n","General population","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","Six studies involved availability interventions, of which four changed the relative proportion of less-healthy to healthier options, and two changed the absolute number of different options available. In statistical analyses that combined results from multiple studies, it was found that reducing the number of available options for a particular range or category of food(s) reduced selection of those food products (from analysing 154 participants) and possibly reduced consumption of those products (from 150 participants). However, the certainty of the evidence for these effects was low.\n\nEighteen studies involved proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. One study found that this reduced selection of food (from analysing 41 participants), whilst in a statistical analysis combining results from multiple studies, it was found that placing food farther away reduced consumption of those food products (from analysing 1098 participants). However, the certainty of the evidence for these effects was very low and low, respectively.","Mindful of its limitations, the current evidence suggests that changing the number of available food options or changing where foods are positioned could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes to food environments. However, more high-quality studies in real-world settings are needed to make this finding more certain."]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Adolescents and\nYoung children (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Young people (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]

{"sheet":"Prevention-MultiComp","index":22,"n_rows":147,"n_cols":5,"rows_kept":147,"cut":false,"hidden":false,"merged":[[92,1,116,1],[92,2,116,2],[92,3,116,3],[92,4,116,4],[146,1,159,1],[146,2,159,2],[146,3,159,3],[146,4,159,4],[117,1,145,1],[117,2,145,2],[117,3,145,3],[117,4,145,4],[35,1,51,1],[35,2,51,2],[35,3,51,3],[35,4,51,4],[52,1,91,1],[52,2,91,2],[52,3,91,3],[52,4,91,4],[8,1,8,4],[10,1,31,1],[10,2,31,2],[10,3,31,4],[33,1,33,4]]}
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[null,"GUIDANCE - MULTI-COMPONENT"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"SYSTEMATIC REVIEWS - MULTI-COMPONENT INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"Patnode CD et al. Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 97. AHRQ Publication No. 12-05175-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; December 2012.\nAvailable here.","Adolescents and Young children (age not specified)","This review aimed to systematically review evidence for the efficacy and harms of primary care interventions to prevent tobacco initiation and encourage tobacco cessation among children and adolescents.\n\nThe reviewers included 24 articles representing 19 unique studies. None of the studies examined childhood or longer-term health outcomes (e.g., respiratory health or adult smoking). Seven trials evaluating combined prevention and cessation interventions were mainly rated as fair quality and included a diverse mix of intervention components and approaches. Pooled analyses of six of the combined trials (n =  8,749) resulted in a nonstatistically significant difference in the smoking prevalence among the intervention group compared with the control group at 6- to 12-months followup. Pooled analyses across all of the prevention trials suggested a small reduction in smoking initiation at 6- to 12-months followup among intervention participants compared with control group participants (RR 0.81, 95% CI 0.70 to 0.93]; k=9; n =  26,624). Meta-analyses of the behavior-based cessation trials (k=7; n =  2,328) and the medication (bupropion) cessation trials (k=2; n =  256) did not show a statistically significant effect on self-reported smoking status among baseline smokers at 6- to 12-months followup. \n\nNo trials evaluating behavior-based interventions (both prevention and cessation) reported possible harms from interventions. Some trials, however, reported a higher absolute prevalence of smoking in the intervention groups compared with the control groups, although none were statistically significant. Three studies were included that examined adverse effects related to bupropion use, and findings were mixed.","The authors concluded that:\n- Interventions designed to reduce the prevalence of tobacco use among children and adolescents represent a clinically and methodologically heterogeneous body of literature\n- Overall, methodological differences between the included trials limits their ability to determine if the relatively small effect found on smoking initiation in this subset of trials represents true benefit across this body of literature\n- In particular, the measurement of smoking status, including what constituted smoking initiation and cessation, varied across all studies\n- In addition, the diversity of both the components and the intensity of the interventions limits their ability to draw conclusions about common efficacious elements"]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012b, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]

{"sheet":"Denormalisation","index":23,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"Denorm-Pharma","index":24,"n_rows":223,"n_cols":5,"rows_kept":223,"cut":false,"hidden":false,"merged":[[47,1,146,1],[47,2,146,2],[47,3,146,4],[147,1,218,1],[147,2,218,2],[147,3,218,4],[8,1,8,4],[10,1,27,1],[10,2,27,2],[10,3,27,4],[28,1,46,1],[28,2,46,2],[28,3,46,4],[220,1,220,4],[222,1,223,1],[222,2,223,2],[222,3,223,3],[222,4,223,4]]}
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[null,"GUIDANCE: PHARMACOTHERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\nThis guideline was checked in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines (Expected publication date: 16 January 2020)."]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"SYSTEMATIC REVIEWS- PHARMACOTHERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"No evidence identified"]

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[null,"GUIDANCE - PSYCHOSOCIAL THERAPY"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"SYSTEMATIC REVIEWS - PSYCHOSOCIAL THERAPY"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"No evidence identified"]

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[null,"GUIDANCE - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people. PH14. London: NICE; 2008.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nWoolfall K et al. The prevention of uptake of smoking by children and young people, with reference to the areas of mass media and the sale of tobacco products: findings from a multi-method primary research study. \nAvailable here.\n\nRichardson et al. NICE Rapid review: Interventions to Prevent the Uptake of Smoking in  Children and Young People. British Columbia: Centre of Excellence for Women's Health; 2008. Available here.","This guideline is for: \n- NHS, local authorities, the criminal justice system and others working in the public, voluntary and community sectors\n- Retailers\n- Mass-media services\n- Children, young people and their carers and other members of the public","This guideline covers anti-smoking mass-media campaigns, for example, on TV, in newspapers and online. It also covers measures to prevent tobacco being sold to children and young people. The aim is to help prevent children and young people from taking up smoking.\n\nIt makes recommendations on:\n- Mass-media campaigns, including how to develop them and the type of messages to put across\n- Illegal sales and how to prevent them\n\nThis guideline was checked in November 2014."]
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[null,"SYSTEMATIC REVIEWS - UNIVERSAL INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S, et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Research 2019;7(8)\nAvailable here","General population","The amount and strength of evidence varies across the six topics. There was moderate evidence that mass media campaigns can influence treatment-seeking behaviours (e.g. use of smoking quitlines). The impact on tobacco use was mixed. Tobacco and illicit drug campaigns appeared to be more effective for young people and children but there was no or inconsistent evidence regarding effectiveness by sex, ethnicity or socioeconomic status. There was moderate evidence that tobacco mass media campaigns are cost-effective, but there was weak or limited evidence in other topic areas. Although there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective, and messages were important, with positive and negative messages and social norms messages affecting smoking behaviour. \nThe evidence suggested that targeting messages to target audiences can be effective. There was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that (1) campaigns can contribute to smoking cessation, (2) tobacco control campaigns can be cost-effective, (3) longer and more intensive campaigns are likely to be more effective and (4) message design and targeting campaigns to particular population groups can be effective."]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Adolescents and\nYoung children (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Young people (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]

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[null,"GUIDANCE - MULTI-COMPONENT"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"SYSTEMATIC REVIEWS - MULTI-COMPONENT INTERVENTIONS"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]

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[null,"ADULT POPULATION"]
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[null,"GUIDANCE - ADULT POPULATION"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering advice or education to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering behavioural support to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for signposting and referral to other services and support. NG102. London: NICE; 2018. Available here.","This guideline is for:\n- Community pharmacies, local pharmaceutical committees and pharmacy organisations\n- Commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England\n- Local professional networks (hosted by NHS England)\n- Health and wellbeing boards.","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n"]
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[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]
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[null,"SYSTEMATIC REVIEWS - ADULT POPULATION"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Lindson N, et al. Strategies to improve smoking cessation rates in primary care. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD011556. DOI: 10.1002/14651858.CD011556.pub2.\nAvailable here","Adult primary healthcare patients. For the purposes of this review, primary care was defined as family medicine or general medical practice.","This review assesses the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings.\n\nThe authors identified moderate‐certainty evidence, limited by inconsistency, that the provision of adjunctive counselling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost‐free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. \n\nThere was also moderate‐certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow‐up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants).\n\nThere was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies the authors judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty.\n","There is moderate‐certainty evidence that providing adjunctive counselling by an allied health professional, cost‐free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. \n\nThere is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, the authors rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. \n\nFurther studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting."]
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[null,"Hartmann-Boyce  J et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub5.\nAvailable here.","People defined as currently smoking cigarettes at enrolment into the studies. Participants could be motivated or unmotivated to quit.","There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than inthose randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.53, 95% confidence interval (CI) 1.21 to 1.93; I2 = 0%; 4 studies, 1924 participants). In absolute terms, this might translate to an additional three quitters per 100 (95% CI 1 to 6).\nThere was low-certainty evidence (limited by very serious imprecision) that the rate of occurrence of Adverse Effects (AEs) was similar (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). Serious Adverse Events (SAEs) were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.44, 95% CI 0.94 to 2.19: I2 = 0; 3 studies, 1183 participants).\nThere was moderate-certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). \n\nThere was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.95, 95% CI 0.52 to 1.72; I2 = 0; 6 studies, 1033 participants).\nCompared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.61, 95% CI 1.44to 4.74; I2 = 0%; 6 studies, 2886 participants). In absolute terms this represents an additional six quitters per 100 (95% CI 2 to 15). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. \nThere was some evidence that non-serious AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants), and again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.51, 95% CI 0.70 to 3.24; I2 = 0%; 7 studies, 1303 participants).\n","There is moderate-certainty evidence that Electronic Cigarettes (ECs) with nicotine increase quit rates compared to NRT and compared to ECs without nicotine.\nEvidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. \nConfidence intervals were for the most part wide for data on Adverse Effects (AEs), SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs. Overall incidence of SAEs was low across all study arms. \n\nThe authors did not detect evidence of harm from nicotine EC, but longest follow-up was two years and the number of studies was small.\nThe main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway.\n\nTo ensure the review continues to provide up-to-date information, this review is now a living systematic review. The authors run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status."]
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[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health."]
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[null,"Vijayaraghavan  M, et al. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013413. DOI: 10.1002/14651858.CD013413.pub2. \nAvailable here","Participants were tobacco smokers, aged 18 years or older, and had experienced homelessness","This Cochrane review aimed to assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence.\nThe authors identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing.\nThey identified low‐certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). \nThey identified very low‐certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six‐month follow‐up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). \nThere was low‐certainty evidence, limited by bias and imprecision, that multi‐issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change their interpretation of these data. \nSingle studies that examined the effects of text‐messaging support, e‐cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results.","There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. \n\nAlthough there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, their certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. \n\nAlthough there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high‐quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long‐term follow‐up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness."]
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[null,"Howes  S, Hartmann‐Boyce  J, Livingstone‐Banks  J, Hong  B, Lindson  N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub5.\nAvailable here\n","Adult smokers","There was high‐certainty evidence that bupropion increased long‐term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate‐certainty evidence, downgraded one level due to imprecision). They found high‐certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants).\nMeta‐analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). \nThe authors also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. \n","There is high‐certainty evidence that bupropion can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. \nDue to the high‐certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change their interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front‐line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly."]
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[null,"Whittaker  R, McRobbie  H, Bullen  C, Rodgers  A, Gu  Y, Dobson  R. Mobile phone text messaging and app‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub5.\nAvailable here.","Adults\nAdolescents","This review includes 26 studies (33,849 participants). Overall, the authors judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high‐income countries. \nThere was moderate‐certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate‐certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). \nTwo studies comparing text messaging with other smoking cessation interventions, and three studies comparing high‐ and low‐intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. \nFive studies compared a smoking cessation smartphone app with lower‐intensity smoking cessation support (either a lower‐intensity app or non‐app minimal support). The authors pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so the authors did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. ","There is moderate‐certainty evidence that automated text message‐based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. \nThere is moderate‐certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. \nThe evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions."]
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[null,"Tzelepis  F, Paul  CL, Williams  CM, Gilligan  C, Regan  T, Daly  J, Hodder  RK, Byrnes  E, Byaruhanga  J, McFadyen  T, Wiggers  J. Real‐time video counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD012659. DOI: 10.1002/14651858.CD012659.pub2.\nAvailable here.","Adults\nAdults with pre-existing health conditions: women with HIV.\n","The authors included two randomised trials with 615 participants. Both studies delivered real‐time video counselling for smoking cessation individually, compared with telephone counselling. They judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow‐up) across the two included studies when real‐time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). The authors judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real‐time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI –0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD –0.20, 95% CI –0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI –0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between‐group differences on satisfaction score (MD 0.70, 95% CI –1.16 to 2.56; 1 study, 29 participants). ","There is very little evidence about the effectiveness of real‐time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. \nHigh‐quality randomised trials comparing real‐time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real‐time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation. "]
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[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Carson‐Chahhoud  KV, Livingstone‐Banks  J, Sharrad  KJ, Kopsaftis  Z, Brinn  MP, To‐A‐Nan  R, Bond  CM. Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003698. DOI: 10.1002/14651858.CD003698.pub3.\nAvailable here.","Adults","The authors identified seven studies including 1774 participants. They judged three studies to be at high risk of bias and four to be at unclear risk.\nEach study provided face‐to‐face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards.\nComparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one‐off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. \n All studies took place in high‐income countries, and recruited participants visiting pharmacies.\nThe authors pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow‐up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low‐certainty evidence). ","Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low‐certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion. "]
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[null,"Ussher  MH, Faulkner  GEJ, Angus  K, Hartmann‐Boyce  J, Taylor  AH. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub6.\nAvailable here. ","Adults","The authors identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group‐based cardiovascular‐type exercise supplemented by a home‐based exercise programme and combined with a multi‐session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi‐session cognitive behavioural smoking cessation programme alone. Overall, they judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. \n\nAmong the 21 studies analysed, the authors found low‐certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). They excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular‐type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular‐type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when the authors excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, they found very low‐certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long‐term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). \n","There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions. "]
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[null,"Lindson  N, Klemperer  E, Hong  B, Ordóñez‐Mena  JM, Aveyard  P. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2.\nAvailable here.","Adults","The authors identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. The authors judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. \n\nThe authors identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects. \n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. \n","The authors concluded that:\n-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 another. Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty.\n-There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence).\n-Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit SAEs or withdrawal symptoms."]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Hollands  GJ et al. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD009164. DOI: 10.1002/14651858.CD009164.pub3.\nAvailable here. ","Adults","The reviewer's identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.\n\nMeta‐analysis of all 10 included studies (12 comparisons) provided moderate‐certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI –0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI –0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant‐centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician‐centred may not (SMD 0.09, 95% CI –0.05 to 0.23; I² = 0%; n = 864).\n\nFive studies assessed short‐term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long‐term smoking abstinence of six months or more. Meta‐analyses resulted in low‐certainty evidence that adherence interventions may slightly increase short‐term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long‐term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self‐efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit.","The authors concluded that:\n- In people who are stopping smoking and receiving behavioural support, there is moderate‐certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence\n- There is only low‐certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer‐term\n- Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both\n- However, there is currently insufficient evidence to confirm which approach is more effective\n- There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support\n\n"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacist-Led Interventions for Tobacco Smoking Cessation: A Review of the Clinical Effectiveness and Cost-Effectiveness. Ottawa: CADTH; 2019.\nAvailable here.","Adults","This CADTH rapid response review aimed to answer the following research questions:\n\n1. What is the clinical effectiveness of pharmacist-led tobacco smoking cessation interventions?\n2. What is the cost-effectiveness of pharmacist-led tobacco smoking cessation interventions versus self-directed smoking cessation interventions?\n\nA total of 458 citations were identified in the literature search. Following screening of titles and abstracts, 413 citations were excluded and 45 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 47 publications were excluded for various reasons, and four publications met the inclusion criteria and were included in this report. These comprised four SRs. Of the excluded studies, one was an overview of reviews\nthat met the inclusion criteria for this report; however, only one of the included SRs was relevant to this report, and because it was captured by the search and contained more comprehensive information, the SR was retained directly and the overview was excluded. Two other SRs met the inclusion criteria but were excluded for having overlapping primary studies with more comprehensive SRs included in this report. ","This rapid response review concluded that:\n- The overall quality of evidence was low, and high heterogeneity existed between the included studies, making it difficult to determine the overall effectiveness of these interventions\n- Very low- to moderate-quality evidence from three systematic reviews suggested that pharmacist-led smoking cessation interventions may lead to higher rates or no difference in rates of smoking cessation, as compared to usual care or no intervention, although there was a high degree of uncertainty in these findings\n- No other clinical effectiveness outcomes, including adverse events, were reported\n- Evidence of unknown quality from one very low-quality systematic review suggested that pharmacist-led smoking cessation interventions were cost-effective in Europe\n- Given the limited availability and low quality of evidence, the clinical effectiveness and cost-effectiveness of pharmacist-led interventions for smoking cessation remain uncertain\n"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Barnes  J et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008.pub3. \nAvailable here. ","Adults","The reviewers included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta‐analysis was not possible. They judged only one study to be at low risk of bias overall; they judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations. \n\nPooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention‐matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity. \n\nMost studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event ‘index’ between hypnotherapy and relaxation. \n","The authors concluded that:\n- There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting\n- If a benefit is present, current evidence suggests the benefit is small at most\n- There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does\n- Further large, high‐quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic"]
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[null,"Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308. \nAvailable here. ","Adults","This Cochrane review aimed to determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation, compared to one another.\n\nThe reviewers identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. The reviewers judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high‐certainty evidence that combination NRT (fast‐acting form + patch) results in higher long‐term quit rates than single form (Risk ratio (RR) 1.25, 95% Confidence Interval (CI) 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). \n\nModerate‐certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate‐certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate‐certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High‐certainty evidence from eight studies suggests that using either a form of fast‐acting NRT or a nicotine patch results in similar long‐term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low‐certainty evidence); 16‐hour versus 24‐hour daily patch use; duration of combination NRT use (low‐ and very low‐certainty evidence); tapering of patch dose versus abrupt patch cessation; fast‐acting NRT type (very low‐certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast‐acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant‐ versus clinician‐selected NRT. However, in most cases these findings are based on very low‐ or low‐certainty evidence, and are the findings from single studies. \n\nAdverse events, serious adverse events and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low‐ or very low‐certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac adverse events, serious adverse events or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). \n","The authors concluded that:\n- There is high‐certainty evidence that using combination NRT versus single‐form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking\n- For patch dose comparisons, evidence was of moderate certainty, due to imprecision: 21 mg patches resulted in higher quit rates than 14 mg (24‐hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16‐hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24‐hour) patches\n- Using a fast‐acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches\n- There is moderate‐certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding\n- Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty\n- New studies should ensure that adverse events, serious adverse events and withdrawals due to treatment are both measured and reported"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Livingstone‐Banks J, Ordóñez‐Mena JM and Hartmann‐Boyce J. Print‐based self‐help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD001118. DOI: 10.1002/14651858.CD001118.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. \n\nThe reviewers identified 75 studies that met their inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. They judged 30 studies (40%) to be at high risk of bias for one or more domains. \n\nThirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n =   13,241; RR 1.19, 95% CI 1.03 to 1.37; I² = 0%). The reviwers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n =   7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n =   2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n =   5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).  \n\nThirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n =   19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n =   14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n =   2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n =   1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n =   14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n =   11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). The reviewers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias. \n\nFive studies evaluated self‐help materials as an adjunct to NRT; pooling three of these provided no evidence of additional benefit (n =   1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower CI crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes. ","The authors concluded that:\n- Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention\n- When people receive advice from a health professional or are using NRT, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded\n- Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention\n- However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit\n- Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available\n- Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available"]
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[null,"Community Preventive Services Task Force. (2019). Tobacco Use and Secondhand Smoke Exposure: Internet-based Interventions to Increase Tobacco Use Cessation. USA.Gov. Available here.\n\nUnderpinning evidence review:\nMcCrabb et al, Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis. Annals of Behavioral Medicine 2019:53(2):180-95. Available here. ","This guidance is for:\nAdolescents and Young Adults\nAdults\nOlder Adults\nParents/Caregivers","The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The underpinning review (McCrabb et al) was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation. The review included 45 studies. The CPSTF examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.\n\nThe CPSTF findings are based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.\n\nFindings\n-Internet-based interventions increased tobacco use cessation rates by a median of 1.2 percentage points overall (31 studies).\n-Differences in cessation rates were slightly larger when internet-based interventions were compared to no intervention, usual care, printed materials, or basic website content (median increase of 1.3 percentage points; 17 studies).\n-Differences in cessation rates were smaller when internet-based interventions were compared to other interventions that provided interactive content, cessation counseling, or evidence-based cessation medications (median increase of 0.8 percentage points; 14 studies).\n-Most studies provided internet, cessation counseling, or medication interventions to participants in the comparison group.\n-Participants in both intervention and comparison groups quit at meaningful rates, which minimized differences.","Recommendation\nThe Community Preventive Services Task Force (CPSTF) recommends internet-based cessation interventions based on sufficient evidence of effectiveness in increasing tobacco use cessation among adult tobacco users. Systematic review evidence showed meaningful improvements in tobacco cessation outcomes when measured six or more months following intervention. "]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Faseru B et al. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD002928. DOI: 10.1002/14651858.CD002928.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component. \n\nIt identified 465 citations, which were assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n =  3370). \nThe definition of partner varied among the studies.  The reviewers compared partner support versus control interventions at six‐ to nine‐month follow‐up and at 12 or more months follow‐up. They also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self‐reported smoking cessation rates, with limited biochemical verification of abstinence. \n\nThe pooled RR for abstinence was 0.97 (95% CI 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post‐treatment. \n\nOf the 11 studies that measured partner support at follow‐up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. The reviewers judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system the reviewers rated the overall quality of the evidence for the two primary outcomes as low. They downgraded due to the risk of bias, as they judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. They also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. ","The authors concluded that:\n- Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation\n- Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified"]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of NRT compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Stead LF, Carroll AJ and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub3.\nAvailable here.","Adults","This Cochrane review aimed to determine the effect of group‐delivered behavioural interventions in achieving long‐term smoking cessation. \n\nThe reviewers identified sixty‐six trials to meet their inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self‐help programme; there was an increase in cessation with the use of a group programme (n =  4395, RR 1.88, 95% CI 1.52 to 2.33, I² = 0%). They judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (n =  7286, RR 1.22, 95% CI 1.03 to 1.43, I² = 59%). They judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. \n\nThere was also low quality evidence of benefit of a group programme compared to no‐intervention controls, (9 trials, n =  1098, RR 2.60, 95% CI 1.80 to 3.76 I² = 55%). They did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, n =  980, RR 0.99, 95% CI 0.76 to 1.28, I² = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same‐length or shorter programmes without these components. ","The authors conclulded that:\n- Group therapy is better for helping people stop smoking than self‐help, and other less intensive interventions\n- There is not enough evidence to evaluate whether groups are more effective, or cost‐effective, than intensive individual counselling\n- There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included "]
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[null,"Taylor GMJ et al. Internet‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858.CD007078.pub5.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to determine the effectiveness of Internet‐based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. \n\nThe reviewers  identified 67 RCTs, including data from over 110,000 participants. They pooled data from 35,969 participants. There were only four RCTs conducted in adolescence or young adults that were eligible for meta‐analysis. \n\nResults for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non‐active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n =   6786). However, statistical heterogeneity was high (I² = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n =   3806, I² = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non‐active control (n =   2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I² = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n =  2769, I² = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n =   14,623, I² = 0%); GRADE rating was moderate. Three studies compared tailored with non‐tailored Internet‐based messages, compared to non‐tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n =  4040), and there was evidence of unexplained substantial statistical heterogeneity (I² = 57%); GRADE rating was low. \n\nResults should be interpreted with caution as the reviewers judged some of the included studies to be at high risk of bias. ","The authors concluded that:\n- The evidence from trials in adults suggests that interactive and tailored Internet‐based interventions with or without additional behavioural support are moderately more effective than non‐active controls at six months or longer\n- There was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity\n- Treatment effectiveness in younger people is unknown "]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I² = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I² = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I² = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"Thomas D et al. System change interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD010742. DOI: 10.1002/14651858.CD010742.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.\n\nThe reviewers included seven cluster‐randomised controlled studies in this review. They rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow‐up (four studies), and for the secondary outcome ‘prescribing of smoking cessation medications' (two studies). \n\nFour studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. ","The authors concluded that:\n- The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services\n- The available research is limited, therefore it was not feasible to draw strong conclusions\n- There is a need for additional high‐quality research to explore the impact of system change interventions on both cessation and system‐level outcomes"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here\n","Adults","Pharmacy-based smoking cessation interventions including behavioural support and/or nicotine replacement therapy are effective and cost-effective in helping adults to stop smoking, particularly when compared with usual care. The pooled odds ratio of the intervention effects for smoking cessation was 1.85 (95% confidence interval 1.25 to 2.75). It is currently unknown which specific types of smoking cessation interventions are the most effective.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. \nThe evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Community pharmacy interventions are effective for smoking cessation.\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"White AR et al. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000009. DOI: 10.1002/14651858.CD000009.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation in smoking cessation, in comparison with no intervention, sham treatment, or other interventions. \n\nThe reviewers included 38 studies. Based on three studies, acupuncture was not shown to be more effective than a waiting list control for long‐term abstinence, with wide CIs and evidence of heterogeneity (n =  393, RR 1.79, 95% CI 0.98 to 3.28, I² = 57%). Compared with sham acupuncture, the RR for the short‐term effect of acupuncture was 1.22 (95% CI 1.08 to 1.38), and for the long‐term effect was 1.10 (95% CI 0.86 to 1.40). The studies were not judged to be free from bias, and there was evidence of funnel plot asymmetry with larger studies showing smaller effects. The heterogeneity between studies was not explained by the technique used. Acupuncture was less effective than NRT. \n\nThere was no evidence that acupuncture is superior to psychological interventions in the short‐ or long‐term. There is limited evidence that acupressure is superior to sham acupressure for short‐term outcomes (3 trials, n =  325, RR 2.54, 95% CI 1.27 to 5.08), but no trials reported long‐term effects. The pooled estimate for studies testing an intervention that included continuous auricular stimulation suggested a short‐term benefit compared to sham stimulation (14 trials, n =  1155, RR 1.69, 95% CI 1.32 to 2.16); subgroup analysis showed an effect for continuous acupressure (7 studies, n =  496, RR 2.73, 95% CI 1.78 to 4.18) but not acupuncture with indwelling needles (6 studies, n =  659, RR 1.24, 95% CI 0.91 to 1.69). At longer follow‐up the CIs did not exclude no effect (5 trials, n =  570, RR 1.47, 95% CI 0.79 to 2.74). The evidence from two trials using laser stimulation was inconsistent and could not be combined. The combined evidence on electrostimulation suggests it is not superior to sham electrostimulation (short‐term abstinence: 6 trials, n =  634, RR 1.13, 95% CI 0.87 to 1.46; long‐term abstinence: 2 trials, n =  405, RR 0.87, 95% CI 0.61 to 1.23). ","The authors concluded that:\n- Although pooled estimates suggest possible short‐term effects there is no consistent, bias‐free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for six months or more; lack of evidence and methodological problems mean that no firm conclusions can be drawn\n- Electrostimulation is not effective for smoking cessation\n- Well‐designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence‐based interventions"]
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[null,"Cahill K and Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4. \nAvailable here.","Adults","This Cochrane review aimed to firstly, categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking; and secondly, to collect and evaluate data on costs and cost effectiveness associated with workplace interventions. \n\nThe reviewers included 57 studies (61 comparisons) in this updated review. They found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, NRT, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (OR for cessation 1.71, 95% CI 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. ","The authors reported that:\n- They found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere\n- Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low\n- They failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data\n- There was limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates\n- Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced"]
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[null,"Leaviss J, Sullivan W, Ren S, Everson-Hock E, Stevenson M, Stevens J, et al. What is the clinical effectiveness and cost effectiveness of cytisine compared with varenicline for smoking cessation: a systematic review and economic evaluation?. Health Technology Assessment 2014;18(33)\nAvailable here","Adult smokers","Twenty-three (RCTs) were included in the systematic review, comprising a total of 10,610 participants. Twenty-one trials of varenicline of differing dosing schedules and two trials of cytisine at standard dose met the inclusion criteria. No head-to-head trials comparing varenicline with cytisine were identified. Cytisine was more efficacious than placebo [hazard ratio (HR) 4.27, 95% credible interval (CrI) 2.05 to 10.05], as was standard-dose varenicline (HR 2.58, 95% Crl 2.16 to 3.15). Standard-dose varenicline treatment was associated with significantly higher rates of headache, insomnia and nausea than placebo; there was no significant difference in the rates of abnormal dreams. There were no significant differences in the rates of headache or nausea between cytisine and placebo; data were identified for neither abnormal dreams nor insomnia. Using expected values, cytisine is anticipated to dominate varenicline, in that it produces more quality-adjusted life-years at a lower associated cost. This occurred in approximately 90% of the scenarios performed. However, owing to the large number of people who wish to quit smoking (estimated to be 3 million over a 10-year period), the implications of making an incorrect decision is large. The expected value of sample information indicated that conducting a head-to-head trial of cytisine and varenicline was worthwhile, and that 1000 smokers per arm was an appropriate number to recruit.","On the basis of the evidence included in this review, varenicline and cytisine are both effective interventions to aid smoking cessation when compared with placebo. Cytisine is estimated to be both more clinically effective and cost-effective than varenicline. However, there is uncertainty in the decision, and a head-to-head trial of cytisine and varenicline would appear to be an effective use of resources.\n"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence. Ottawa: CADTH; 2014.\nAvailable here.","Not specified","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of newer nicotine replacement products (Nicorette Quick Mist, Nicorette Combo Quit, Nicorette Mini Lozenges) for smoking cessation?\n2. What is the clinical evidence for the use of supratherapeutic doses of NRT?\n3. What is the clinical evidence for the use of nicotine replacement products to reduce smoking for those who do not quit?\n\nThe literature search identified 303 citations, with no additional articles identified from other sources. After screening the abstracts, 13 were deemed potentially relevant and 9 met the criteria for inclusion in this review: 3 SRs and 6 RCTs.\n\nNo clinical evidence was identified for the NRT products specifically termed as the Nicorette Quick Mist, Nicorette Combo Quit, or Nicorette Mini Lozenges. Limited evidence showed that nicotine mouth spray or the combination of nicotine patch plus gum achieved higher smoking cessation than placebo. Modestly higher smoking cessation rates were observed with high doses nicotine patch compared with standard nicotine patch dose. NRT appears effective in reduction of smoking for those who did not want to quit. However, findings reported in this review should be interpreted with caution due to the potential methodological limitations and clinical heterogeneity of the body evidence. Better designed RCTs in Canadian settings are needed to determine the clinical effectiveness of the newer NRT products or the use of high doses of NRT for smoking cessation, as well as the role of NRT in smoking reduction.","This rapid response review reported that:\n- No evidence was found specific to the new products Nicorette QuickMist, Nicorette ComboQuit, and Nicorette mini lozenges\n- Limited evidence shows a higher quit rate with: nicotine mouth spray, as compared with placebo; the combination of nicotine patch plus gum, as compared with placebo; and\nhigh-dose nicotine patch, as compared with standard-dose nicotine patch\n- NRT appears effective in the reduction of smoking for those who do not want to quit\n- These findings should be interpreted with caution because of limitations of the evidence"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Stead LF, Hartmann‐Boyce J, Perera R and Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3.\nAvailable here.","Adults\n","This Cochrane review aimed to evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. \n\nSeventy‐seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall the reviewers did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, RR for cessation at longest follow‐up 1.37, 95% CI 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.\n \nTelephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta‐regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually NRT) than when the control group only received self‐help material or a brief intervention. \n\nA further eight studies were too diverse to contribute to meta‐analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change, and none detected evidence of effect. ","The authors concluded that:\n- Proactive telephone counselling aids smokers who seek help from quitlines\n- Telephone quitlines provide an important route of access to support for smokers, and call‐back counselling enhances their usefulness\n- There is limited evidence about the optimal number of calls\n- Proactive telephone counselling also helps people who receive it in other settings\n- There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit\n- Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self‐help materials, or brief advice, or compared to pharmacotherapy alone "]
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[null,"Chen Y, Madan J, Welton N, Yahaya I, Aveyard P. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment 2012;16(38)\nAvailable here","Adults","This effectiveness review included 60 RCTs/quasi-RCTs reported in 77 publications. Pooled estimate for prolonged abstinence [relative risk (RR) = 1.32, 95% confidence interval (CI) 1.21 to 1.45] and point prevalence abstinence (RR = 1.14, 95% CI 1.07 to 1.22) suggested that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials. There was no significant difference in effect sizes between aid to cessation studies (which provide support to smokers who are ready to quit) and cessation induction studies (which attempt to encourage a cessation attempt in smokers who are not yet ready to quit). Results from MTC also showed small but significant intervention effect (time to relapse, mean hazard ratio 0.87, 95% credible interval 0.83 to 0.92).","The effectiveness review concluded that computer and other electronic aids increase the likelihood of cessation compared with no intervention or generic self-help materials, but the effect is small. The effectiveness does not appear to vary with respect to mode of delivery and concurrent non-electronic co-interventions. The cost-effectiveness review suggests that making some form of electronic support available to smokers actively seeking to quit is highly likely to be cost-effective. This is true whether the electronic intervention is delivered alongside brief advice or more intensive counselling. The key source of uncertainty is that around the comparative effectiveness of different types of electronic interventions. \nThe review suggests that further research is needed on the relative benefits of different forms of delivery for electronic aids, the content of delivery, and the acceptability of these technologies for smoking cessation with subpopulations of smokers, particularly disadvantaged groups. More evidence is also required on the relationship between involving users in the design of interventions and the impact this has on effectiveness, and finally on how electronic aids developed and tested in research settings are applied in routine practice and in the community."]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Quitline interventions. Atlanta: CPTSF; 2012c. \nAvailable here.","Adults","This CPSTF finding on quitline effectiveness is based on evidence from an SR published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up.This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.\n\nEvidence of effectiveness for quitline promotional efforts is based on an SR of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).\n\nThe SRs were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nThe Task Force recommendation is based on evidence from 71 studies that evaluated effectiveness of proactive telephone counseling. Twelve studies evaluated treatment effectiveness for callers to quitlines available to the general public and observed a median absolute %age point increase in tobacco cessation of 3.1 %age points (interquartile interval [IQI]: 0.5 to 3.3 %age points). Fifty-one studies evaluated interventions for clients in clinical and research settings and observed a median absolute %age point increase in tobacco cessation of 1.7 %age points (IQI: 0.0 to 8.5 %age points). \n\nOnly six of 77 included studies provided evidence on effectiveness of reactive (caller initiated) quitline counseling. Three of these studies evaluated effectiveness of counseling for a single quitline contact and overall findings were inconsistent. The other three studies evaluated effectiveness of offering tobacco users access to quitline services, and similarly, overall results were inconsistent.","The CPSTF concluded that:\n- Quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting are recommended\n- Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions\n- Three interventions effective at increasing use of quitlines are mass-reach health communication interventions that combine cessation messages with a quitline number, provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting, and quitline referral interventions for health care systems and providers\n- Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence-based cessation treatments. Atlanta: CPTSF; 2012d. \nAvailable here.","Adults","This CPSTF is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al, 5 studies, search period 1980-2000) combined with more recent evidence (13 studies, search period January 2000July 2012). Based on this updated review, the Task Force recommendation was changed from sufficient evidence to strong evidence of effectiveness. \n\nPrimary evidence for the finding comes from 14 of these 18 studies that evaluated the effectiveness of reducing out-of-pocket costs for cessation treatments on rates of tobacco cessation, total number of tobacco users who quit, or the prevalence of tobacco use in defined populations. Twelve of the 14 studies provided measurements of change in quit rates and observed a median absolute % increase of 4.3 %age points (IQI: + 0.2 to +6.0 %age points) with follow-up periods of 3.5 months or longer. The two remaining studies observed decreases in smoking prevalence over two years in populations provided with a new tobacco cessation benefit. \n\nThe included studies also provided measurements of change in use of the covered cessation treatments, and in overall quit attempts. Fifteen studies examined changes in the use of cessation treatments, of which 11 reported differences in the rate of use and observed a median absolute % increase of 7.0 %age points (IQI: +1.4 to +18.3 %age points). Seven studies examined changes in overall quit attempts, with six studies reporting a median absolute % difference in quit attempt rates of +2.8 %age points (IQI: -0.6 to +9.1 %age points). \n\nEvidence-based treatments considered in the Task Force recommendation were based on the findings of Treating Tobacco Use and Dependence: 2008 update (Fiore et al., 2008) a series of recent systematic reviews conducted to document the evidence of effectiveness of clinical interventions and cessation treatments to reduce tobacco use among patients in health care settings and systems. Cessation treatments described in the included studies for this review were categorised for description and analysis as cessation counseling and cessation medications. The evidence-based treatments provided at reduced out-of-pocket costs in 13 of the 18 studies included both medications and counseling. Five studies assessed the effectiveness of reducing out-of-pocket costs for cessation medications only, and observed results similar to the overall body of evidence. Only one study assessed the effectiveness of reduced out-of-pocket costs only for cessation counseling, so the effectiveness of this benefits approach remains unclear. ","The CPSTF concluded that:\n- Policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit, are recommended\n- Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications\n- Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions"]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Bize R et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. \n\nThe reviewers  included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested carbon monoxide feedback alone and carbon monoxide combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used carbon monoxide measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of carbon monoxide and spirometry feedback in different settings. ","The authors concluded that:\n- There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation\n- Of the fifteen included studies, only two detected a significant effect of the intervention\n- Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal\n- A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect\n- Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta‐analyses; neither of these found evidence of an effect\n- Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"Lancaster  T and Stead  LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000191. DOI: 10.1002/14651858.CD000191.pub2. \nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. \n\nTwo studies provided long‐term follow‐up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled RR for quitting for silver acetate vs placebo was 1.04 (95% CI 0.69 to 1.57). ","The authors concluded that:\n- Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation\n- The CI for the ratio are quite wide but the upper limit of the CI for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%\n- Any effect of this agent is therefore likely to be smaller than NRT\n- The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]
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[null,"Hartmann‐Boyce  J, Cahill  K, Hatsukami  D and Cornuz  J. Nicotine vaccines for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007072. DOI: 10.1002/14651858.CD007072.pub2. \nAvailable here.","Adults","This Cochrane review aimed to assess the efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type of adverse events associated with the use of nicotine vaccines. \n\nThere are no nicotine vaccines currently licensed for public use, but there are a number in development. The reviewers found four trials which met their inclusion criteria, three comparing NicVAX to placebo and one comparing NIC002 (formerly NicQbeta) to placebo. All were smoking cessation trials conducted by pharmaceutical companies as part of the drug development process, and all trials were judged to be at high or unclear risk of bias in at least one domain. Overall, 2642 smokers participated in the included studies in this review. None of the four included studies detected a statistically significant difference in long‐term cessation between participants receiving vaccine and those receiving placebo. The RR for 12 month cessation in active and placebo groups was 1.35 (95% CI 0.82 to 2.22) in the trial of NIC002 and 1.74 (95% CI 0.73 to 4.18) in one NicVAX trial. Two Phase III NicVAX trials, for which full results were not available, reported similar quit rates of approximately 11% in both groups. In the two studies with full results available, post hoc analyses detected higher cessation rates in participants with higher levels of nicotine antibodies, but these findings are not readily generalisable. The two studies with full results showed nicotine vaccines to be well tolerated, with the majority of adverse events classified as mild or moderate. In the study of NIC002, participants receiving the vaccine were more likely to report mild to moderate adverse events, most commonly flu‐like symptoms, whereas in the study of NicVAX there was no significant difference between the two arms. Information on adverse events was not available for the large Phase III trials of NicVAX. \n\nVaccine candidates are likely to undergo significant changes before becoming available to the general public, and those included in this review may not be the first to reach market; this limits the external validity of the results reported in this review in terms of both effectiveness and tolerability. ","The authors concluded that:\n- There is currently no evidence that nicotine vaccines enhance long‐term smoking cessation\n- Rates of serious adverse events recorded in the two trials with full data available were low, and the majority of adverse events reported were at mild to moderate levels\n- The evidence available suggests nicotine vaccines do not induce compensatory smoking or affect withdrawal symptoms\n- No nicotine vaccines are currently licensed for use in any country but a number are under development\n- Further trials of nicotine vaccines are needed, comparing vaccines with placebo for smoking cessation\n- Further trials are also needed to explore the potential of nicotine vaccines to prevent relapse. Results from past, current and future research should be reported in full Adverse events and serious adverse events should continue to be carefully monitored and thoroughly reported"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacologic-Based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses. Ottawa: CADTH; 2012.\nAvailable here.","Adults","This CADTH HTA report aimed to compare the pharmacological agents (drug-based smoking cessation aids) to determine which of these works best (clinical effectiveness) at six months and 12 months after patients attempt to quit smoking. It also aimed to perform an economic analysis to determine which smoking cessation\ntherapy was the most cost-effective for patients, drug plans, and the Canadian health care system.\n\nEighty-one trials (from August 1982 to June 2009) were identified, involving a total of 40,317 participants. Varenicline, bupropion, and all six NRTs (patch, gum, lozenge, inhaler, spray, and sublingual) were found to be more efficacious than placebo after six months and one year of follow-up. Use of NRTs (OR 1.89, CredI 95% 1.63 to 2.18) or use of bupropion (OR 1.95, CredI 95% 1.58 to 2.41) was found to approximately double the odds of quitting successfully and maintaining abstinence for at least 12 months compared with placebo. Use of varenicline (OR 2.78, CredI 95% 2.17 to 3.57) also improved the odds of success between two- and three-fold. The use of mixed treatment comparisons in the review found varenicline to be superior to conventional NRT use and bupropion. There were no differences in efficacy between bupropion and NRT or between the various forms of NRT alternatives.\n\nNicotine gum, nicotine patch, and bupropion were shown to be superior compared with placebo at 12 months of follow-up in five trials (n = 1,673) assessing five different interventions for smoking cessation in smokers with cardiovascular or smoking-related diseases. For patients with chronic obstructive pulmonary disease, nicotine sublingual (one trial, n = 370) and bupropion (two trials, n = 579) were superior to placebo.\n\nThere were few RCTs of combined therapy versus monotherapy. The addition of nicotine gum to nicotine patch was superior compared with nicotine patch alone for the six-month continuous abstinence rate, but not at one year of follow-up (one RCT, n = 374). The combined therapies of nicotine patch and inhaler or bupropion and NRT did not provide an added effect compared with monotherapy (four RCTs). Thus, combined therapy should be prescribed with caution because the evidence is scarce and the adverse effects unknown.\n\nA review of existing economic analyses showed that varenicline (with or without behavioural interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results should be interpreted with caution because most of the studies comparing varenicline with bupropion or NRT were funded by the manufacturer of varenicline.\n\nThe economic analyses targeting a general population showed that, for all ages and gender, bupropion and varenicline dominated (i.e., cost less and was more effective) nicotine gum, patch, lozenge, and inhaler. If providers' willingness to pay was greater than $10,000 per QALY, then varenicline was preferred.","Based on the included evidence, this HTA report cnsludes that:\n- All pharmacotherapies under review (NRT, bupropion, and varenicline) are efficacious in helping the general population (relatively healthy smokers) quit smoking for at least six to 12 months and therefore, could all be used as aids for smoking cessation in the general population of smokers\n- Bupropion or NRT were found to be effective for those with cardiovascular disease or chronic obstructive pulmonary disease who wanted to quit smoking\n- For pharmacological interventions targeting a general population, bupropion and varenicline were dominating options (cost less and were more effective) over nicotine gum, patch, lozenge, and inhaler. If a provider's willingness to pay was greater than $10,000 per QALY gained, varenicline was the optimal treatment choice compared with NRT and bupropion"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions. Atlanta: CPTSF; 2011a. \nAvailable here.","Adolescents (age not specified)\nAdults \n","The CPSTF finding is based on evidence published in 2009 (Whittaker et al., search period through December 2008) combined with more recent evidence (search period December 2008–August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. \n\nPrimary evidence for the Task Force finding comes from six studies that evaluated the effectiveness of interventions using automated text messages for recruited participants willing to make a quit attempt. Studies were conducted in Norway, New Zealand, and the United Kingdom. All six included studies were RCTs and assessed self-reported (4 studies) or biochemically verified (2 studies) cessation outcomes at 6- or 12-month follow-up. The median loss to follow-up rate was 10%. One study included NRT, which was provided to participants in both the intervention and comparison groups.\n\nIn three studies, mobile phone text messaging was the primary cessation support intervention. The median difference in cessation rates at 6 months was an improvement of 2.9 %age points (range of values: +1.7 %age points to +4.9 %age points). In the other three studies, mobile phone messages were complemented by Internet-based components. The median difference in cessation rates at 6 months or longer was an improvement of 9 %age points (range of values: -1.2 %age points to +13.3 %age points). Only one study included NRT, which was provided to participants in both the intervention and comparison groups. ","The CPSTF concluded that:\n- Mobile phone-based interventions for tobacco cessation are recommended to increase tobacco use abstinence among people who want to quit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Internet-Based Cessation Interventions. Atlanta: CPTSF; 2011b. \nAvailable here.","Adolescents (age not specified)\nAdults","The CPSTF finding is based on evidence from SR published in 2010 (Civljak et al., search period through June 2010) combined with more recent evidence (search period June 2010-August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nPrimary evidence for the Task Force finding comes from 24 studies that evaluated the effectiveness of Internet-based interventions, implemented alone or in combination with additional interventions designed to increase tobacco cessation. As defined in the 2010 SR, the studies included in the present review were organised and considered for each comparison evaluated. Thirteen studies provided a comparison of an Internet-based intervention with usual care or a non-Internet-based intervention. Across the body of evidence, the effect estimates from these studies were inconsistent. A subset of seven of these studies targeted adult tobacco users and observed a median absolute %age point change in tobacco cessation of 3.2 %age points (IQI: -1.7 %age points to 12.5 %age points). Eleven of the 24 studies provided comparisons of one Internet-based intervention with a different Internet-based intervention. Effect estimates from these studies were inconsistent, and the examined comparisons were of limited use to the Task Force’s assessment of effectiveness.  \n\nAn additional analysis examined ten of the 24 studies that compared Internet-based interventions that provided tailored and interactive content with non-tailored-Internet or no-Internet interventions. Effect estimates from these studies were inconsistent, with a median absolute %age point increase in tobacco cessation of 2.1 %age points (IQI: 0.1 %age points to 12.5 %age points). ","The CPSTF concluded that:\n- There is insufficient evidence to determine whether internet-based interventions increase tobacco use cessation\n- Studies included in the review reported inconsistent effects, and interpretation was complicated by differences in internet-based content, components, and interactions; frequent provision of evidence-based interventions to comparison groups; and moderate to high rates of loss to follow-up"]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]
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[null,"Carr S, et al. An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 2011; 15(9).\nAvailable here.","General adult population","This review aimed to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK.\nFour studies were identified that examined the impact of LAs in smoking cessation. All of the interventions were delivered on a one-to-one basis. The support was delivered via telephone or face-to-face meetings in addition to telephone calls. The contacts were supported with videos and pamphlets and access to free NRT.\nTwo studies West (1998) and May (2006) used the intervention of buddy groups, allocating a partner and encouraging exchange of telephone numbers. Financial incentives were also sued in both studies. Woodruff 2002 reviewed past quit attempts, discussed the pros and cons of smoking and quitting, discussed self-monitoring to identify smoking patterns, identified potential reinforcements and substitute behaviours and discussed appropriate coping strategies, set a quit date, discussed experiences while quitting and relapse prevention, and talked about overall lifestyle change. Emmons (2005) emphasised the smoker’s choice, personal responsibility for change and enhancement of self-efficacy. The calls were tailored to the participants’ stage of readiness to quit smoking and interest in other health topics and goals. Nicotine replacement therapy (NRT) was discussed, and was made available without cost to the intervention group’s participants and their spouses/partners who indicated in the counselling calls that they were ready to make a serious quit attempt.\nSignificantly more remained abstinent from smoking in the buddy support group after 4 weeks [15% difference, effect size 2.79 (95% CI 1.26 to 6.22)] in West 1998 but not in May 2006 (adjusted OR 1.16, 95% CI 0.76 to 1.78). Woodruff 2002120 reports that 20.3% of the intervention group had quit at 3 months compared with 8.7% of the comparison group. However, these results are based on a per-protocol analysis that ignores differential attrition in the intervention arm. Applying an intention-to-treat analysis, and assuming that all of those lost to follow-up have relapsed, gives a quit rate of 17.3% in the intervention group and 8.3% in the control group. Emmons 2005 reported that the quit rate was significantly higher in the peer counselling group than the control group (16.8% vs 8.5%, p < 0.0003) at 8 months. This difference was maintained at the 12-month follow-up (15% vs 9%, p < 0.01). Controlling for baseline self-efficacy and depression, the peer counselling group was more likely to quit smoking by the 12-month follow-up compared with the control group (12-month OR 1.99, 95% CI 1.27 to 3.14)\n\nOverall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life (QoL). The buddy schemes explored in these studies have much to offer to an analysis of intervention components and may still offer potential as a practice model.","Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. \n\nReporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions.\n \nA future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence. "]

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[null,"ADOLESCENT POPULATION"]
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[null,"GUIDANCE - ADOLESCENT POPULATION"]
[null,"Source:","Audience:","Recommendations:"]
[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people. PH14. London: NICE; 2008.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nWoolfall K et al. The prevention of uptake of smoking by children and young people, with reference to the areas of mass media and the sale of tobacco products: findings from a multi-method primary research study. \nAvailable here.\n\nRichardson et al. NICE Rapid review: Interventions to Prevent the Uptake of Smoking in  Children and Young People. British Columbia: Centre of Excellence for Women's Health; 2008. Available here.","This guideline is for: \n- NHS, local authorities, the criminal justice system and others working in the public, voluntary and community sectors\n- Retailers\n- Mass-media services\n- Children, young people and their carers and other members of the public","This guideline covers anti-smoking mass-media campaigns, for example, on TV, in newspapers and online. It also covers measures to prevent tobacco being sold to children and young people. The aim is to help prevent children and young people from taking up smoking.\n\nIt makes recommendations on:\n- Mass-media campaigns, including how to develop them and the type of messages to put across\n- Illegal sales and how to prevent them\n\nThis guideline was checked in November 2014."]
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[null,"SYSTEMATIC REVIEWS - ADOLESCENT POPULATION"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Non-pharmacological and Pharmacological Intervention for Smoking Cessation Programs in Youth: A Review of Clinical Effectiveness and Guidelines.\nOttawa: CADTH; 2020 Feb. (CADTH rapid response report: summary with critical appraisal).\nAvailable here\n","Adolescents","Regarding the clinical effectiveness for pharmacological and non-pharmacological smoking cessation interventions, one RCT was identified in the search. Evidence from this RCT suggested that there were no significant differences in smoking cessation or smoking frequency outcomes when comparing a multicomponent intervention group (brief advice, nicotine patch therapy and a 6-week text messaging intervention) to brief advice and nicotine patch therapy alone.\nThree SRs and eight RCTs addressed the clinical effectiveness of non-pharmacological smoking cessation interventions research question, and the results were mixed. Evidence from the SRs did not reveal improved smoking cessation outcomes for most comparisons; two MAs did find improved smoking cessation outcomes in favour of the intervention. Of the seven RCTs that examined smoking cessation outcomes, three studies found reductions in favour of the smoking cessation intervention, three did not find differences between groups, and one study found improvements at 3 months in favour of the intervention but not at 6-month follow-up.","It may be early to draw conclusions about pharmacological and non-pharmacological smoking cessation interventions for youth given the mixed findings identified in this report. Larger, sufficiently powered comparative studies evaluating pharmacological and non-pharmacological smoking cessation interventions may help reduce this uncertainty."]
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[null,"Whittaker  R, McRobbie  H, Bullen  C, Rodgers  A, Gu  Y, Dobson  R. Mobile phone text messaging and app‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub5.\nAvailable here.","Adults\nAdolescents","This review includes 26 studies (33,849 participants). Overall, the authors judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high‐income countries. \nThere was moderate‐certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate‐certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). \nTwo studies comparing text messaging with other smoking cessation interventions, and three studies comparing high‐ and low‐intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. \nFive studies compared a smoking cessation smartphone app with lower‐intensity smoking cessation support (either a lower‐intensity app or non‐app minimal support). The authors pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so the authors did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. ","There is moderate‐certainty evidence that automated text message‐based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. \nThere is moderate‐certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. \nThe evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions."]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Community Preventive Services Task Force. (2019). Tobacco Use and Secondhand Smoke Exposure: Internet-based Interventions to Increase Tobacco Use Cessation. USA.Gov. Available here.\n\nUnderpinning evidence review:\nMcCrabb et al, Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis. Annals of Behavioral Medicine 2019:53(2):180-95. Available here. ","This guidance is for:\nAdolescents and Young Adults\nAdults\nOlder Adults\nParents/Caregivers","The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The underpinning review (McCrabb et al) was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation. The review included 45 studies. The CPSTF examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.\n\nThe CPSTF findings are based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.\n\nFindings\n-Internet-based interventions increased tobacco use cessation rates by a median of 1.2 percentage points overall (31 studies).\n-Differences in cessation rates were slightly larger when internet-based interventions were compared to no intervention, usual care, printed materials, or basic website content (median increase of 1.3 percentage points; 17 studies).\n-Differences in cessation rates were smaller when internet-based interventions were compared to other interventions that provided interactive content, cessation counseling, or evidence-based cessation medications (median increase of 0.8 percentage points; 14 studies).\n-Most studies provided internet, cessation counseling, or medication interventions to participants in the comparison group.\n-Participants in both intervention and comparison groups quit at meaningful rates, which minimized differences.\n","Recommendation\nThe Community Preventive Services Task Force (CPSTF) recommends internet-based cessation interventions based on sufficient evidence of effectiveness in increasing tobacco use cessation among adult tobacco users. Systematic review evidence showed meaningful improvements in tobacco cessation outcomes when measured six or more months following intervention. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Adolescents and\nYoung children (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Taylor GMJ et al. Internet‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD007078. DOI: 10.1002/14651858.CD007078.pub5.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to determine the effectiveness of Internet‐based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. \n\nThe reviewers  identified 67 RCTs, including data from over 110,000 participants. They pooled data from 35,969 participants. There were only four RCTs conducted in adolescence or young adults that were eligible for meta‐analysis. \n\nResults for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non‐active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n =   6786). However, statistical heterogeneity was high (I² = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n =   3806, I² = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non‐active control (n =   2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I² = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n =  2769, I² = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n =   14,623, I² = 0%); GRADE rating was moderate. Three studies compared tailored with non‐tailored Internet‐based messages, compared to non‐tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n =  4040), and there was evidence of unexplained substantial statistical heterogeneity (I² = 57%); GRADE rating was low. \n\nResults should be interpreted with caution as the reviewers judged some of the included studies to be at high risk of bias. ","The authors concluded that:\n- The evidence from trials in adults suggests that interactive and tailored Internet‐based interventions with or without additional behavioural support are moderately more effective than non‐active controls at six months or longer\n- There was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity\n- Treatment effectiveness in younger people is unknown "]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine Replcacement Therapy, Bupropion and Varenicline for Tobacco Cessation: A Review of Clinical Effectiveness. Ottawa: CADTH; 2016.\nAvailable here.","Smokers of any age","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the comparative clinical effectiveness of NRT versus bupropion or varenicline in the general population of tobacco users? \n2. What is the comparative clinical effectiveness of NRT, bupropion or varenicline versus placebo in the general population of tobacco users?\n\nA total of 558 citations were identified in the literature search. Following screening of titles and abstracts, 531 citations were excluded and 27 potentially relevant reports from the electronic search were retrieved for full-text review. Of the potentially relevant articles, 10 studies were included in this report.\n\nThe findings of this report should be considered in the context of the previous CADTH HTA on the subject (Technology report: 130 Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses), which employed a more thorough methodology and analysis of the primary studies on this topic. The HTA found that varenicline was superior to bupropion and conventional use of the nicotine patch, and that all pharmacotherapies included in the HTA were efficacious in aiding the general population to quit smoking. The current review gives an overview of the recent evidence published since this HTA, and provides areas for consideration within the body of evidence on this subject, including the previous CADTH HTA. Regarding NRT versus placebo, most studies published between 2012 and 2016 showed no difference in tobacco related outcomes, but the research was conducted in specific sub-populations (e.g., adolescents, smokeless tobacco users, or persons who had previously quit and were preventing relapse) and may be less relevant to the general population of smokers. The findings and recommendations of the HTA are still considered relevant.         \n \nTen relevant studies are included in this review. The findings suggest that varenicline groups achieved higher rates of abstinence compared to both NRT and placebo, bupropion and NRT were of similar effectiveness, and bupropion and varenicline both had higher abstinence rates compared to placebo. The number of SRs that reported adverse events in any of the treatment groups was six. When side effects did occur, they were usually mild in presentation and localized (e.g., skin irritation from the nicotine patch).  \n \nIt is uncertain how much these findings of clinical effectiveness were influenced by the baseline characteristics of the study participants (e.g., how many cigarettes they smoked per day prior to therapy), as well as the differences among the behavioural therapies being offered along with the pharmacological therapies. These behavioural interventions differed across the studies, as therapies counselling and information presented as a booklet. Many smoking and tobacco cessation programs offer a combination of behavioural and pharmacological interventions. The success of these cessation programs may depend on the type of treatment being offered. \n \n ","This rapid response review concluded that:\n- The clinical effectiveness of NRT compared to bupropion was found to be similar\n- Studies that compared varenicline to NRT reported higher rates for abstinence for participants in the varenicline group\n-There is some evidence to suggest that participants using bupropion, and those using varenicline achieved higher rates of abstinence when compared to placebo\n- Findings for NRT versus placebo or control were mixed, with some studies reporting no difference and one study reporting higher rates of abstinence for those on NRT"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Adolescents and children (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth Delivery of Group Smoking Cessation Programs for Adolescents and Young Adults: Clinical Effectiveness. Ottawa: CADTH; 2015.\nAvailable here.","Adolescents and young adults (age not specified)","This CADTH rapid response review aimed to answer the following research question:\nWhat is the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults? \n\nNo relevant HTAs, SRs, meta-analyses, RCTs, or non-randomised studies were identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adults. ","This rapid response review reported that:\n- No relevant literature was identified regarding the clinical effectiveness of the use of telehealth for the delivery of group smoking cessation programs for adolescents and young adult "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Hughes JR et al. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.\nAvailable here.","Adolescents and\nAdults with or without\nPre-existing health condition: Depression or history of depression","This Cochrane review aimed to assess the effect and safety of antidepressant medications to aid long‐term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); selegiline; sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine. \n\nTwenty‐four new trials were identified since the 2009 update, bringing the total number of included trials to 90. There were 65 trials of bupropion and ten trials of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long‐term cessation (44 trials, n =  13,728, RR 1.62, 95% CI 1.49 to 1.76). There was moderate quality evidence, limited by a relatively small number of trials and participants, that nortriptyline also significantly increased long‐term cessation when used as the sole pharmacotherapy (six trials, n =  975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 trials, n =  3487, RR 1.19, 95% CI 0.94 to 1.51) or nortriptyline (4 trials, n =  1644, RR 1.21, 95% CI 0.94 to 1.55) to NRT provides an additional long‐term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline appear to be equally effective and of similar efficacy to NRT (bupropion versus nortriptyline 3 trials, n =  417, RR 1.30, 95% CI 0.93 to 1.82; bupropion versus NRT 8 trials, n =  4096, RR 0.96, 95% CI 0.85 to 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four trials comparing bupropion to varenicline showed significantly lower quitting with bupropion than with varenicline (n =  1810, RR 0.68, 95% CI 0.56 to 0.83). Meta‐analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the CI only narrowly missed statistical significance (33 trials, n =  9631, RR 1.30, 95% CI 1.00 to 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is unclear. Nortriptyline has the potential for serious side‐effects, but none have been seen in the few small trials for smoking cessation. \n\nThere was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1.22, n =  1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, n =  466, RR 0.70, 95% CI 0.64 to 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1.79, n =  827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, n =  147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John's wort (hypericum) (2 trials, n =  261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, n =  120, RR 0.70, 95% CI 0.24 to 2.07). ","The authors concluded that:\n- The antidepressants bupropion and nortriptyline aid long‐term smoking cessation\n- Adverse events with either medication appear to rarely be serious or lead to stopping medication\n- Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement\n- Evidence also suggests that bupropion is less effective than varenicline, but further research is needed to confirm this finding\n- Evidence suggests that neither selective serotonin reuptake inhibitors (e.g. fluoxetine) nor monoamine oxidase inhibitors aid cessation"]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Young people (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence. Ottawa: CADTH; 2014.\nAvailable here.","Not specified","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of newer nicotine replacement products (Nicorette Quick Mist, Nicorette Combo Quit, Nicorette Mini Lozenges) for smoking cessation?\n2. What is the clinical evidence for the use of supratherapeutic doses of NRT?\n3. What is the clinical evidence for the use of nicotine replacement products to reduce smoking for those who do not quit?\n\nThe literature search identified 303 citations, with no additional articles identified from other sources. After screening the abstracts, 13 were deemed potentially relevant and 9 met the criteria for inclusion in this review: 3 SRs and 6 RCTs.\n\nNo clinical evidence was identified for the NRT products specifically termed as the Nicorette Quick Mist, Nicorette Combo Quit, or Nicorette Mini Lozenges. Limited evidence showed that nicotine mouth spray or the combination of nicotine patch plus gum achieved higher smoking cessation than placebo. Modestly higher smoking cessation rates were observed with high doses nicotine patch compared with standard nicotine patch dose. NRT appears effective in reduction of smoking for those who did not want to quit. However, findings reported in this review should be interpreted with caution due to the potential methodological limitations and clinical heterogeneity of the body evidence. Better designed RCTs in Canadian settings are needed to determine the clinical effectiveness of the newer NRT products or the use of high doses of NRT for smoking cessation, as well as the role of NRT in smoking reduction.","This rapid response review reported that:\n- No evidence was found specific to the new products Nicorette QuickMist, Nicorette ComboQuit, and Nicorette mini lozenges\n- Limited evidence shows a higher quit rate with: nicotine mouth spray, as compared with placebo; the combination of nicotine patch plus gum, as compared with placebo; and\nhigh-dose nicotine patch, as compared with standard-dose nicotine patch\n- NRT appears effective in the reduction of smoking for those who do not want to quit\n- These findings should be interpreted with caution because of limitations of the evidence"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mass-Reach Health Communication Interventions. Atlanta: CPTSF; 2013. \nAvailable here.","Adolescents\nAdults","The Task Force recommendation is based on strong evidence of effectiveness from a Community Guide systematic review published in 2001 (Hopkins et al., 27 studies, search period 1980-2000) combined with more recent evidence (70 studies, search period 2000-July 2012). The Task Force finding is based on results from 64 of the 70 studies from the updated search that evaluated interventions using television as the only or primary media channel. Evidence is considered strong based on number of studies, magnitude of effect estimates, and consistency of effects for a range of important tobacco use outcomes.\n\nIncluded studies assessed mass-reach health communication interventions in the United States (44 studies), Australia (13 studies), Canada (2 studies), Israel (1 study), New Zealand (2 studies), Switzerland (1 study), Taiwan (1 study), the Netherlands (3 studies), and the United Kingdom (3 studies). Most of the studies evaluated these interventions at the state or regional level (42 studies) with the remaining studies at the national (23 studies) and city or local (5 studies) level.\nInterventions were implemented alone (17 studies), with other components (21 studies), or as part of a comprehensive tobacco control program (27 studies). Eight studies did not report on this characteristic. Interventions were implemented with adults (49 studies) or young people (21 studies) as the main audience.","The CPSTF concluded that:\n- Mass-reach health communication interventions are recommended, based on strong evidence of effectiveness in: 1) decreasing the prevalence of tobacco use; 2) increasing cessation and use of available services such as quitlines; and 3) decreasing initiation of tobacco use among young people.\n- Based on findings from studies in which television was the primary media channel, the evidence was considered strong\n- Economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"Moodie C et al. Plain tobacco packaging: a systematic review. London: Public Health Research Consortium. 2012.\nAvailable here.","Adolescents\nAdults","The primary aim of this review was to assess the impact of plain tobacco packaging on the appeal of the packaging or product; salience and effectiveness of health warnings; and perceptions of product strength and harm. Its secondary aims were to assess any other potential impacts (benefits or disbenefits) of plain packaging not identified by the Framework Convention on Tobacco Control; examine whether the effects of plain packaging vary by gender, age, socio-economic status and ethnicity; and describe the facilitators and barriers to the introduction of plain packaging identified within the included studies.  \n\nA total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.","The authors reported that:\n- Plain packaging has been shown to\nreduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs\n- It increases the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings\n- It reduces the confusion about product harm that can result from branded packs\n- It was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit\n- Some evidence was found that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants)  "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012b, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions. Atlanta: CPTSF; 2011a. \nAvailable here.","Adolescents (age not specified)\nAdults \n","The CPSTF finding is based on evidence published in 2009 (Whittaker et al., search period through December 2008) combined with more recent evidence (search period December 2008–August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. \n\nPrimary evidence for the Task Force finding comes from six studies that evaluated the effectiveness of interventions using automated text messages for recruited participants willing to make a quit attempt. Studies were conducted in Norway, New Zealand, and the United Kingdom. All six included studies were RCTs and assessed self-reported (4 studies) or biochemically verified (2 studies) cessation outcomes at 6- or 12-month follow-up. The median loss to follow-up rate was 10%. One study included NRT, which was provided to participants in both the intervention and comparison groups.\n\nIn three studies, mobile phone text messaging was the primary cessation support intervention. The median difference in cessation rates at 6 months was an improvement of 2.9 %age points (range of values: +1.7 %age points to +4.9 %age points). In the other three studies, mobile phone messages were complemented by Internet-based components. The median difference in cessation rates at 6 months or longer was an improvement of 9 %age points (range of values: -1.2 %age points to +13.3 %age points). Only one study included NRT, which was provided to participants in both the intervention and comparison groups. ","The CPSTF concluded that:\n- Mobile phone-based interventions for tobacco cessation are recommended to increase tobacco use abstinence among people who want to quit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Internet-Based Cessation Interventions. Atlanta: CPTSF; 2011b. \nAvailable here.","Adolescents (age not specified)\nAdults","The CPSTF finding is based on evidence from SR published in 2010 (Civljak et al., search period through June 2010) combined with more recent evidence (search period June 2010-August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nPrimary evidence for the Task Force finding comes from 24 studies that evaluated the effectiveness of Internet-based interventions, implemented alone or in combination with additional interventions designed to increase tobacco cessation. As defined in the 2010 SR, the studies included in the present review were organised and considered for each comparison evaluated. Thirteen studies provided a comparison of an Internet-based intervention with usual care or a non-Internet-based intervention. Across the body of evidence, the effect estimates from these studies were inconsistent. A subset of seven of these studies targeted adult tobacco users and observed a median absolute %age point change in tobacco cessation of 3.2 %age points (IQI: -1.7 %age points to 12.5 %age points). Eleven of the 24 studies provided comparisons of one Internet-based intervention with a different Internet-based intervention. Effect estimates from these studies were inconsistent, and the examined comparisons were of limited use to the Task Force’s assessment of effectiveness.  \n\nAn additional analysis examined ten of the 24 studies that compared Internet-based interventions that provided tailored and interactive content with non-tailored-Internet or no-Internet interventions. Effect estimates from these studies were inconsistent, with a median absolute %age point increase in tobacco cessation of 2.1 %age points (IQI: 0.1 %age points to 12.5 %age points). ","The CPSTF concluded that:\n- There is insufficient evidence to determine whether internet-based interventions increase tobacco use cessation\n- Studies included in the review reported inconsistent effects, and interpretation was complicated by differences in internet-based content, components, and interactions; frequent provision of evidence-based interventions to comparison groups; and moderate to high rates of loss to follow-up"]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]

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[null,"PREGNANT & POSTPARTUM WOMEN POPULATION"]
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[null,"GUIDANCE - PREGNANT & POSTPARTUM WOMEN POPULATION"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2019.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","This guideline covers the care that healthy women and their babies should be offered during pregnancy. It aims to ensure that pregnant women are offered regular check-ups, information and support.\n\nIt provides the following guidance:\n- Woman‑centred care and informed decision‑making \n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\nLast updated: 04 February 2019"]
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[null,"SYSTEMATIC REVIEWS - PREGNANT & POSTPARTUM WOMEN POPULATION"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.","Adolescents; general adult population; pregnant women.","This is an update of a 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nAmong adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months follow up. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events.\nCompared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months’ follow up. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, non-tailored self-help materials, real-time video counseling, biofeedback, exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions.\nNo trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. ","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Claire  R, Chamberlain  C, Davey  MA, Cooper  SE, Berlin  I, Leonardi‐Bee  J, Coleman  T. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub3.\nAvailable here\n","Pregnant women","Compared to placebo and non‐placebo (behavioural support only) controls, there was low‐certainty evidence that NRT increased the likelihood of smoking abstinence in later pregnancy (RR 1.37, 95% CI 1.08 to 1.74; I² = 34%, 9 studies, 2336 women). However, in subgroup analysis by comparator type, there was a subgroup difference between placebo‐controlled and non‐placebo controlled RCTs (test for subgroup differences P = 0.008). There was unclear evidence of an effect in placebo‐controlled RCTs (RR 1.21, 95% CI 0.95 to 1.55; I² = 0%, 6 studies, 2063 women), whereas non‐placebo‐controlled trials showed clearer evidence of a benefit (RR 8.55, 95% CI 2.05 to 35.71; I² = 0%, 3 studies, 273 women). An additional subgroup analysis in which studies were grouped by the type of NRT used found no difference in the effectiveness of NRT in those using patches or fast‐acting NRT (test for subgroup differences P = 0.08). \nThere was no evidence of a difference between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities, or neonatal death. In one study infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' at two years of age compared to the placebo group. Non‐serious adverse effects observed with NRT included headache, nausea, and local reactions (e.g. skin irritation from patches or foul taste from gum), but data could not be pooled. Adherence to NRT treatment regimens was generally low. \nThe authors identified low‐certainty evidence that there was no difference in smoking abstinence rates observed in later pregnancy in women using bupropion when compared to placebo control (RR 0.74, 95% CI 0.21 to 2.64; I² = 0%, 2 studies, 76 women). Evidence investigating the safety outcomes of bupropion use was sparse, but the existing evidence showed no difference between the bupropion and control group. \n","NRT used for smoking cessation in pregnancy may increase smoking cessation rates in late pregnancy. However, this evidence is of low certainty, as the effect was not evident when potentially biased, non‐placebo‐controlled RCTs were excluded from the analysis. Future studies may therefore change this conclusion. The authors found no evidence that NRT has either positive or negative impacts on birth outcomes; however, the evidence for some of these outcomes was also judged to be of low certainty due to imprecision and inconsistency. They found no evidence that bupropion may be an effective aid for smoking cessation during pregnancy, and there was little evidence evaluating its safety in this population. Further research evidence on the efficacy and safety of pharmacotherapy and EC use for smoking cessation in pregnancy is needed, ideally from placebo‐controlled RCTs that achieve higher adherence rates and that monitor infants' outcomes into childhood. Future RCTs of NRT should investigate higher doses than those tested in the studies included in this review."]
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[null,"Livingstone‐Banks  J, Norris  E, Hartmann‐Boyce  J, West  R, Jarvis  M, Chubb  E, Hajek  P. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub6.\nAvailable here. ","Adults\nPregnant women","The authors included 81 studies (69,094 participants), five of which are new to this update. They judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe authors focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate‐certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40,  I2 = 0%; low‐certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate‐certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I = 66%; low‐certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate‐certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. \n","Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means the authors are only moderately certain of this.\n \nIn people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. \n\nModerate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean the authors could not rule out a clinically important benefit at this stage. Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. \nMore research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit. "]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Reduction and Cessation Interventions for Pregnant Women and Mothers of Infants: A Review of the Clinical Effectiveness. Ottawa: CADTH; 2017a.\nAvailable here.","Pregnant women and Women in post partum period","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of smoking reduction programs for Pregnant women or mothers of infants? \n2. What is the clinical effectiveness of smoking cessation interventions for Pregnant women or mothers of infants? \n\nA total of 492 citations were identified in the literature search. Following screening of titles and abstracts, 443 citations were excluded and 49 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search. Of these potentially relevant articles, 44 publications were excluded for various reasons, while seven publications, including two SRs and five RCTs, met the inclusion criteria and were included in this report. \n\n","The rapid response review concluded that:\n- Evidence on the effectiveness of smoking reduction interventions was limited\n- Psychosocial interventions for smoking cessation appeared to be effective, while the effect of health education and social support was less certain\n- The results suggest that psychosocial interventions reduced the risk of infants born with low birthweight, increased the mean birthweight, and decreased the risk of neonatal intensive care unit admission\n- Pharmacological interventions appeared to be effective during treatment or at the end of pregnancy\n- NRT did not seem to have any positive or negative effects on infant outcomes, while the safety of bupropion was inconclusive"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for Smoking Cessation or Reduction: A Review of the Clinical Evidence. Ottawa: CADTH; 2014.\nAvailable here.","Not specified","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of newer nicotine replacement products (Nicorette Quick Mist, Nicorette Combo Quit, Nicorette Mini Lozenges) for smoking cessation?\n2. What is the clinical evidence for the use of supratherapeutic doses of NRT?\n3. What is the clinical evidence for the use of nicotine replacement products to reduce smoking for those who do not quit?\n\nThe literature search identified 303 citations, with no additional articles identified from other sources. After screening the abstracts, 13 were deemed potentially relevant and 9 met the criteria for inclusion in this review: 3 SRs and 6 RCTs.\n\nNo clinical evidence was identified for the NRT products specifically termed as the Nicorette Quick Mist, Nicorette Combo Quit, or Nicorette Mini Lozenges. Limited evidence showed that nicotine mouth spray or the combination of nicotine patch plus gum achieved higher smoking cessation than placebo. Modestly higher smoking cessation rates were observed with high doses nicotine patch compared with standard nicotine patch dose. NRT appears effective in reduction of smoking for those who did not want to quit. However, findings reported in this review should be interpreted with caution due to the potential methodological limitations and clinical heterogeneity of the body evidence. Better designed RCTs in Canadian settings are needed to determine the clinical effectiveness of the newer NRT products or the use of high doses of NRT for smoking cessation, as well as the role of NRT in smoking reduction.","This rapid response review reported that:\n- No evidence was found specific to the new products Nicorette QuickMist, Nicorette ComboQuit, and Nicorette mini lozenges\n- Limited evidence shows a higher quit rate with: nicotine mouth spray, as compared with placebo; the combination of nicotine patch plus gum, as compared with placebo; and\nhigh-dose nicotine patch, as compared with standard-dose nicotine patch\n- NRT appears effective in the reduction of smoking for those who do not want to quit\n- These findings should be interpreted with caution because of limitations of the evidence"]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]

{"sheet":"Pre-existing health condition","index":31,"n_rows":1187,"n_cols":5,"rows_kept":1187,"cut":false,"hidden":false,"merged":[[193,1,206,1],[193,2,206,2],[193,3,206,4],[76,1,192,1],[76,2,192,2],[76,3,192,4],[21,1,21,4],[23,1,43,1],[23,2,43,2],[23,3,43,4],[64,1,75,1],[64,2,75,2],[64,3,75,4],[44,1,63,1],[44,2,63,2],[44,3,63,4],[275,1,295,1],[275,2,295,2],[275,3,295,3],[275,4,295,4],[232,1,254,1],[232,2,254,2],[232,3,254,3],[232,4,254,4],[208,1,208,4],[255,1,274,1],[255,2,274,2],[255,3,274,3],[255,4,274,4],[210,1,231,1],[210,2,231,2],[210,3,231,3],[210,4,231,4],[296,1,330,1],[296,2,330,2],[296,3,330,3],[296,4,330,4],[927,1,954,1],[927,2,954,2],[927,3,954,3],[927,4,954,4],[370,1,384,1],[370,2,384,2],[370,3,384,3],[370,4,384,4],[955,1,988,1],[955,2,988,2],[955,3,988,3],[955,4,988,4],[331,1,369,1],[331,2,369,2],[331,3,369,3],[331,4,369,4],[989,1,1033,1],[989,2,1002,2],[989,3,1033,3],[989,4,1033,4],[1075,4,1122,4],[1034,1,1074,1],[1034,2,1074,2],[1034,3,1074,3],[1034,4,1074,4],[18,1,19,4],[1186,1,1216,1],[1186,2,1216,2],[1186,3,1216,3],[1186,4,1216,4],[1158,1,1185,1],[1158,2,1185,2],[1158,3,1185,3],[1158,4,1185,4],[1123,1,1157,1],[1123,2,1157,2],[1123,3,1157,3],[1123,4,1157,4],[1075,1,1122,1],[1075,2,1122,2],[1075,3,1122,3]]}
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[null,"PRE-EXISTING HEALTH CONDITION POPULATION"]
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[null,"GUIDANCE - PRE-EXISTING HEALTH CONDITION POPULATION"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"SYSTEMATIC REVIEWS - PRE-EXISTING HEALTH CONDITION POPULATION"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Patnode et al. Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Evidence Synthesis Number 196. AHRQ Publication No. 20-05264-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2021. \nAvailable here.","Adolescents; general adult population; pregnant women.","This is an update of 2015 systematic review, addressing the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation.\nThe authors included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking.\nSeveral trials were conducted in clinical subgroups, including among hospital inpatients and disease-specific subgroups (i.e., people with CVD, asthma, substance use disorder, depression, and bipolar/schizoaffective disorder.\nNineteen additional reviews synthesized the evidence on the benefits of pharmacotherapy or behavioral interventions among specific subpopulations of adults These included: eight reviews limited to persons with severe mental illness and two limited to those with or in treatment for alcohol or drug dependence. Within these 19 reviews, most included trials were limited to these subpopulations and very few included trials (or reviews) addressed the relative effectiveness according to subgroup (e.g., the relative effects among those with or without depression). Results of reviews featuring population subgroups (such as mental illness and substance dependence) were consistent with the broader evidence among general adult populations (reviews in which many of these subpopulation studies were included) and suggested effectiveness of both pharmacotherapy and behavioral interventions, alone and combined, to quit smoking. Where pooled results were presented, the direction and magnitude of effects was almost identical to that seen with the broader evidence base, although the number of studies within each review was considerably smaller given the focus on specific subpopulations.\n","There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes."]
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[null,"Tzelepis  F, Paul  CL, Williams  CM, Gilligan  C, Regan  T, Daly  J, Hodder  RK, Byrnes  E, Byaruhanga  J, McFadyen  T, Wiggers  J. Real‐time video counselling for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD012659. DOI: 10.1002/14651858.CD012659.pub2.\nAvailable here.","Adults\nAdults with pre-existing health conditions: women with HIV.","The authors included two randomised trials with 615 participants. Both studies delivered real‐time video counselling for smoking cessation individually, compared with telephone counselling. They judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow‐up) across the two included studies when real‐time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). The authors judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real‐time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI –0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD –0.20, 95% CI –0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI –0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between‐group differences on satisfaction score (MD 0.70, 95% CI –1.16 to 2.56; 1 study, 29 participants). ","There is very little evidence about the effectiveness of real‐time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. \nHigh‐quality randomised trials comparing real‐time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real‐time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation. "]
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[null,"Zeng  L et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD011751. DOI: 10.1002/14651858.CD011751.pub3. \nAvailable here. ","Adults with Pre-existing health condition: Lung cancer","The reviewers identified no randomised controlled trials (RCTs) RCTs that met their inclusion criteria. Among the 1817 records retrieved using their search strategy, they retrieved 19 studies for further investigation. They excluded 15 trials: ten trials because they could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. They excluded one trial because, though it was completed in 2004, no results are available. They assessed four ongoing trials for inclusion when data become available. \n","The authors concluded that:\n- There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer\n- There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other\n- People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions\n- However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded\n- This systematic review identified a need for RCTs to explore these "]
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[null,"Roelsgaard  IK et al. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012958. DOI: 10.1002/14651858.CD012958.pub2. Available here.","Adults with Pre-existing health conditions: Inflammatory joint diseases","This Cochrane rveiw aimed to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with inflammatory joint diseases.\n\nThe reviewers included two studies with 57 smokers with a diagnosis of rheumatoid arthritis. They identified no studies including other inflammtry joint diseases. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight‐week cognitive‐behavioural patient education intervention on CVD risk for people with rheumatoid arthritis and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta‐analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non‐serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. They assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE.","The authors concluded that:\n\n- They found very little research investigating the efficacy of smoking cessation intervention specifically in people with inflammatory joint diseases\n- Included studies are limited by imprecision, risk of bias, and indirectness\n- Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with inflammatory joint diseases\n- High‐quality, adequately powered studies are warranted\n- In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long‐term smoking cessation"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Smoking Cessation Interventions for Patients with Severe Mental Illnesses: A Review of Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2017b.\nAvailable here.","Adults with Pre-existing health condition: Severe mental illness","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical evidence regarding the effectiveness of smoking cessation interventions for patients with severe mental illnesses? \n2. What are the evidence-based guidelines regarding smoking cessation interventions for patients with severe mental illnesses?\n\nThis report made use of a previous Rapid Response (Smoking cessation interventions for patients with severe mental illnesses: clinical effectiveness and guidelines) on the same subject to identify studies, which was supplemented by an updated search. The original search, which was completed in July 2016, identified 325 citations, of which 25 were ordered for full-text screening. A total of 86 additional citations were identified in the literature search update. Following screening of titles and abstracts of the 86 new citations, 65 citations were excluded and 21 potentially relevant reports from the electronic search were retrieved for full-text review. Forty-five potentially relevant publications were retrieved from the grey literature search and, in addition to the 25 from the previous reference list on the topic and the 21 added in the update, 91 full texts were reviewed. Of these potentially relevant articles, 68 publications were excluded for various reasons, while 23 publications met the inclusion criteria and were included in this report. \n\nWhile concerns about safety may prevent pharmacological options from being used more often among people with severe illness, the current review did not find evidence for an increased risk of adverse events compared to the general population, or worsening of psychiatric symptoms when using NRT, varenicline or bupropion with people with severe mental illness.  \n\nAll three interventions were found to improve smoking cessation rates compared to placebo or no treatment, varenicline and bupropion may be more effective than NRT, and additional psychosocial support may enhance success. Nausea and sleep disturbances were common when using varenicline, but peaked and declined with time. Sustained effects beyond the treatment period were not generally measured, nor were varying dosages except for one study which found higher NRT dose did not improve outcomes.\n\nIn general, the quality of studies was low and sample sizes small, suggesting the need for better reporting across these studies and more adequately powered analyses.","This rapid response review concluded that:\n- NRT, varenicline and bupropion were all generally found to improve smoking cessation rates, most commonly measured as 7-day point prevalence abstinence against placebo, among people with severe mental illness\n- Varenicline and bupropion may be more effective than NRT\n- The longest follow up duration on treatment was six months, and sustained effects beyond this were unclear, except in one study that did not find an increase in suicide attempts/behaviours after one year\n- There was no evidence that adverse events occurred more often than in those without mental illness, or that psychiatric symptoms worsened\n- Nausea and sleep disturbances were common with varenicline\n- All studies included some form of psychosocial support in addition to the pharmacological intervention, and only one study considered randomizing different dosages for NRT, and did not find a difference\n- In general, the quality of studies was low and sample sizes small\n- One guideline was found, which did not favour any treatment, but suggested considering NRT, varenicline or bupropion for patients with severe mental illness, with safety caveats for the latter two that may require closer patient monitoring"]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I² = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I² = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Jeyashree K et al. Smoking cessation interventions for pulmonary tuberculosis treatment outcomes. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011125. DOI: 10.1002/14651858.CD011125.pub2.\nAvailable here.","Adults with Pre-existing health condition: Tuberculosis","This Cochrane review aimed to analyse the effect of tobacco smoking cessation interventions on the treatment outcomes of people with adult pulmonary tuberculosis (TB).\n\nThere were no RCTs that met the eligibility criteria. A number of potentially eligible studies are underway, and the reviewers will assess them for inclusion in the next update of this review. ","The authors concluded that:\n- There is a lack of high‐quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes\n- There is a need for good‐quality RCTs that assess the effect of smoking cessation interventions on TB treatment outcomes in both the short and long term\n- Establishing such an evidence base would be an essential step towards the implementation of smoking cessation interventions in TB control programmes worldwide"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I² = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I² = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Barth J, Jacob T, Daha  I and Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD006886. DOI: 10.1002/14651858.CD006886.pub2.\nAvailable here.","Adults with Pre-existing health condition: Coronary heart disease (CHD)","This Cochrane review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with CHD in short‐term (6 to 12 month follow‐up) and long‐term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification.\n\nThe reviewers found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long‐term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self‐help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction. \n\nAfter an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (RR 1.22, 95% CI 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow‐up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non‐validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self‐help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow‐up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow‐up, one or more contacts in total over an hour with no follow‐up or any initial contact plus follow‐up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long‐term follow‐up (over 12 months), and did not show any benefits. \n\nAdverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). ","The authors concluded that:\n- Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration\n- After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost‐effectiveness analyses are needed\n- Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. NRT) compared with pharmacological treatment alone and investigate economic outcomes"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Mindfulness Interventions for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Use Disorders: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015b.\nAvailable here.","Adults with Pre-existing health condition and other populatiion: Post traumatic stress disorder, generalised anxiety disorder and depression","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders? \n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, depression, or substance use disorders? \n\nFor the purposes of this map, data relevant to the map has only been presented here.\n  \nOne SR and one RCT assessing mindfulness interventions in patients with substance use disorder were identified. The SR was conducted in Italy and included 24 studies (14 RCTs and ten non-RCTs). Twelve studies focused on alcohol and/or heterogeneous substance use, four on cigarette smoking, three on opiate use, one on marijuana use, and one on metamphetamine use. Eight studies focused on mindfulness-based stress reduction or related mindfulness-based interventions, five on acceptance and commitment therapy, three on Spiritual self-schema therapy , two on Dialectical behavioral therapy, one study focused on a Vipassana meditation (where individuals assume a seated position and focus their attention onto the breath), one study focused on goal management training in adjunct to mindfulness meditation, and one study focused on a motivational intervention in adjunct to mindfulness meditation. Ten of the included studies compared mindfulness-based interventions to a waiting list, eight compared it with an active treatment, two compared it with non-specific educational interventions designed to be structurally its equivalent. One study included adult patients enrolled in a substance abuse aftercare program. Mindfulness-based relapse prevention was compared to relapse prevention or treatment as usual in this RCT. Relapse to drug use and heavy drinking frequency of substance use in the past 90 days was assessed. \n \nThe evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited, where only one RCT was identified which concluded that the mindfulness intervention was more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. The only SR for substance use disorders included in this report concluded a lack of randomisation or of randomisation details, objective measures of drug use, and of information for treatment adherence, as well as small sample sizes, and raised concerns as to whether observed findings were actually due to the delivered interventions or are more properly attributable to methodological biases of included studies. \n\nSix evidence-based guidelines considered the use of mindfulness in clinical practice, of which one suggested  that Mindfulness-Based Stress Reduction can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals. ","This rapid response review reported that:\n- One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking\n- One evidence-based guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals \n "]
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[null,"Hughes JR et al. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.\nAvailable here.","Adolescents and\nAdults with or without\nPre-existing health condition: Depression or history of depression","This Cochrane review aimed to assess the effect and safety of antidepressant medications to aid long‐term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); selegiline; sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine. \n\nTwenty‐four new trials were identified since the 2009 update, bringing the total number of included trials to 90. There were 65 trials of bupropion and ten trials of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long‐term cessation (44 trials, n =  13,728, RR 1.62, 95% CI 1.49 to 1.76). There was moderate quality evidence, limited by a relatively small number of trials and participants, that nortriptyline also significantly increased long‐term cessation when used as the sole pharmacotherapy (six trials, n =  975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 trials, n =  3487, RR 1.19, 95% CI 0.94 to 1.51) or nortriptyline (4 trials, n =  1644, RR 1.21, 95% CI 0.94 to 1.55) to NRT provides an additional long‐term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline appear to be equally effective and of similar efficacy to NRT (bupropion versus nortriptyline 3 trials, n =  417, RR 1.30, 95% CI 0.93 to 1.82; bupropion versus NRT 8 trials, n =  4096, RR 0.96, 95% CI 0.85 to 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four trials comparing bupropion to varenicline showed significantly lower quitting with bupropion than with varenicline (n =  1810, RR 0.68, 95% CI 0.56 to 0.83). Meta‐analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the CI only narrowly missed statistical significance (33 trials, n =  9631, RR 1.30, 95% CI 1.00 to 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is unclear. Nortriptyline has the potential for serious side‐effects, but none have been seen in the few small trials for smoking cessation. \n\nThere was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1.22, n =  1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, n =  466, RR 0.70, 95% CI 0.64 to 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1.79, n =  827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, n =  147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John's wort (hypericum) (2 trials, n =  261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, n =  120, RR 0.70, 95% CI 0.24 to 2.07). ","The authors concluded that:\n- The antidepressants bupropion and nortriptyline aid long‐term smoking cessation\n- Adverse events with either medication appear to rarely be serious or lead to stopping medication\n- Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement\n- Evidence also suggests that bupropion is less effective than varenicline, but further research is needed to confirm this finding\n- Evidence suggests that neither selective serotonin reuptake inhibitors (e.g. fluoxetine) nor monoamine oxidase inhibitors aid cessation"]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Rigotti NA, Clair C, Munafò MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3. \nAvailable here.","Adults with\nPre-existing health condition: Hospitalised patients\n","This Cochrane review aimed to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. \n\nFifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (RR 1.37, 95% CI 1.27 to 1.48; 25 trials). A specific benefit for post‐discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post‐discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. \n\nAdding NRT to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non‐significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow‐up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilisation endpoints, and found significant reductions in all‐cause mortality and hospital readmission rates over a two‐year follow‐up period. These trials were all conducted in acute care hospitals. \n\nA comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). ","The authors concluded that:\n- High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\n- The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals\n- There was no evidence of effect for interventions of lower intensity or shorter duration\n- This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone\n- There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone"]

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[null,"PRIMARY CARE SETTING"]
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[null,"GUIDANCE: PRIMARY CARE SETTING"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: Promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering advice or education to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for offering behavioural support to promote health and wellbeing. NG102. London: NICE; 2018. Available here.\n\nNational Institute for Health and Care Excellence. Community pharmacy: Promoting health and wellbeing. Evidence reviews for signposting and referral to other services and support. NG102. London: NICE; 2018. Available here.","This guideline is for:\n- Community pharmacies, local pharmaceutical committees and pharmacy organisations\n- Commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England\n- Local professional networks (hosted by NHS England)\n- Health and wellbeing boards.","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. \n\nIt includes recommendations on:\n- Health and wellbeing hub\n- Overarching principles of good practice\n- Awareness raising and providing information\n- Advice and education\n- Behavioural support\n- Referrals and signposting\n"]
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[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here.\n","This guideline will be of interest to:\n- Healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers","This guideline includes the following guidleines on smoking cessation:\nActive Smoking:\n- All people who smoke should be advised to stop and offered support to help facilitate this in order to minimise cardiovascular and general health risk\nPassive smoking:\n- Exposure to passive smoking increases cardiovascular risk and should be minimised\nSmoking cessation interventions:\n- Varenicline or combination nicotine replacement therapy (NRT) should be offered alone or as part of a smoking cessation programme to augment professional advice and increase long-term abstinence rates\n- Bupropion and single NRT may also be considered as smoking cessation treatments\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction. QS92. London: NICE; 2015. \nAvailable here.\n","\n","This quality standard covers ways of reducing harm from smoking. It includes advice on supporting people who do not want to give up smoking in one step. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1. People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking\n- Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine\n- Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products\n- Statement 4. 'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"National Institute for Health and Care Excellence. Smoking: preventing uptake in children and young people. PH14. London: NICE; 2008.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nWoolfall K et al. The prevention of uptake of smoking by children and young people, with reference to the areas of mass media and the sale of tobacco products: findings from a multi-method primary research study. \nAvailable here.\n\nRichardson et al. NICE Rapid review: Interventions to Prevent the Uptake of Smoking in  Children and Young People. British Columbia: Centre of Excellence for Women's Health; 2008. Available here.","This guideline is for: \n- NHS, local authorities, the criminal justice system and others working in the public, voluntary and community sectors\n- Retailers\n- Mass-media services\n- Children, young people and their carers and other members of the public","This guideline covers anti-smoking mass-media campaigns, for example, on TV, in newspapers and online. It also covers measures to prevent tobacco being sold to children and young people. The aim is to help prevent children and young people from taking up smoking.\n\nIt makes recommendations on:\n- Mass-media campaigns, including how to develop them and the type of messages to put across\n- Illegal sales and how to prevent them\n\nThis guideline was checked in November 2014."]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]
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[null,"SYSTEMATIC REVIEWS: PRIMARY CARE SETTING"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Lindson N, et al. Strategies to improve smoking cessation rates in primary care. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD011556. DOI: 10.1002/14651858.CD011556.pub2.\nAvailable here","Adult primary healthcare patients. For the purposes of this review, primary care was defined as family medicine or general medical practice.","This review assesses the effectiveness of strategies intended to increase the success of smoking cessation interventions in primary care settings.\n\nThe authors identified moderate‐certainty evidence, limited by inconsistency, that the provision of adjunctive counselling by a health professional other than the physician (RR 1.31, 95% CI 1.10 to 1.55; I2 = 44%; 22 studies, 18,150 participants), and provision of cost‐free medications (RR 1.36, 95% CI 1.05 to 1.76; I2 = 63%; 10 studies,7560 participants) increased smoking quit rates in primary care. \n\nThere was also moderate‐certainty evidence, limited by risk of bias, that the addition of tailored print materials to standard smoking cessation treatment increased the number of people who had successfully stopped smoking at six months' follow‐up or more (RR 1.29, 95% CI 1.04 to 1.59; I2 = 37%; 6 studies, 15,978 participants).\n\nThere was no clear evidence that providing participants who smoked with biomedical risk feedback increased their likelihood of quitting (RR 1.07, 95% CI 0.81 to 1.41; I2 = 40%; 7 studies, 3491 participants), or that provider smoking cessation training (RR 1.10, 95% CI 0.85 to 1.41; I2 = 66%; 7 studies, 13,685 participants) or provider incentives (RR 1.14, 95% CI 0.97 to 1.34; I2 = 0%; 2 studies, 2454 participants) increased smoking abstinence rates. However, in assessing the former two strategies the authors judged the evidence to be of low certainty and in assessing the latter strategies it was of very low certainty.\n","There is moderate‐certainty evidence that providing adjunctive counselling by an allied health professional, cost‐free smoking cessation medications, and tailored printed materials as part of smoking cessation support in primary care can increase the number of people who achieve smoking cessation. \n\nThere is no clear evidence that providing participants with biomedical risk feedback, or primary care providers with training or incentives to provide smoking cessation support enhance quit rates. However, the authors rated this evidence as of low or very low certainty, and so conclusions are likely to change as further evidence becomes available. Most of the studies in this review evaluated smoking cessation interventions that had already been extensively tested in the general population. \n\nFurther studies should assess strategies designed to optimize the delivery of those interventions already known to be effective within the primary care setting."]
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[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. \nThere is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. \nFurther evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. \nFuture studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. \nThere was insufficient evidence that interventions affected oral health."]
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[null,"Selph S, Patnode CD, et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.\nAvailable here.","Children and adolescents up to 18 years of age for cessation and 25 years of age for prevention.","The review aims to identify primary care relevant interventions for tobacco use prevention and cessation in children and adolescents. Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.\nBehavioural interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioural interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). \nBehavioural interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and non-smokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. \nTwo trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.","Behavioural interventions can reduce the likelihood of smoking initiation in non-smoking youth and young adults. Research is needed to identify effective behavioural interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. \nDue to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed."]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Hollands  GJ et al. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD009164. DOI: 10.1002/14651858.CD009164.pub3.\nAvailable here. ","Adults","The reviewer's identified two new studies, giving a total of 10 studies, involving 3655 participants. The medication adherence interventions studied were all provided in addition to standard behavioural support.They typically provided further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). Seven studies targeted adherence to NRT, two to bupropion and one to varenicline. Most studies were judged to be at high or unclear risk of bias, with four of these studies judged at high risk of attrition or detection bias. Only one study was judged to be at low risk of bias.\n\nMeta‐analysis of all 10 included studies (12 comparisons) provided moderate‐certainty evidence that adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I² = 6%; n = 3655), limited by risk of bias. Subgroup analyses for the primary outcome identified no significant subgroup effects, with effect sizes for subgroups imprecisely estimated. However, there was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I² = 39%; n = 1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI –0.03 to 0.24; I² = 0%; n = 839) or on both (SMD 0.04, 95% CI –0.08 to 0.16; I² = 0%; n = 1064), may not be effective. Participant‐centred interventions may be effective (SMD 0.12, 95% CI 0.02 to 0.23; I² = 20%; n = 2791), whereas those that are clinician‐centred may not (SMD 0.09, 95% CI –0.05 to 0.23; I² = 0%; n = 864).\n\nFive studies assessed short‐term smoking abstinence (five comparisons), while an overlapping set of five studies (seven comparisons) assessed long‐term smoking abstinence of six months or more. Meta‐analyses resulted in low‐certainty evidence that adherence interventions may slightly increase short‐term smoking cessation rates (RR 1.08, 95% CI 0.96 to 1.21; I² = 0%; n = 1795) and long‐term smoking cessation rates (RR 1.16, 95% CI 0.96 to 1.40; I² = 48%; n = 3593). In both cases, the evidence was limited by risk of bias and imprecision, with CIs encompassing minimal harm as well as moderate benefit, and a high likelihood that further evidence will change the estimate of the effect. There was no evidence that interventions to increase adherence to medication led to any adverse events. Studies did not report on factors plausibly associated with increases in adherence, such as self‐efficacy, understanding of and attitudes toward treatment, and motivation and intentions to quit.","The authors concluded that:\n- In people who are stopping smoking and receiving behavioural support, there is moderate‐certainty evidence that enhanced behavioural support focusing on adherence to smoking cessation medications can modestly improve adherence\n- There is only low‐certainty evidence that this may slightly improve the likelihood of cessation in the shorter or longer‐term\n- Interventions to increase adherence can aim to address the practicalities of taking medication, change perceptions about medication, such as reasons to take it or concerns about doing so, or both\n- However, there is currently insufficient evidence to confirm which approach is more effective\n- There is no evidence on whether such interventions are effective for people who are stopping smoking without standard behavioural support\n\n"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacist-Led Interventions for Tobacco Smoking Cessation: A Review of the Clinical Effectiveness and Cost-Effectiveness. Ottawa: CADTH; 2019.\nAvailable here.","Adults","This CADTH rapid response review aimed to answer the following research questions:\n\n1. What is the clinical effectiveness of pharmacist-led tobacco smoking cessation interventions?\n2. What is the cost-effectiveness of pharmacist-led tobacco smoking cessation interventions versus self-directed smoking cessation interventions?\n\nA total of 458 citations were identified in the literature search. Following screening of titles and abstracts, 413 citations were excluded and 45 potentially relevant reports from the electronic search were retrieved for full-text review. Six potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 47 publications were excluded for various reasons, and four publications met the inclusion criteria and were included in this report. These comprised four SRs. Of the excluded studies, one was an overview of reviews\nthat met the inclusion criteria for this report; however, only one of the included SRs was relevant to this report, and because it was captured by the search and contained more comprehensive information, the SR was retained directly and the overview was excluded. Two other SRs met the inclusion criteria but were excluded for having overlapping primary studies with more comprehensive SRs included in this report. ","This rapid response review concluded that:\n- The overall quality of evidence was low, and high heterogeneity existed between the included studies, making it difficult to determine the overall effectiveness of these interventions\n- Very low- to moderate-quality evidence from three systematic reviews suggested that pharmacist-led smoking cessation interventions may lead to higher rates or no difference in rates of smoking cessation, as compared to usual care or no intervention, although there was a high degree of uncertainty in these findings\n- No other clinical effectiveness outcomes, including adverse events, were reported\n- Evidence of unknown quality from one very low-quality systematic review suggested that pharmacist-led smoking cessation interventions were cost-effective in Europe\n- Given the limited availability and low quality of evidence, the clinical effectiveness and cost-effectiveness of pharmacist-led interventions for smoking cessation remain uncertain\n"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308. \nAvailable here. ","Adults","This Cochrane review aimed to determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation, compared to one another.\n\nThe reviewers identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. The reviewers judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high‐certainty evidence that combination NRT (fast‐acting form + patch) results in higher long‐term quit rates than single form (Risk ratio (RR) 1.25, 95% Confidence Interval (CI) 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). \n\nModerate‐certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate‐certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate‐certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High‐certainty evidence from eight studies suggests that using either a form of fast‐acting NRT or a nicotine patch results in similar long‐term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low‐certainty evidence); 16‐hour versus 24‐hour daily patch use; duration of combination NRT use (low‐ and very low‐certainty evidence); tapering of patch dose versus abrupt patch cessation; fast‐acting NRT type (very low‐certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast‐acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant‐ versus clinician‐selected NRT. However, in most cases these findings are based on very low‐ or low‐certainty evidence, and are the findings from single studies. \n\nAdverse events, serious adverse events and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low‐ or very low‐certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac adverse events, serious adverse events or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). \n","The authors concluded that:\n- There is high‐certainty evidence that using combination NRT versus single‐form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking\n- For patch dose comparisons, evidence was of moderate certainty, due to imprecision: 21 mg patches resulted in higher quit rates than 14 mg (24‐hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16‐hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24‐hour) patches\n- Using a fast‐acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches\n- There is moderate‐certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding\n- Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty\n- New studies should ensure that adverse events, serious adverse events and withdrawals due to treatment are both measured and reported"]
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[null,"Clair C et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub5. \nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking‐related diseases in helping them to quit smoking. \n\nThe reviwers included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking‐related disease risk (five studies); and feedback on smoking‐related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking‐related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking‐related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). ","The authors concluded that:\n- There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation\n- The most promising results relate to spirometry and carotid ultrasound, where moderate‐certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but CIs very narrowly missed one, and the point estimate favoured the intervention\n- A sensitivity analysis removing those studies at high risk of bias did detect a benefit\n- Moderate‐certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring\n- Low‐certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking‐related risk by genetic marker testing\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Livingstone‐Banks J et al. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub5.\nAvailable here.","Adults\nPregnant Women ","This Cochrane review aimed to assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking.\n\nThe reviewers included 77 studies (67,285 participants), 15 of which are new to this update. They judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty‐eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe reviewers focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, RR 1.23, 95% CI 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and NRT in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide CIs with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population.","The authors concluded that:\n- Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means they are only moderately certain of this\n- In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard\n- Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity\n- Moderate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though CIs mean they could not rule out a clinically important benefit at this stage\n- Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with NRT in preventing relapse in assisted abstainers\n-  More research is needed in this area, especially as the evidence for extended NRT in unassisted abstainers did suggest a benefit"]
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[null,"Livingstone‐Banks J, Ordóñez‐Mena JM and Hartmann‐Boyce J. Print‐based self‐help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD001118. DOI: 10.1002/14651858.CD001118.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. \n\nThe reviewers identified 75 studies that met their inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. They judged 30 studies (40%) to be at high risk of bias for one or more domains. \n\nThirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n =   13,241; RR 1.19, 95% CI 1.03 to 1.37; I² = 0%). The reviwers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n =   7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n =   2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n =   5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).  \n\nThirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n =   19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n =   14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n =   2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n =   1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n =   14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n =   11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). The reviewers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias. \n\nFive studies evaluated self‐help materials as an adjunct to NRT; pooling three of these provided no evidence of additional benefit (n =   1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower CI crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes. ","The authors concluded that:\n- Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention\n- When people receive advice from a health professional or are using NRT, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded\n- Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention\n- However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit\n- Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available\n- Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available"]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Faseru B et al. Enhancing partner support to improve smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD002928. DOI: 10.1002/14651858.CD002928.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine if an intervention to enhance one‐to‐one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner‐support component. \n\nIt identified 465 citations, which were assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n =  3370). \nThe definition of partner varied among the studies.  The reviewers compared partner support versus control interventions at six‐ to nine‐month follow‐up and at 12 or more months follow‐up. They also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self‐reported smoking cessation rates, with limited biochemical verification of abstinence. \n\nThe pooled RR for abstinence was 0.97 (95% CI 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post‐treatment. \n\nOf the 11 studies that measured partner support at follow‐up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. The reviewers judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system the reviewers rated the overall quality of the evidence for the two primary outcomes as low. They downgraded due to the risk of bias, as they judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. They also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. ","The authors concluded that:\n- Interventions that aim to enhance partner support appear to have no impact on increasing long‐term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation\n- Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small‐scale studies, before large trials assessing the impact on smoking cessation can be justified"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Carson‐Chahhoud KV et al. Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD001006. DOI: 10.1002/14651858.CD001006.pub3.\nAvailable here.","Adolescents and\nYoung children (9-25 years)","This Cochrane review aimed to evaluate the effects of mass media interventions on preventing smoking in young people (under 25 years). It also aimed to determine whether it can reduce smoking uptake, improve smoking attitudes, intentions and knowledge; improve self‐efficacy/self‐esteem; and improve perceptions about smoking, including the choice to follow positive role models. \n\nThe reviewers identified eight eligible studies reporting information about mass media smoking campaigns, one of which is new for this update. Seven of the studies used a controlled trial design and one an interrupted time‐series analysis. Risks of bias were high across all included studies and there was considerable heterogeneity in study design, intervention and population being assessed.\n\nThree studies (n =  17,385), one of which compared a mass media intervention to no intervention and two of which evaluated mass media interventions as adjuncts to school‐based interventions, found that the mass media interventions reduced the smoking behaviour of young people. The remaining five studies (n =  72,740) did not detect a significant effect on smoking behaviour. These included three studies comparing a mass media intervention to no intervention, one study evaluating a mass media intervention as an adjunct to a school‐based intervention, and one interrupted time‐series study of a social media intervention. The three campaigns which found a significant effect described their theoretical basis, used formative research in designing the campaign messages, and used message broadcast of reasonable intensity over extensive periods of time. However, some of the campaigns which did not detect an effect also exhibited these characteristics. Effective campaigns tended to last longer (minimum 3 years) and were more intense (more contact time) for both school‐based lessons (minimum eight lessons per grade) and media spots (minimum four weeks' duration across multiple media channels with between 167 and 350 TV and radio spots). Implementation of combined school‐based components (e.g. school posters) and the use of repetitive media messages delivered by multiple channels (e.g. newspapers, radio, television) appeared to contribute to successful campaigns.","The authors concluded that:\n- Certainty about the effects of mass media campaigns on smoking behaviour in youth is very low, due to inconsistency between studies in both design and results, and due to methodological issues amongst the included studies. It would therefore be unwise to offer firm conclusions based on the evidence in this review\n- Methodologically rigorous studies investigating the effect of social media and novel forms of technology as part of tobacco prevention campaigns for youth are needed"]
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[null,"Stead LF, Carroll AJ and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub3.\nAvailable here.","Adults","This Cochrane review aimed to determine the effect of group‐delivered behavioural interventions in achieving long‐term smoking cessation. \n\nThe reviewers identified sixty‐six trials to meet their inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self‐help programme; there was an increase in cessation with the use of a group programme (n =  4395, RR 1.88, 95% CI 1.52 to 2.33, I² = 0%). They judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (n =  7286, RR 1.22, 95% CI 1.03 to 1.43, I² = 59%). They judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. \n\nThere was also low quality evidence of benefit of a group programme compared to no‐intervention controls, (9 trials, n =  1098, RR 2.60, 95% CI 1.80 to 3.76 I² = 55%). They did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, n =  980, RR 0.99, 95% CI 0.76 to 1.28, I² = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same‐length or shorter programmes without these components. ","The authors conclulded that:\n- Group therapy is better for helping people stop smoking than self‐help, and other less intensive interventions\n- There is not enough evidence to evaluate whether groups are more effective, or cost‐effective, than intensive individual counselling\n- There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included "]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I² = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I² = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I² = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Bala MM, Strzeszynski L and Topor‐Madry R. Mass media interventions for smoking cessation in adults. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD004704. DOI: 10.1002/14651858.CD004704.pub4.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of mass media interventions in reducing smoking among adults. \n\nEleven campaigns met the inclusion criteria for this review. Studies differed in design, settings, duration, content and intensity of intervention, length of follow‐up, methods of evaluation and also, in definitions and measures of smoking behaviour used. \n\nAmong seven campaigns reporting smoking prevalence, significant decreases were observed in the California and Massachusetts statewide tobacco control campaigns compared with the rest of the USA. Some positive effects on prevalence in the whole population or in the subgroups were observed in three of the remaining seven studies. Three large‐scale campaigns of the seven presenting results for tobacco consumption found statistically significant decreases. \n\nAmong the eight studies presenting abstinence or quit rates, four showed some positive effect, although in one of them the effect was measured for quitting and cutting down combined. Among the three that did not show significant decreases, one demonstrated a significant intervention effect on smokers and ex‐smokers combined. ","The authors concluded that:\n- There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality\n- One state‐wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign\n- Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme\n- Six of nine studies carried out in communities or regions showed some positive effects on smoking behaviour and at least one significant change in smoking prevalence (Sydney)\n- The intensity and duration of mass media campaigns may influence effectiveness, but length of follow‐up and concurrent secular trends and events can make this difficult to quantify\n- No consistent relationship was observed between campaign effectiveness and age, education, ethnicity or gender"]
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[null,"Thomas D et al. System change interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD010742. DOI: 10.1002/14651858.CD010742.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.\n\nThe reviewers included seven cluster‐randomised controlled studies in this review. They rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow‐up (four studies), and for the secondary outcome ‘prescribing of smoking cessation medications' (two studies). \n\nFour studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. ","The authors concluded that:\n- The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services\n- The available research is limited, therefore it was not feasible to draw strong conclusions\n- There is a need for additional high‐quality research to explore the impact of system change interventions on both cessation and system‐level outcomes"]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I² = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I² = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Hartmann‐Boyce J et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the safety and effect of using ECs to help people who smoke achieve long‐term smoking abstinence. \n\nOur searches identified over 1700 records, from which we include 24 completed studies (three RCTs, two of which were eligible for our cessation meta‐analysis, and 21 cohort studies). Eleven of these studies are new for this version of the review. We identified 27 ongoing studies. Two RCTs compared ECs with placebo (non‐nicotine) ECs, with a combined sample size of 662 participants. One trial included minimal telephone support and one recruited smokers not intending to quit, and both used early ECs models with low nicotine content and poor battery life. The reviewers judged the RCTs to be at low risk of bias, but under the GRADE system they rated the overall quality of the evidence for their outcomes as ‘low’ or ‘very low’, because of imprecision due to the small number of trials. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means the reviewers are very uncertain about the estimate. Participants using ECs were more likely to have abstained from smoking for at least six months compared with participants using placebo ECs (RR 2.29, 95% CI 1.05 to 4.96; placebo 4% versus ECs 9%; 2 studies; 662 participants. GRADE: low). The one study that compared ECs to nicotine patch found no significant difference in six‐month abstinence rates, but the CIs do not rule out a clinically important difference (RR 1.26, 95% CI 0.68 to 2.34; 584 participants. GRADE: very low). \n\nOf the included studies, none reported serious adverse events considered related to ECs use. The most frequently reported adverse events were mouth and throat irritation, most commonly dissipating over time. One RCT provided data on the proportion of participants experiencing any adverse events. The proportion of participants in the study arms experiencing adverse events was similar (ECs vs placebo EC: RR 0.97, 95% CI 0.71 to 1.34 (298 participants); ECs vs patch: RR 0.99, 95% CI 0.81 to 1.22 (456 participants)). The second RCT reported no statistically significant difference in the frequency of adverse events at three‐ or 12‐month follow‐up between the EC and placebo EC groups, and showed that in all groups the frequency of adverse events (with the exception of throat irritation) decreased significantly over time. ","The authors concluded that:\n- There is evidence from two trials that ECs help smokers to stop smoking in the long term compared with placebo ECs\n- The small number of trials, low event rates and wide CIs around the estimates means that the reviewers confidence in the result is rated 'low' by GRADE standards\n- The lack of difference between the effect of ECs compared with nicotine patches found in one trial is uncertain for similar reasons\n- None of the included studies (short‐ to mid‐term, up to two years) detected serious adverse events considered possibly related to EC use\n- The most commonly reported adverse effects were irritation of the mouth and throat\n- The long‐term safety of ECs is unknown\n\nIn this update, the authors found a further 15 ongoing RCTs which appear eligible for this review. "]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Jeyashree K et al. Smoking cessation interventions for pulmonary tuberculosis treatment outcomes. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011125. DOI: 10.1002/14651858.CD011125.pub2.\nAvailable here.","Adults with Pre-existing health condition: Tuberculosis","This Cochrane review aimed to analyse the effect of tobacco smoking cessation interventions on the treatment outcomes of people with adult pulmonary tuberculosis (TB).\n\nThere were no RCTs that met the eligibility criteria. A number of potentially eligible studies are underway, and the reviewers will assess them for inclusion in the next update of this review. ","The authors concluded that:\n- There is a lack of high‐quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes\n- There is a need for good‐quality RCTs that assess the effect of smoking cessation interventions on TB treatment outcomes in both the short and long term\n- Establishing such an evidence base would be an essential step towards the implementation of smoking cessation interventions in TB control programmes worldwide"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I² = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I² = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Adolescents and children (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Comprehensive Tobacco Control Programs. Atlanta: CPTSF; 2014. \nAvailable here.","Adolescents\nAdults","This review was conducted on behalf of the Community Preventive Services Task Force (CPSTF) by a team of specialists in SR methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. \n\nThe Task Force finding is based on strong evidence of effectiveness from 61 studies (search period through August 2014). Of the included studies, 43 examined the impact of local, state, or national programs on tobacco-related outcomes, and 18 evaluated the relationship between program funding or strength and program effectiveness. Fifty-six studies evaluated program impact on cigarette use only. Evidence indicates that comprehensive tobacco control programs are effective in reducing tobacco use among adults and young people, and increases in program funding are associated with increases in program effectiveness.\n\nIncluded studies assessed comprehensive tobacco control programs in the United States (55 studies), Australia (2 studies), Canada (1 study), France (1 study), Ireland (1 study) and nations within the European Union (1 study). Most of the U.S. studies evaluated comprehensive programs at the state level (48 studies from 10 states) with the remaining studies at the city (3 studies from New York City) and local or community level (4 studies from New York and Texas).","The CPSTF concluded that: \n- Comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure are recommended\n- Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths\n- Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs"]
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[null,"White AR et al. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000009. DOI: 10.1002/14651858.CD000009.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation in smoking cessation, in comparison with no intervention, sham treatment, or other interventions. \n\nThe reviewers included 38 studies. Based on three studies, acupuncture was not shown to be more effective than a waiting list control for long‐term abstinence, with wide CIs and evidence of heterogeneity (n =  393, RR 1.79, 95% CI 0.98 to 3.28, I² = 57%). Compared with sham acupuncture, the RR for the short‐term effect of acupuncture was 1.22 (95% CI 1.08 to 1.38), and for the long‐term effect was 1.10 (95% CI 0.86 to 1.40). The studies were not judged to be free from bias, and there was evidence of funnel plot asymmetry with larger studies showing smaller effects. The heterogeneity between studies was not explained by the technique used. Acupuncture was less effective than NRT. \n\nThere was no evidence that acupuncture is superior to psychological interventions in the short‐ or long‐term. There is limited evidence that acupressure is superior to sham acupressure for short‐term outcomes (3 trials, n =  325, RR 2.54, 95% CI 1.27 to 5.08), but no trials reported long‐term effects. The pooled estimate for studies testing an intervention that included continuous auricular stimulation suggested a short‐term benefit compared to sham stimulation (14 trials, n =  1155, RR 1.69, 95% CI 1.32 to 2.16); subgroup analysis showed an effect for continuous acupressure (7 studies, n =  496, RR 2.73, 95% CI 1.78 to 4.18) but not acupuncture with indwelling needles (6 studies, n =  659, RR 1.24, 95% CI 0.91 to 1.69). At longer follow‐up the CIs did not exclude no effect (5 trials, n =  570, RR 1.47, 95% CI 0.79 to 2.74). The evidence from two trials using laser stimulation was inconsistent and could not be combined. The combined evidence on electrostimulation suggests it is not superior to sham electrostimulation (short‐term abstinence: 6 trials, n =  634, RR 1.13, 95% CI 0.87 to 1.46; long‐term abstinence: 2 trials, n =  405, RR 0.87, 95% CI 0.61 to 1.23). ","The authors concluded that:\n- Although pooled estimates suggest possible short‐term effects there is no consistent, bias‐free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for six months or more; lack of evidence and methodological problems mean that no firm conclusions can be drawn\n- Electrostimulation is not effective for smoking cessation\n- Well‐designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence‐based interventions"]
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[null,"Hughes JR et al. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.\nAvailable here.","Adolescents and\nAdults with or without\nPre-existing health condition: Depression or history of depression","This Cochrane review aimed to assess the effect and safety of antidepressant medications to aid long‐term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); selegiline; sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine. \n\nTwenty‐four new trials were identified since the 2009 update, bringing the total number of included trials to 90. There were 65 trials of bupropion and ten trials of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long‐term cessation (44 trials, n =  13,728, RR 1.62, 95% CI 1.49 to 1.76). There was moderate quality evidence, limited by a relatively small number of trials and participants, that nortriptyline also significantly increased long‐term cessation when used as the sole pharmacotherapy (six trials, n =  975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 trials, n =  3487, RR 1.19, 95% CI 0.94 to 1.51) or nortriptyline (4 trials, n =  1644, RR 1.21, 95% CI 0.94 to 1.55) to NRT provides an additional long‐term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline appear to be equally effective and of similar efficacy to NRT (bupropion versus nortriptyline 3 trials, n =  417, RR 1.30, 95% CI 0.93 to 1.82; bupropion versus NRT 8 trials, n =  4096, RR 0.96, 95% CI 0.85 to 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four trials comparing bupropion to varenicline showed significantly lower quitting with bupropion than with varenicline (n =  1810, RR 0.68, 95% CI 0.56 to 0.83). Meta‐analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the CI only narrowly missed statistical significance (33 trials, n =  9631, RR 1.30, 95% CI 1.00 to 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is unclear. Nortriptyline has the potential for serious side‐effects, but none have been seen in the few small trials for smoking cessation. \n\nThere was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1.22, n =  1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, n =  466, RR 0.70, 95% CI 0.64 to 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1.79, n =  827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, n =  147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John's wort (hypericum) (2 trials, n =  261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, n =  120, RR 0.70, 95% CI 0.24 to 2.07). ","The authors concluded that:\n- The antidepressants bupropion and nortriptyline aid long‐term smoking cessation\n- Adverse events with either medication appear to rarely be serious or lead to stopping medication\n- Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement\n- Evidence also suggests that bupropion is less effective than varenicline, but further research is needed to confirm this finding\n- Evidence suggests that neither selective serotonin reuptake inhibitors (e.g. fluoxetine) nor monoamine oxidase inhibitors aid cessation"]
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[null,"Ussher MH, Taylor AH and Faulkner GEJ. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub5.\nAvailable here.","Adolescents\nAdults\nPregnant women  ","This Cochrane review aimed to determine whether exercise‐based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. \n\nThe reviewers identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three‐month follow‐up and a benefit for exercise of borderline significance (p = 0.05) at the 12‐month follow‐up. Another study reported significantly higher abstinence rates at six month follow‐up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three‐month follow‐up but not at the end of treatment or 12‐month follow‐up. The other studies showed no significant effect for exercise on abstinence. ","The authors reported that:\n- Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term\n- All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise\n- Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups "]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Stead LF, Hartmann‐Boyce J, Perera R and Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3.\nAvailable here.","Adults\n","This Cochrane review aimed to evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. \n\nSeventy‐seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall the reviewers did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, RR for cessation at longest follow‐up 1.37, 95% CI 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.\n \nTelephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta‐regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually NRT) than when the control group only received self‐help material or a brief intervention. \n\nA further eight studies were too diverse to contribute to meta‐analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change, and none detected evidence of effect. ","The authors concluded that:\n- Proactive telephone counselling aids smokers who seek help from quitlines\n- Telephone quitlines provide an important route of access to support for smokers, and call‐back counselling enhances their usefulness\n- There is limited evidence about the optimal number of calls\n- Proactive telephone counselling also helps people who receive it in other settings\n- There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit\n- Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self‐help materials, or brief advice, or compared to pharmacotherapy alone "]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Interventions to increase the unit price for tobacco products. Atlanta: CPTSF; 2012a. \nAvailable here.","Adolescents\nAdults","The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews published in 2011, combined with more recent evidence (search period 2009-July 2012; 13 studies). This evaluation updates and consolidates two previous reviews conducted for The Community Guide (Hopkins et al. 2001; Community Preventive Services Task Force, 2001). \n\nIncluded studies consistently demonstrated that changes in tobacco product prices resulted in favorable changes in important tobacco use outcomes. The Task Force concludes that policy interventions, specifically excise taxes and fees applied to units of sale, are effective in reducing tobacco use when, and because, they increase the purchase price for tobacco products. \n\nOf the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.","The CPSTF concluded that:\n- Interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use are recommended\n- Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products: reduces the total amount of tobacco consumed; reduces the prevalence of tobacco use; increases the number of tobacco users who quit; reduces initiation of tobacco use among young people; and reduces tobacco-related morbidity and mortality\n- Public health effects are proportional to the size of the price increase and the scale of implementation\n- Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%\n- Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity\n- Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence-based cessation treatments. Atlanta: CPTSF; 2012d. \nAvailable here.","Adults","This CPSTF is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al, 5 studies, search period 1980-2000) combined with more recent evidence (13 studies, search period January 2000July 2012). Based on this updated review, the Task Force recommendation was changed from sufficient evidence to strong evidence of effectiveness. \n\nPrimary evidence for the finding comes from 14 of these 18 studies that evaluated the effectiveness of reducing out-of-pocket costs for cessation treatments on rates of tobacco cessation, total number of tobacco users who quit, or the prevalence of tobacco use in defined populations. Twelve of the 14 studies provided measurements of change in quit rates and observed a median absolute % increase of 4.3 %age points (IQI: + 0.2 to +6.0 %age points) with follow-up periods of 3.5 months or longer. The two remaining studies observed decreases in smoking prevalence over two years in populations provided with a new tobacco cessation benefit. \n\nThe included studies also provided measurements of change in use of the covered cessation treatments, and in overall quit attempts. Fifteen studies examined changes in the use of cessation treatments, of which 11 reported differences in the rate of use and observed a median absolute % increase of 7.0 %age points (IQI: +1.4 to +18.3 %age points). Seven studies examined changes in overall quit attempts, with six studies reporting a median absolute % difference in quit attempt rates of +2.8 %age points (IQI: -0.6 to +9.1 %age points). \n\nEvidence-based treatments considered in the Task Force recommendation were based on the findings of Treating Tobacco Use and Dependence: 2008 update (Fiore et al., 2008) a series of recent systematic reviews conducted to document the evidence of effectiveness of clinical interventions and cessation treatments to reduce tobacco use among patients in health care settings and systems. Cessation treatments described in the included studies for this review were categorised for description and analysis as cessation counseling and cessation medications. The evidence-based treatments provided at reduced out-of-pocket costs in 13 of the 18 studies included both medications and counseling. Five studies assessed the effectiveness of reducing out-of-pocket costs for cessation medications only, and observed results similar to the overall body of evidence. Only one study assessed the effectiveness of reduced out-of-pocket costs only for cessation counseling, so the effectiveness of this benefits approach remains unclear. ","The CPSTF concluded that:\n- Policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit, are recommended\n- Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications\n- Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Quitline interventions. Atlanta: CPTSF; 2012. \nAvailable here.","Adults","This CPSTF finding on quitline effectiveness is based on evidence from an SR published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up.This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.\n\nEvidence of effectiveness for quitline promotional efforts is based on an SR of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).\n\nThe SRs were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nThe Task Force recommendation is based on evidence from 71 studies that evaluated effectiveness of proactive telephone counseling. Twelve studies evaluated treatment effectiveness for callers to quitlines available to the general public and observed a median absolute %age point increase in tobacco cessation of 3.1 %age points (interquartile interval [IQI]: 0.5 to 3.3 %age points). Fifty-one studies evaluated interventions for clients in clinical and research settings and observed a median absolute %age point increase in tobacco cessation of 1.7 %age points (IQI: 0.0 to 8.5 %age points). \n\nOnly six of 77 included studies provided evidence on effectiveness of reactive (caller initiated) quitline counseling. Three of these studies evaluated effectiveness of counseling for a single quitline contact and overall findings were inconsistent. The other three studies evaluated effectiveness of offering tobacco users access to quitline services, and similarly, overall results were inconsistent.","The CPSTF concluded that:\n- Quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting are recommended\n- Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions\n- Three interventions effective at increasing use of quitlines are mass-reach health communication interventions that combine cessation messages with a quitline number, provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting, and quitline referral interventions for health care systems and providers\n- Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"Lancaster  T and Stead  LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000191. DOI: 10.1002/14651858.CD000191.pub2. \nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. \n\nTwo studies provided long‐term follow‐up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled RR for quitting for silver acetate vs placebo was 1.04 (95% CI 0.69 to 1.57). ","The authors concluded that:\n- Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation\n- The CI for the ratio are quite wide but the upper limit of the CI for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%\n- Any effect of this agent is therefore likely to be smaller than NRT\n- The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012b, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacologic-Based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses. Ottawa: CADTH; 2012.\nAvailable here.","Adults","This CADTH HTA report aimed to compare the pharmacological agents (drug-based smoking cessation aids) to determine which of these works best (clinical effectiveness) at six months and 12 months after patients attempt to quit smoking. It also aimed to perform an economic analysis to determine which smoking cessation\ntherapy was the most cost-effective for patients, drug plans, and the Canadian health care system.\n\nEighty-one trials (from August 1982 to June 2009) were identified, involving a total of 40,317 participants. Varenicline, bupropion, and all six NRTs (patch, gum, lozenge, inhaler, spray, and sublingual) were found to be more efficacious than placebo after six months and one year of follow-up. Use of NRTs (OR 1.89, CredI 95% 1.63 to 2.18) or use of bupropion (OR 1.95, CredI 95% 1.58 to 2.41) was found to approximately double the odds of quitting successfully and maintaining abstinence for at least 12 months compared with placebo. Use of varenicline (OR 2.78, CredI 95% 2.17 to 3.57) also improved the odds of success between two- and three-fold. The use of mixed treatment comparisons in the review found varenicline to be superior to conventional NRT use and bupropion. There were no differences in efficacy between bupropion and NRT or between the various forms of NRT alternatives.\n\nNicotine gum, nicotine patch, and bupropion were shown to be superior compared with placebo at 12 months of follow-up in five trials (n = 1,673) assessing five different interventions for smoking cessation in smokers with cardiovascular or smoking-related diseases. For patients with chronic obstructive pulmonary disease, nicotine sublingual (one trial, n = 370) and bupropion (two trials, n = 579) were superior to placebo.\n\nThere were few RCTs of combined therapy versus monotherapy. The addition of nicotine gum to nicotine patch was superior compared with nicotine patch alone for the six-month continuous abstinence rate, but not at one year of follow-up (one RCT, n = 374). The combined therapies of nicotine patch and inhaler or bupropion and NRT did not provide an added effect compared with monotherapy (four RCTs). Thus, combined therapy should be prescribed with caution because the evidence is scarce and the adverse effects unknown.\n\nA review of existing economic analyses showed that varenicline (with or without behavioural interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results should be interpreted with caution because most of the studies comparing varenicline with bupropion or NRT were funded by the manufacturer of varenicline.\n\nThe economic analyses targeting a general population showed that, for all ages and gender, bupropion and varenicline dominated (i.e., cost less and was more effective) nicotine gum, patch, lozenge, and inhaler. If providers' willingness to pay was greater than $10,000 per QALY, then varenicline was preferred.","Based on the included evidence, this HTA report cnsludes that:\n- All pharmacotherapies under review (NRT, bupropion, and varenicline) are efficacious in helping the general population (relatively healthy smokers) quit smoking for at least six to 12 months and therefore, could all be used as aids for smoking cessation in the general population of smokers\n- Bupropion or NRT were found to be effective for those with cardiovascular disease or chronic obstructive pulmonary disease who wanted to quit smoking\n- For pharmacological interventions targeting a general population, bupropion and varenicline were dominating options (cost less and were more effective) over nicotine gum, patch, lozenge, and inhaler. If a provider's willingness to pay was greater than $10,000 per QALY gained, varenicline was the optimal treatment choice compared with NRT and bupropion"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Mobile Phone-Based Cessation Interventions. Atlanta: CPTSF; 2011a. \nAvailable here.","Adolescents (age not specified)\nAdults \n","The CPSTF finding is based on evidence published in 2009 (Whittaker et al., search period through December 2008) combined with more recent evidence (search period December 2008–August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure. \n\nPrimary evidence for the Task Force finding comes from six studies that evaluated the effectiveness of interventions using automated text messages for recruited participants willing to make a quit attempt. Studies were conducted in Norway, New Zealand, and the United Kingdom. All six included studies were RCTs and assessed self-reported (4 studies) or biochemically verified (2 studies) cessation outcomes at 6- or 12-month follow-up. The median loss to follow-up rate was 10%. One study included NRT, which was provided to participants in both the intervention and comparison groups.\n\nIn three studies, mobile phone text messaging was the primary cessation support intervention. The median difference in cessation rates at 6 months was an improvement of 2.9 %age points (range of values: +1.7 %age points to +4.9 %age points). In the other three studies, mobile phone messages were complemented by Internet-based components. The median difference in cessation rates at 6 months or longer was an improvement of 9 %age points (range of values: -1.2 %age points to +13.3 %age points). Only one study included NRT, which was provided to participants in both the intervention and comparison groups. ","The CPSTF concluded that:\n- Mobile phone-based interventions for tobacco cessation are recommended to increase tobacco use abstinence among people who want to quit"]
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[null,"The Community Preventive Services Task Force. Tobacco Use and Secondhand Smoke Exposure: Internet-Based Cessation Interventions. Atlanta: CPTSF; 2011b. \nAvailable here.","Adolescents (age not specified)\nAdults","The CPSTF finding is based on evidence from SR published in 2010 (Civljak et al., search period through June 2010) combined with more recent evidence (search period June 2010-August 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in SR methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nPrimary evidence for the Task Force finding comes from 24 studies that evaluated the effectiveness of Internet-based interventions, implemented alone or in combination with additional interventions designed to increase tobacco cessation. As defined in the 2010 SR, the studies included in the present review were organised and considered for each comparison evaluated. Thirteen studies provided a comparison of an Internet-based intervention with usual care or a non-Internet-based intervention. Across the body of evidence, the effect estimates from these studies were inconsistent. A subset of seven of these studies targeted adult tobacco users and observed a median absolute %age point change in tobacco cessation of 3.2 %age points (IQI: -1.7 %age points to 12.5 %age points). Eleven of the 24 studies provided comparisons of one Internet-based intervention with a different Internet-based intervention. Effect estimates from these studies were inconsistent, and the examined comparisons were of limited use to the Task Force’s assessment of effectiveness.  \n\nAn additional analysis examined ten of the 24 studies that compared Internet-based interventions that provided tailored and interactive content with non-tailored-Internet or no-Internet interventions. Effect estimates from these studies were inconsistent, with a median absolute %age point increase in tobacco cessation of 2.1 %age points (IQI: 0.1 %age points to 12.5 %age points). ","The CPSTF concluded that:\n- There is insufficient evidence to determine whether internet-based interventions increase tobacco use cessation\n- Studies included in the review reported inconsistent effects, and interpretation was complicated by differences in internet-based content, components, and interactions; frequent provision of evidence-based interventions to comparison groups; and moderate to high rates of loss to follow-up"]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]
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[null,"The Community Preventive Services Task Force. Health Communication and Social Marketing: Campaigns That Include Mass Media and Health-Related Product Distribution. Atlanta: CPTSF; 2010. \nAvailable here.","Adolescents (age not specified)\nAdults","This CPSTF review aimed to  evaluate the effectiveness of an intervention process—the combination of a health communication campaign, including mass media, with health-related product distribution—for promoting the desired behavior change in the target audience. The specific behaviors promoted in the included studies were the use of products that: \n- Facilitate adoption and/or maintenance of health-promoting behaviors (i.e., increased physical activity through pedometer distribution combined with walking campaigns)\n-Facilitate and/or help to sustain cessation of harmful behaviors (i.e., smoking cessation through free or reduced cost over-the-counter NRT)\n-  Protect against behavior-related disease or injury (i.e., condoms, child safety seats, recreational safety helmets, sun-protection products)\n\nOf the health-related products that met the inclusion criteria, 6 were represented in this review (i.e., child safety seats, condoms, pedometers, recreational safety helmets, over-the-counter NRT, and sun-protection products). Only information relevant to this map has been included here.\n\nIncluded studies evaluated campaigns to promote use of over-the-counter NRT (3 study arms). Communication campaigns used several different channels, always with mass media (e.g., TV, radio, newspapers) and nearly always including small media (e.g., brochures, posters, fliers) and interpersonal communication (e.g., peer outreach, hotline numbers),over periods of time that ranged from 1 week to 36 months. Most often, messages were disseminated via community events (e.g., health fairs, festivals), and occasionally through social media (e.g., Facebook). Some campaigns were accompanied by other activities such as providing services (e.g. quitline counseling). Across all campaigns, a wide variety of people were reached including males and females, children and adults, and people from different racial and ethnic groups.\n\nAlthough the magnitude of intervention effects varied, favorable results were found for interventions promoting all of the evaluated products, with median effect estimates ranging from an increase of 10.0 pct pts for over-the-counter NRT (3 studies).","The authors concluded that:\n- Based on strong evidence of effectiveness for producing intended behavior changes, health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products, are recommended\n- Because results were positive across all of the six behaviors evaluated, these findings are likely to apply to a broader range of health-related products that meet the review’s product eligibility criteria in the intervention definition\n- The SR focused only on interventions that included a mass media component; therefore, this recommendation is specific to such interventions\n- The results may or may not apply to campaigns that do not include a mass media component, which were outside of the scope of the review "]

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[null,"SECONDARY & TERTIARY CARE SETTING"]
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[null,"GUIDANCE - SECONDARY & TERTIARY CARE SETTING"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: harm reduction.PH45. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nJone S et al. NICE public health guidance on tobacco harm reduction: Safety, risk and pharmacokinetics profiles of tobacco harm reduction technologies. Cardiff: Cedar; 2012. \nAvailable here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 2: The effectiveness of tobacco harm reduction approaches with the intention of quitting, with and without assistance. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan F et al. NICE guidance: Tobacco: harm reduction. Review 3: The effectiveness of long-term harm reduction approaches without prior intention of quitting. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2013. Available here.\n\nTurley et al. NICE guidance: Tobacco: harm reduction. Review 4: Barriers and facilitators to implementing smoking cessation and tobacco harm reduction approaches; including user and provider perspectives. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.\n\nMorgan H, Morgan F, Weightman A and Whitehead S. Rapid review for NICE: long term use of non-tobacco nicotine containing products in individuals who have quit smoking abruptly. Cardiff: Support Unit for Research Evidence (SURE), Cardiff University; 2012. Available here.","This guideline is for:\n- Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation\n- Organisations providing education and training\n- Manufacturers and retailers of licensed nicotine-containing products","This guideline covers reducing harm from smoking. It aims to help people, particularly those who are highly dependent on nicotine, who:\n- May not be able (or do not want) to stop smoking in one step\n- May want to stop smoking, without necessarily giving up nicotine\n- May not be ready to stop smoking, but want to reduce the amount they smoke.\n\nIt includes recommendations on:\n- Raising awareness of licensed nicotine-containing products\n- Self-help materials\n- Choosing a harm-reduction approach\n- Behavioural support\n- Advising on and supplying licensed nicotine-containing products\n- Supporting temporary abstinence\n- Commissioning stop smoking services\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: supporting people to stop. QS43. London: NICE; 2013.\nAvailable here.",null,"This quality standard covers support for people to stop smoking. It includes referral to stop smoking services and treatments to help people to stop smoking. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop\n- Statement 2 People who smoke are offered a referral to an evidence‑based smoking cessation service\n- Statement 3 People who smoke are offered behavioural support with pharmacotherapy by an evidence‑based smoking cessation service\n- Statement 4 People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course \n- Statement 5 People who smoke who have set a quit date with an evidence‑based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date"]
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[null,"National Institute for Health and Care Excellence. Smoking: stopping in pregnancy and after childbirth. PH26. London: NICE; 2010.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nBauld L and Coleman T. The Effectiveness of Smoking Cessation Interventions during Pregnancy: A Briefing Paper. Nottingham and Bath: UK centre for Tobacco Control Studies; 2009. Available here. \n\nHemsing et al. NICE rapid Review: Interventions to Improve partner Support and Partner Cessation During Pregnancy. British Columbia: Centre of excellence for Women's Health; 2009. Available here. \n\nMyers K, West O and Hajek P. Rapid review of interventions to prevent relapse in pregnant ex-smokers. London: Tobacco Dependence Research Unit, Queen Mary University of London. Available here. \n\nBaxter S et al. Systematic review of how to stop smoking in pregnancy and following childbirth. Sheffield: ScHARR, University of Sheffield; 2009. Available here.","This guideline is for:\n- Healthcare professionals\n- Practitioners working in local authorities, education and the wider public, private, voluntary and community sectors\n- Commissioners, managers and providers\n- Women who are pregnant or planning a pregnancy, or who have a child aged up to 12 months, and their families and carers","This guideline covers support to help women stop smoking during pregnancy and in the first year after childbirth. It includes identifying women who need help to quit, referring them to stop smoking services and providing intensive and ongoing support to help them stop. The guideline also advises how to tailor services for women from disadvantaged groups in which smoking rates are high.\n\nIt includes recommendations on:\n- Identifying pregnant women who smoke and referring them to NHS Stop Smoking services\n- Contacting and supporting women who have been referred\n- Use of NRT and other pharmacological support\n- Meeting the needs of disadvantaged pregnant women who smoke\n- Partners and others in the household who smoke\n- Training to deliver interventions\n\nThis guideline was last updated in March 2018."]
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[null,"National Institute for Health and Care Excellence. Antenatal care for uncomplicated pregnancies. CG62. London: NICE; 2019.\nAvailable here.","This guideline is for:\n- Healthcare professionals\n- Women who are pregnant, their families and carers","This guideline covers the care that healthy women and their babies should be offered during pregnancy. It aims to ensure that pregnant women are offered regular check-ups, information and support.\n\nIt provides the following guidance:\n- Woman‑centred care and informed decision‑making \n- Provision and organisation of care\n- Lifestyle considerations (includes guidance on \"Smoking in pregnancy\")\n- Management of common symptoms of pregnancy\n- Clinical examination of pregnant women\n- Screening for haematological conditions\n- Screening for fetal anomalies\n- Screening for infections\n- Screening for clinical conditions\n- Fetal growth and well‑being\n- Management of specific clinical conditions\n\nLast updated 04 February 2019"]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]
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[null,"SYSTEMATIC REVIEWS - SECONDARY & TERTIARY CARE SETTING"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Barnes  J et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008.pub3. \nAvailable here. ","Adults","The reviewers included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta‐analysis was not possible. They judged only one study to be at low risk of bias overall; they judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations. \n\nPooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention‐matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity. \n\nMost studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event ‘index’ between hypnotherapy and relaxation. \n","The authors concluded that:\n- There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting\n- If a benefit is present, current evidence suggests the benefit is small at most\n- There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does\n- Further large, high‐quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic"]
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[null,"Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD013308. DOI: 10.1002/14651858.CD013308. \nAvailable here. ","Adults","This Cochrane review aimed to determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation, compared to one another.\n\nThe reviewers identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. The reviewers judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high‐certainty evidence that combination NRT (fast‐acting form + patch) results in higher long‐term quit rates than single form (Risk ratio (RR) 1.25, 95% Confidence Interval (CI) 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). \n\nModerate‐certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate‐certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate‐certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High‐certainty evidence from eight studies suggests that using either a form of fast‐acting NRT or a nicotine patch results in similar long‐term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low‐certainty evidence); 16‐hour versus 24‐hour daily patch use; duration of combination NRT use (low‐ and very low‐certainty evidence); tapering of patch dose versus abrupt patch cessation; fast‐acting NRT type (very low‐certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast‐acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant‐ versus clinician‐selected NRT. However, in most cases these findings are based on very low‐ or low‐certainty evidence, and are the findings from single studies. \n\nAdverse events, serious adverse events and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low‐ or very low‐certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac adverse events, serious adverse events or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). \n","The authors concluded that:\n- There is high‐certainty evidence that using combination NRT versus single‐form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking\n- For patch dose comparisons, evidence was of moderate certainty, due to imprecision: 21 mg patches resulted in higher quit rates than 14 mg (24‐hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16‐hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24‐hour) patches\n- Using a fast‐acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches\n- There is moderate‐certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding\n- Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty\n- New studies should ensure that adverse events, serious adverse events and withdrawals due to treatment are both measured and reported"]
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[null,"Clair C et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub5. \nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking‐related diseases in helping them to quit smoking. \n\nThe reviwers included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking‐related disease risk (five studies); and feedback on smoking‐related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking‐related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking‐related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). ","The authors concluded that:\n- There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation\n- The most promising results relate to spirometry and carotid ultrasound, where moderate‐certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but CIs very narrowly missed one, and the point estimate favoured the intervention\n- A sensitivity analysis removing those studies at high risk of bias did detect a benefit\n- Moderate‐certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring\n- Low‐certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking‐related risk by genetic marker testing\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I2 = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Livingstone‐Banks J et al. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub5.\nAvailable here.","Adults\nPregnant Women ","This Cochrane review aimed to assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking.\n\nThe reviewers included 77 studies (67,285 participants), 15 of which are new to this update. They judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty‐eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe reviewers focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, RR 1.23, 95% CI 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and NRT in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide CIs with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population.","The authors concluded that:\n- Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means they are only moderately certain of this\n- In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard\n- Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity\n- Moderate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though CIs mean they could not rule out a clinically important benefit at this stage\n- Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with NRT in preventing relapse in assisted abstainers\n-  More research is needed in this area, especially as the evidence for extended NRT in unassisted abstainers did suggest a benefit"]
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[null,"Livingstone‐Banks J, Ordóñez‐Mena JM and Hartmann‐Boyce J. Print‐based self‐help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD001118. DOI: 10.1002/14651858.CD001118.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. \n\nThe reviewers identified 75 studies that met their inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. They judged 30 studies (40%) to be at high risk of bias for one or more domains. \n\nThirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n =   13,241; RR 1.19, 95% CI 1.03 to 1.37; I² = 0%). The reviwers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n =   7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n =   2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n =   5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).  \n\nThirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n =   19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n =   14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n =   2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n =   1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n =   14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n =   11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). The reviewers judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias. \n\nFive studies evaluated self‐help materials as an adjunct to NRT; pooling three of these provided no evidence of additional benefit (n =   1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower CI crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes. ","The authors concluded that:\n- Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention\n- When people receive advice from a health professional or are using NRT, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded\n- Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention\n- However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit\n- Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available\n- Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available"]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI (CI) 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of nicotine replacement therapy (NRT) compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"van den Brand FA et al. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD004305. DOI: 10.1002/14651858.CD004305.pub5.\nAvailable here.","Adults","This Cochrane review primarily aimed to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). \n\nIn the current update, the reviewers have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both. \n\nFull financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from $97 to $7646 for the comparison of full coverage with partial or no coverage. \n\nThere was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants). \n\nFull financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants). \n\nFull financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: NRT: RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants. \n\nThere was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants). \n\nThe reviewers assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. They detected some imprecision but judged this to be of minor consequence on the outcomes of this study. ","The authors concluded that:\n- Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting \n- There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers\n- The reviewers were only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001292. DOI: 10.1002/14651858.CD001292.pub3.\nAvailable here.","Adults","This Cochrane review addressed the following hypothese:\n1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.\n2. Individual counselling is more effective than self‐help materials in promoting smoking cessation.\n3. A more intensive counselling intervention is more effective than a less intensive intervention. \n\nThe reviewers identified 49 trials with around 19,000 participants. Thirty‐three trials compared individual counselling to a minimal behavioural intervention. There was high‐quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self‐help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% CI 1.40 to 1.77; 27 studies, 11,100 participants; I2 = 50%). There was moderate‐quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (NRT) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I2 = 0%). There was moderate‐quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I2 = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. ","The authors concluded that:\n- There is high‐quality evidence that individually‐delivered smoking cessation counselling can assist smokers to quit\n- There is moderate‐quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention. "]
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[null,"Thomas D et al. System change interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD010742. DOI: 10.1002/14651858.CD010742.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.\n\nThe reviewers included seven cluster‐randomised controlled studies in this review. They rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow‐up (four studies), and for the secondary outcome ‘prescribing of smoking cessation medications' (two studies). \n\nFour studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. ","The authors concluded that:\n- The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services\n- The available research is limited, therefore it was not feasible to draw strong conclusions\n- There is a need for additional high‐quality research to explore the impact of system change interventions on both cessation and system‐level outcomes"]
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[null,"Apollonio D, Philipps R and Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD010274. DOI: 10.1002/14651858.CD010274.pub2.\nAvailable here.","Adults with Pre-existing health condition: Adults in concurrent treatment for or in recovery from alcohol and other drug dependence","This Cochrane review aimed to evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. \n\nThirty‐five RCTs, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of NRT or non‐NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear. \n\nAnalyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta‐analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.88, 95% CI 1.35 to 2.57, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow‐up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I2 = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).\n \nInterventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40). \nOffering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I2 = 66%)). \n\nData on adverse effect of the interventions were limited.","The authors concluded that:\n- The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence\n- There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs\n- The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency\n- The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment\n- Certain results were sensitive to the length of follow‐up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non‐NRT or combined pharmacotherapy\n- Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence"]
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[null,"Hartmann‐Boyce J et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the safety and effect of using ECs to help people who smoke achieve long‐term smoking abstinence. \n\nOur searches identified over 1700 records, from which we include 24 completed studies (three RCTs, two of which were eligible for our cessation meta‐analysis, and 21 cohort studies). Eleven of these studies are new for this version of the review. We identified 27 ongoing studies. Two RCTs compared ECs with placebo (non‐nicotine) ECs, with a combined sample size of 662 participants. One trial included minimal telephone support and one recruited smokers not intending to quit, and both used early ECs models with low nicotine content and poor battery life. The reviewers judged the RCTs to be at low risk of bias, but under the GRADE system they rated the overall quality of the evidence for their outcomes as ‘low’ or ‘very low’, because of imprecision due to the small number of trials. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means the reviewers are very uncertain about the estimate. Participants using ECs were more likely to have abstained from smoking for at least six months compared with participants using placebo ECs (RR 2.29, 95% CI 1.05 to 4.96; placebo 4% versus ECs 9%; 2 studies; 662 participants. GRADE: low). The one study that compared ECs to nicotine patch found no significant difference in six‐month abstinence rates, but the CIs do not rule out a clinically important difference (RR 1.26, 95% CI 0.68 to 2.34; 584 participants. GRADE: very low). \n\nOf the included studies, none reported serious adverse events considered related to ECs use. The most frequently reported adverse events were mouth and throat irritation, most commonly dissipating over time. One RCT provided data on the proportion of participants experiencing any adverse events. The proportion of participants in the study arms experiencing adverse events was similar (ECs vs placebo EC: RR 0.97, 95% CI 0.71 to 1.34 (298 participants); ECs vs patch: RR 0.99, 95% CI 0.81 to 1.22 (456 participants)). The second RCT reported no statistically significant difference in the frequency of adverse events at three‐ or 12‐month follow‐up between the EC and placebo EC groups, and showed that in all groups the frequency of adverse events (with the exception of throat irritation) decreased significantly over time. ","The authors concluded that:\n- There is evidence from two trials that ECs help smokers to stop smoking in the long term compared with placebo ECs\n- The small number of trials, low event rates and wide CIs around the estimates means that the reviewers confidence in the result is rated 'low' by GRADE standards\n- The lack of difference between the effect of ECs compared with nicotine patches found in one trial is uncertain for similar reasons\n- None of the included studies (short‐ to mid‐term, up to two years) detected serious adverse events considered possibly related to EC use\n- The most commonly reported adverse effects were irritation of the mouth and throat\n- The long‐term safety of ECs is unknown\n\nIn this update, the authors found a further 15 ongoing RCTs which appear eligible for this review. "]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Pool ERM et al. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD011120. DOI: 10.1002/14651858.CD011120.pub2.\nAvailable here.","Adults with Pre-existing health condition: HIV and AIDS","This Cochrane review aimed to assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. \n\nThe reviewers  identified 14 studies relevant to this review, of which they included 12 in a meta‐analysis (n =   2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy. \n\nThere was moderate quality evidence from six studies for the long‐term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (RR 1.00, 95% CI 0.72 to 1.39) with no evidence of heterogeneity (I2 = 0%). The pooled long‐term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short‐term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I2 = 42%). Abstinence in the control group at short‐term follow‐up was 8% (n =   67/848) and in the intervention group was 13% (n =   118/937). The effect of tailoring the intervention for PLWHA was unclear. \n\nThe reviewers further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. They failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. ","The authors concluded that:\n- There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long‐term\n- There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short‐term abstinence\n- Despite this, tobacco cessation interventions should be offered to PLWHA, since even non‐sustained periods of abstinence have proven benefits\n- Further large, well designed studies of cessation interventions for PLWHA are needed"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Lindson‐Hawley N et al. Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD005231. DOI: 10.1002/14651858.CD005231.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effects of interventions intended to reduce the harm to health of continued tobacco use, and the following specific questions were considered: \n1. Do interventions intended to reduce harm have an effect on long‐term health status?\n2. Do they lead to a reduction in the number of cigarettes smoked?; do they have an effect on smoking abstinence?\n3. Do they have an effect on biomarkers of tobacco exposure?\n4. Do they have an effect on biomarkers of damage caused by tobacco? \n\nTwenty‐four trials evaluated interventions to help those who smoke to cut down the amount smoked or to replace their regular cigarettes with potential reduced-exposure tobacco products, compared to placebo, brief intervention, or a comparison intervention. None of these trials directly tested whether harm reduction strategies reduced the harms to health caused by smoking. \n\nMost trials (14/24) tested NRT as an intervention to assist reduction. In a pooled analysis of eight trials, NRT significantly increased the likelihood of reducing cigarettes per day by at least 50% for people using nicotine gum or inhaler or a choice of product compared to placebo (RR 1.75, 95% CI 1.44 to 2.13; 3081 participants). Where average changes from baseline were compared for different measures, carbon monoxide and cotinine generally showed smaller reductions than cigarettes per day. Use of NRT versus placebo also significantly increased the likelihood of ultimately quitting smoking (RR 1.87, 95% CI 1.43 to 2.44; 8 trials, 3081 participants; quality of the evidence: low). Two trials comparing NRT and behavioural support to brief advice found a significant effect on reduction, but no significant effect on cessation. One trial was found that investigated each of the following harm reduction intervention aids: bupropion, varenicline, ECs, snus, plus another of nicotine patches to facilitate temporary abstinence. The evidence for all five intervention types was therefore imprecise, and it is unclear whether or not these aids increase the likelihood of smoking reduction or cessation. Two trials investigating two different types of behavioural advice and instructions on reducing cigarettes per day also provided imprecise evidence. Therefore, the evidence base for this comparison is inadequate to support the use of these types of behavioural advice to reduce smoking. \n\nFour studies of potential reduced-exposure tobacco products (cigarettes with reduced levels of tar, carbon and nicotine, and in one case delivered using an electronically‐heated cigarette smoking system) showed some reduction in exposure to some toxicants, but it is unclear whether this would substantially alter the risk of harm. The reviewers judged the included studies to be generally at a low or unclear risk of bias; however, there were some ratings of high risk, due to a lack of blinding and the potential for detection bias. Using the GRADE system, we rated the overall quality of the evidence for our cessation outcomes as ‘low’ or ‘very low’, due to imprecision and indirectness. A ‘low’ grade means that further research is very likely to have an important impact on the confidence in the estimate of effect and is likely to change the estimate. A ‘very low’ grade means that the reviewers are very uncertain about the estimate. ","The authors concluded that:\n- People who do not wish to quit can be helped to cut down the number of cigarettes they smoke and to quit smoking in the long term, using NRT, despite original intentions not to do so\n- The evidence contributing to the cessation outcome for NRT was rated as 'low' by GRADE standards\n- There is a lack of evidence to support the use of other harm reduction aids to reduce the harm caused by continued tobacco smoking but this could simply be due to the lack of high‐quality studies (The reviewers' confidence in cessation outcomes for these aids is rated 'low' or 'very low' due to imprecision by GRADE standards), meaning thatthey may have missed a worthwhile effect, or due to a lack of effect on reduction or quit rates\n- It is therefore important that more high‐quality RCTs are conducted, and that these also measure the long‐term health effects of treatments"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Coleman T et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 12. Art. No.: CD010078. DOI: 10.1002/14651858.CD010078.pub2.\nAvailable here.","Pregnant women ","This Cochrane review aimed to determine the efficacy and safety of smoking cessation pharmacotherapies (including NRT, varenicline and bupropion), other medications, or electronic nicotine delivery systems when used for smoking cessation in pregnancy. \n\nThis review includes a total of nine trials which enrolled 2210 pregnant smokers: eight trials of NRT and one trial of bupropion as adjuncts to behavioural support/cognitive behavioural therapy (CBT). The risk of bias was generally low across trials with virtually all domains of the 'Risk of bias' assessment tool being satisfied for the majority of studies. The reviewers found no trials investigating varenicline or electronic nicotine delivery systems. Compared to placebo and non‐placebo controls, there was a difference in smoking rates observed in later pregnancy favouring use of NRT (RR 1.41, 95% CI 1.03 to 1.93, eight studies, 2199 women).  However, subgroup analysis of placebo‐RCTs provided a lower RR in favour of NRT (RR 1.28, 95% CI 0.99 to 1.66, five studies, 1926 women), whereas within the two non‐placebo RCTs there was a strong positive effect of NRT, (RR 8.51, 95% CI 2.05 to 35.28, three studies, 273 women; P value for random‐effects subgroup interaction test = 0.01). There were no differences between NRT and control groups in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care, caesarean section, congenital abnormalities or neonatal death. Compared to placebo group infants, at two years of age, infants born to women who had been randomised to NRT had higher rates of 'survival without developmental impairment' (one trial). Generally, adherence with trial NRT regimens was low. Non‐serious side effects observed with NRT included headache, nausea and local reactions (e.g. skin irritation from patches or foul taste from gum), but these data could not be pooled. ","The authors concluded that:\n- NRT used in pregnancy for smoking cessation increases smoking cessation rates measured in late pregnancy by approximately 40%\n- There is evidence, suggesting that when potentially‐biased, non‐placebo RCTs are excluded from analyses, NRT is no more effective than placebo\n- There is no evidence that NRT used for smoking cessation in pregnancy has either positive or negative impacts on birth outcomes\n- Evidence from the only trial to have followed up infants after birth, suggests use of NRT promotes healthy developmental outcomes in infants\n- Further research evidence on NRT efficacy and safety is needed, ideally from placebo‐controlled RCTs which achieve higher adherence rates and which monitor infants' outcomes into childhood\n- Accruing data suggests that it would be ethical for future RCTs to investigate higher doses of NRT than those tested in the included studies "]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"Canadian Agency for Drugs and Technologies in Health. Mindfulness Interventions for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Use Disorders: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015b.\nAvailable here.","Adults with Pre-existing health condition and other populatiion: Post traumatic stress disorder, generalised anxiety disorder and depression","This CADTH rapid response review aimed to answer the following research questions:\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders? \n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, depression, or substance use disorders? \n\nFor the purposes of this map, data relevant to the map has only been presented here.\n  \nOne SR and one RCT assessing mindfulness interventions in patients with substance use disorder were identified. The SR was conducted in Italy and included 24 studies (14 RCTs and ten non-RCTs). Twelve studies focused on alcohol and/or heterogeneous substance use, four on cigarette smoking, three on opiate use, one on marijuana use, and one on metamphetamine use. Eight studies focused on mindfulness-based stress reduction or related mindfulness-based interventions, five on acceptance and commitment therapy, three on Spiritual self-schema therapy , two on Dialectical behavioral therapy, one study focused on a Vipassana meditation (where individuals assume a seated position and focus their attention onto the breath), one study focused on goal management training in adjunct to mindfulness meditation, and one study focused on a motivational intervention in adjunct to mindfulness meditation. Ten of the included studies compared mindfulness-based interventions to a waiting list, eight compared it with an active treatment, two compared it with non-specific educational interventions designed to be structurally its equivalent. One study included adult patients enrolled in a substance abuse aftercare program. Mindfulness-based relapse prevention was compared to relapse prevention or treatment as usual in this RCT. Relapse to drug use and heavy drinking frequency of substance use in the past 90 days was assessed. \n \nThe evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited, where only one RCT was identified which concluded that the mindfulness intervention was more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. The only SR for substance use disorders included in this report concluded a lack of randomisation or of randomisation details, objective measures of drug use, and of information for treatment adherence, as well as small sample sizes, and raised concerns as to whether observed findings were actually due to the delivered interventions or are more properly attributable to methodological biases of included studies. \n\nSix evidence-based guidelines considered the use of mindfulness in clinical practice, of which one suggested  that Mindfulness-Based Stress Reduction can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals. ","This rapid response review reported that:\n- One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking\n- One evidence-based guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals \n "]
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[null,"Hughes JR et al. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD000031. DOI: 10.1002/14651858.CD000031.pub4.\nAvailable here.","Adolescents and\nAdults with or without\nPre-existing health condition: Depression or history of depression","This Cochrane review aimed to assess the effect and safety of antidepressant medications to aid long‐term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; lazabemide; moclobemide; nortriptyline; paroxetine; S‐Adenosyl‐L‐Methionine (SAMe); selegiline; sertraline; St. John's wort; tryptophan; venlafaxine; and zimeledine. \n\nTwenty‐four new trials were identified since the 2009 update, bringing the total number of included trials to 90. There were 65 trials of bupropion and ten trials of nortriptyline, with the majority at low or unclear risk of bias. There was high quality evidence that, when used as the sole pharmacotherapy, bupropion significantly increased long‐term cessation (44 trials, n =  13,728, RR 1.62, 95% CI 1.49 to 1.76). There was moderate quality evidence, limited by a relatively small number of trials and participants, that nortriptyline also significantly increased long‐term cessation when used as the sole pharmacotherapy (six trials, n =  975, RR 2.03, 95% CI 1.48 to 2.78). There is insufficient evidence that adding bupropion (12 trials, n =  3487, RR 1.19, 95% CI 0.94 to 1.51) or nortriptyline (4 trials, n =  1644, RR 1.21, 95% CI 0.94 to 1.55) to NRT provides an additional long‐term benefit. Based on a limited amount of data from direct comparisons, bupropion and nortriptyline appear to be equally effective and of similar efficacy to NRT (bupropion versus nortriptyline 3 trials, n =  417, RR 1.30, 95% CI 0.93 to 1.82; bupropion versus NRT 8 trials, n =  4096, RR 0.96, 95% CI 0.85 to 1.09; no direct comparisons between nortriptyline and NRT). Pooled results from four trials comparing bupropion to varenicline showed significantly lower quitting with bupropion than with varenicline (n =  1810, RR 0.68, 95% CI 0.56 to 0.83). Meta‐analyses did not detect a significant increase in the rate of serious adverse events amongst participants taking bupropion, though the CI only narrowly missed statistical significance (33 trials, n =  9631, RR 1.30, 95% CI 1.00 to 1.69). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Bupropion has been associated with suicide risk, but whether this is causal is unclear. Nortriptyline has the potential for serious side‐effects, but none have been seen in the few small trials for smoking cessation. \n\nThere was no evidence of a significant effect for selective serotonin reuptake inhibitors on their own (RR 0.93, 95% CI 0.71 to 1.22, n =  1594; 2 trials fluoxetine, 1 paroxetine, 1 sertraline) or as an adjunct to NRT (3 trials of fluoxetine, n =  466, RR 0.70, 95% CI 0.64 to 1.82). Significant effects were also not detected for monoamine oxidase inhibitors (RR 1.29, 95% CI 0.93 to 1.79, n =  827; 1 trial moclobemide, 5 selegiline), the atypical antidepressant venlafaxine (1 trial, n =  147, RR 1.22, 95% CI 0.64 to 2.32), the herbal therapy St John's wort (hypericum) (2 trials, n =  261, RR 0.81, 95% CI 0.26 to 2.53), or the dietary supplement SAMe (1 trial, n =  120, RR 0.70, 95% CI 0.24 to 2.07). ","The authors concluded that:\n- The antidepressants bupropion and nortriptyline aid long‐term smoking cessation\n- Adverse events with either medication appear to rarely be serious or lead to stopping medication\n- Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement\n- Evidence also suggests that bupropion is less effective than varenicline, but further research is needed to confirm this finding\n- Evidence suggests that neither selective serotonin reuptake inhibitors (e.g. fluoxetine) nor monoamine oxidase inhibitors aid cessation"]
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[null,"Thomsen T, Villebro N and Moller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002294. DOI: 10.1002/14651858.CD002294.pub4.\nAvailable here.","Adults with\nPre-existing health condition: Pre-operative","This Cochrane review aimed to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. \n\nThirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison. \n\nTen trials evaluated the effect of behavioural support on cessation at the time of surgery; NRT was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face‐to‐face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer‐based scheduled reduced smoking intervention. One placebo‐controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, while another placebo‐controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (RR 10.76; 95% CI 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide CIs (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long‐term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long‐term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long‐term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants). \n\nSeven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). ","The authors concluded that:\n- There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short‐term smoking cessation and may reduce postoperative morbidity\n- One trial of varenicline begun shortly before surgery has shown a benefit on long‐term cessation but did not detect an effect on early abstinence or on postoperative complications\n- The optimal preoperative intervention intensity remains unknown\n- Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long‐term smoking cessation"]
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[null,"Likis FE et al. Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment No.214. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 14-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2014. \nAvailable here.","Pregnant women and Women in post partum period","This review was prepared by the Vanderbilt Evidence-based Practice Center and it aimed to systematically review the evidence about smoking cessation interventions in Pregnant women and Women in post partum period.\n\nThe reviewers  included 59 unique studies reported in 72 publications. Of the 56 RCTs, 13 were good, 15 fair, and 28 poor quality. Studies evaluated counseling-based interventions, educational materials, NRT, peer support, multicomponent interventions, and other unique interventions. Multicomponent approaches were most likely to be effective, but results were inconsistent. \n\nIn the meta-analysis, incentives demonstrated the strongest effect; other components with a greater than 80-% likelihood of success were feedback about biologic measures, information, personal followup, NRT, and quit guides. \n\nFindings regarding infant outcomes were inconsistent or did not reach statistical significance. \n\nNo serious harms were identified in four studies that reported adverse events.\n\n","The review concluded that:\n- Across interventions, data are sparse to evaluate sustained cessation among Pregnant women and Women in post partum period\n- Approaches that combine multiple components will have the best likelihood of success\n- Selecting which components to include is more complex and should be based on the particular considerations of the clinical setting, including patient characteristics and resource allocation, but incentives demonstrated the greatest effect among components studied\n- Infant outcomes are limited to data collected at time of birth; no studies assessed longer term or child outcomes\n- Harms data were rarely reported"]
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[null,"Stead  LF et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.\nAvailable here.","Adolescents\nAdults","This Cochrane review aimed to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti‐smoking advice on disease‐specific and all‐cause mortality. \n\nThe reviewers  identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. \nPooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (RR 1.66, 95% CI 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow‐up visits. Only one study determined the effect of smoking advice on mortality. \n\nThis study found no statistically significant differences in death rates at 20 years follow‐up. ","The authors concluded that:\n- Simple advice has a small effect on cessation rates\n- Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%\n- Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions "]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"Tsoi DT, Porwal M and Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD007253. DOI: 10.1002/14651858.CD007253.pub3.\nAvailable here.","Adults with Pre-existing health condition: Schizophrenia","This Cochrane review aimed to evaluate the benefits and harms of different treatments for nicotine dependence in schizophrenia. \n\nThe reviewers included 34 trials (16 trials of cessation; nine trials of reduction; one trial of relapse prevention; eight trials that reported smoking outcomes for interventions aimed at other purposes). Seven trials compared bupropion with placebo; meta‐analysis showed that cessation rates after bupropion were significantly higher than placebo at the end of treatment (seven trials, n =  340; RR 3.03; 95% CI 1.69 to 5.42) and after six months (five trials, n =  214, RR 2.78; 95% CI 1.02 to 7.58). There were no significant differences in positive, negative and depressive symptoms between bupropion and placebo groups. There were no reports of major adverse events such as seizures with bupropion. \n\nSmoking cessation rates after varenicline were significantly higher than placebo, at the end of treatment (2 trials, n =  137; RR 4.74, 95% CI 1.34 to 16.71). Only one trial reported follow‐up at six months and the CIs were too wide to provide evidence of a sustained effect (one trial, n =  128, RR 5.06, 95% CI 0.67 to 38.24). There were no significant differences in psychiatric symptoms between the varenicline and placebo groups. Nevertheless, there were reports of suicidal ideation and behaviours from two people on varenicline. \n\nTwo studies reported that contingent reinforcement with money may increase smoking abstinence rates and reduce the level of smoking in patients with schizophrenia. However, it is uncertain whether these benefits can be maintained in the longer term. There was no evidence of benefit for the few trials of other pharmacological therapies (including NRT) and psychosocial interventions in helping smokers with schizophrenia to quit or reduce smoking. ","The authors concluded that:\n- Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state\n- Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out\n- Contingent reinforcement may help this group of patients to quit and reduce smoking in the short term\n- They failed to find convincing evidence that other interventions have a beneficial effect on smoking in schizophrenia"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Stead LF, Hartmann‐Boyce J, Perera R and Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3.\nAvailable here.","Adults\n","This Cochrane review aimed to evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. \n\nSeventy‐seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall the reviewers did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, RR for cessation at longest follow‐up 1.37, 95% CI 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.\n \nTelephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta‐regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually NRT) than when the control group only received self‐help material or a brief intervention. \n\nA further eight studies were too diverse to contribute to meta‐analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change, and none detected evidence of effect. ","The authors concluded that:\n- Proactive telephone counselling aids smokers who seek help from quitlines\n- Telephone quitlines provide an important route of access to support for smokers, and call‐back counselling enhances their usefulness\n- There is limited evidence about the optimal number of calls\n- Proactive telephone counselling also helps people who receive it in other settings\n- There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit\n- Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self‐help materials, or brief advice, or compared to pharmacotherapy alone "]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Quitline interventions. Atlanta: CPTSF; 2012. \nAvailable here.","Adults","This CPSTF finding on quitline effectiveness is based on evidence from an SR published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up.This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.\n\nEvidence of effectiveness for quitline promotional efforts is based on an SR of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).\n\nThe SRs were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.\n\nThe Task Force recommendation is based on evidence from 71 studies that evaluated effectiveness of proactive telephone counseling. Twelve studies evaluated treatment effectiveness for callers to quitlines available to the general public and observed a median absolute %age point increase in tobacco cessation of 3.1 %age points (interquartile interval [IQI]: 0.5 to 3.3 %age points). Fifty-one studies evaluated interventions for clients in clinical and research settings and observed a median absolute %age point increase in tobacco cessation of 1.7 %age points (IQI: 0.0 to 8.5 %age points). \n\nOnly six of 77 included studies provided evidence on effectiveness of reactive (caller initiated) quitline counseling. Three of these studies evaluated effectiveness of counseling for a single quitline contact and overall findings were inconsistent. The other three studies evaluated effectiveness of offering tobacco users access to quitline services, and similarly, overall results were inconsistent.","The CPSTF concluded that:\n- Quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting are recommended\n- Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions\n- Three interventions effective at increasing use of quitlines are mass-reach health communication interventions that combine cessation messages with a quitline number, provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting, and quitline referral interventions for health care systems and providers\n- Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments"]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: reducing out-of-pocket costs for evidence-based cessation treatments. Atlanta: CPTSF; 2012. \nAvailable here.","Adults","This CPSTF is based on evidence from a Community Guide systematic review published in 2001 (Hopkins et al, 5 studies, search period 1980-2000) combined with more recent evidence (13 studies, search period January 2000July 2012). Based on this updated review, the Task Force recommendation was changed from sufficient evidence to strong evidence of effectiveness. \n\nPrimary evidence for the finding comes from 14 of these 18 studies that evaluated the effectiveness of reducing out-of-pocket costs for cessation treatments on rates of tobacco cessation, total number of tobacco users who quit, or the prevalence of tobacco use in defined populations. Twelve of the 14 studies provided measurements of change in quit rates and observed a median absolute % increase of 4.3 %age points (IQI: + 0.2 to +6.0 %age points) with follow-up periods of 3.5 months or longer. The two remaining studies observed decreases in smoking prevalence over two years in populations provided with a new tobacco cessation benefit. \n\nThe included studies also provided measurements of change in use of the covered cessation treatments, and in overall quit attempts. Fifteen studies examined changes in the use of cessation treatments, of which 11 reported differences in the rate of use and observed a median absolute % increase of 7.0 %age points (IQI: +1.4 to +18.3 %age points). Seven studies examined changes in overall quit attempts, with six studies reporting a median absolute % difference in quit attempt rates of +2.8 %age points (IQI: -0.6 to +9.1 %age points). \n\nEvidence-based treatments considered in the Task Force recommendation were based on the findings of Treating Tobacco Use and Dependence: 2008 update (Fiore et al., 2008) a series of recent systematic reviews conducted to document the evidence of effectiveness of clinical interventions and cessation treatments to reduce tobacco use among patients in health care settings and systems. Cessation treatments described in the included studies for this review were categorised for description and analysis as cessation counseling and cessation medications. The evidence-based treatments provided at reduced out-of-pocket costs in 13 of the 18 studies included both medications and counseling. Five studies assessed the effectiveness of reducing out-of-pocket costs for cessation medications only, and observed results similar to the overall body of evidence. Only one study assessed the effectiveness of reduced out-of-pocket costs only for cessation counseling, so the effectiveness of this benefits approach remains unclear. ","The CPSTF concluded that:\n- Policies and programs to reduce tobacco users' out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit, are recommended\n- Evidence is considered strong based on findings from clinic-based trials and population-based policy evaluations of reduced out-of-pocket costs for both cessation counseling and medications\n- Clear communication of benefit changes to both tobacco users and healthcare providers increases use and impact of these interventions"]
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[null,"Carson KV et al. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012a, Issue 1. Art. No.: CD009046. DOI: 10.1002/14651858.CD009046.pub2. \nAvailable here.","Indigenous population: Adolescents, \nAdults and \nPregnant women","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. \n\nFour studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with CBT, whilst the remaining two used CBT through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (RR 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (RR 1.33, 95%CI 0.95 to 1.85, p=not significant). ","The authors concluded that:\n- A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations\n- Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results\n- The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence but this evidence base is not strong with a small number of methodologically sound trials investigating these interventions\n- More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Rigotti NA, Clair C, Munafò MR and Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD001837. DOI: 10.1002/14651858.CD001837.pub3. \nAvailable here.","Adults with\nPre-existing health condition: Hospitalised patients\n","This Cochrane review aimed to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. \n\nFifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (RR 1.37, 95% CI 1.27 to 1.48; 25 trials). A specific benefit for post‐discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post‐discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. \n\nAdding NRT to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non‐significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow‐up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilisation endpoints, and found significant reductions in all‐cause mortality and hospital readmission rates over a two‐year follow‐up period. These trials were all conducted in acute care hospitals. \n\nA comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). ","The authors concluded that:\n- High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients\n- The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals\n- There was no evidence of effect for interventions of lower intensity or shorter duration\n- This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone\n- There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone"]
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[null,"Bize R et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. \n\nThe reviewers  included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested carbon monoxide feedback alone and carbon monoxide combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used carbon monoxide measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of carbon monoxide and spirometry feedback in different settings. ","The authors concluded that:\n- There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation\n- Of the fifteen included studies, only two detected a significant effect of the intervention\n- Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal\n- A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect\n- Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta‐analyses; neither of these found evidence of an effect\n- Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"Hartmann‐Boyce  J, Cahill  K, Hatsukami  D and Cornuz  J. Nicotine vaccines for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007072. DOI: 10.1002/14651858.CD007072.pub2. \nAvailable here.","Adults","This Cochrane review aimed to assess the efficacy of nicotine vaccines for smoking cessation and for relapse prevention, and to assess the frequency and type of adverse events associated with the use of nicotine vaccines. \n\nThere are no nicotine vaccines currently licensed for public use, but there are a number in development. The reviewers found four trials which met their inclusion criteria, three comparing NicVAX to placebo and one comparing NIC002 (formerly NicQbeta) to placebo. All were smoking cessation trials conducted by pharmaceutical companies as part of the drug development process, and all trials were judged to be at high or unclear risk of bias in at least one domain. Overall, 2642 smokers participated in the included studies in this review. None of the four included studies detected a statistically significant difference in long‐term cessation between participants receiving vaccine and those receiving placebo. The RR for 12 month cessation in active and placebo groups was 1.35 (95% CI 0.82 to 2.22) in the trial of NIC002 and 1.74 (95% CI 0.73 to 4.18) in one NicVAX trial. Two Phase III NicVAX trials, for which full results were not available, reported similar quit rates of approximately 11% in both groups. In the two studies with full results available, post hoc analyses detected higher cessation rates in participants with higher levels of nicotine antibodies, but these findings are not readily generalisable. The two studies with full results showed nicotine vaccines to be well tolerated, with the majority of adverse events classified as mild or moderate. In the study of NIC002, participants receiving the vaccine were more likely to report mild to moderate adverse events, most commonly flu‐like symptoms, whereas in the study of NicVAX there was no significant difference between the two arms. Information on adverse events was not available for the large Phase III trials of NicVAX. \n\nVaccine candidates are likely to undergo significant changes before becoming available to the general public, and those included in this review may not be the first to reach market; this limits the external validity of the results reported in this review in terms of both effectiveness and tolerability. ","The authors concluded that:\n- There is currently no evidence that nicotine vaccines enhance long‐term smoking cessation\n- Rates of serious adverse events recorded in the two trials with full data available were low, and the majority of adverse events reported were at mild to moderate levels\n- The evidence available suggests nicotine vaccines do not induce compensatory smoking or affect withdrawal symptoms\n- No nicotine vaccines are currently licensed for use in any country but a number are under development\n- Further trials of nicotine vaccines are needed, comparing vaccines with placebo for smoking cessation\n- Further trials are also needed to explore the potential of nicotine vaccines to prevent relapse. Results from past, current and future research should be reported in full\n- Adverse events and serious adverse events should continue to be carefully monitored and thoroughly reported"]

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[null,"EDUCATIONAL INSTITUTE SETTING"]
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[null,"GUIDANCE - EDUCATIONAL INSTITUTE SETTING"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking prevention in schools. PH23. London: NICE; 2010. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Ischool-based interventions to prevent the uptake of smoking among children and young people. Evidence Update April 2013. London: NICE; 2013. Available here.\n","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Education professionals\n- People who work in the wider public, private, voluntary and community sectors\n- Children, young people, and their families and carers","This guideline covers smoking prevention interventions that are delivered in schools or other educational institutions. It aims to prevent children and young people aged under 19 from taking up smoking.\n\nIt includes recommendations on:\n- Organisation-wide or 'whole-school' approaches\n- Adult-led interventions\n- Peer-led interventions\n- Staff training and development\n- Coordinating with local, regional and national tobacco control strategies\n\nThis guideline was checked in April 2013."]
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[null,"SYSTEMATIC REVIEWS - EDUCATIONAL INSTITUTE SETTING"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Holliday  R, et al. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.\nAvailable here.","Tobacco users (smokers or smokeless tobacco users) of any age willing to enrol in a tobacco cessation trial.","This systematic review aimed to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.\nTwenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings.\nCompared with usual care, brief advice, very brief advice, or less active treatment, the authors found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. The authors found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). They did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.","There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. \nThere is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. \nFurther evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health."]
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[null,"Hartmann‐Boyce  J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub4. \nAvailable here. ","Adults\nAdolescents","Eighty‐three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, the reviewers judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. They pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (risk ratio [RR] 1.15, 95% Confidence interval [CI] 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow‐up, and this effect was not different when they compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). \n","The authors concluded that:\n- There is high‐certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates\n- Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials\n- Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support\n- More research is needed to assess the effectiveness of specific components that comprise behavioural support"]
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[null,"Lindson N et al. Smoking reduction interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013183. DOI: 10.1002/14651858.CD013183.pub2. Available here.","Adults","This Cochrane review aimed to assess the effect of reduction‐to‐quit interventions on long‐term smoking cessation.\n\nThe reviewers identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. They judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.\n\nThey identified very low‐certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction‐to‐quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction‐to‐quit interventions with abrupt quitting (standard care) they found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). They judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction‐to‐quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. The analysis comparing reduction using pharmacotherapy with reduction alone found low‐certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast‐acting NRT or varenicline are used (both moderate‐certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low‐ or very low‐quality evidence). More evidence is likely to change the interpretation of the latter effects.\n\nAlthough there was some evidence from within‐study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self‐help resources alone, the relative efficacy of various other characteristics of reduction‐to‐quit interventions investigated through within‐ and between‐study comparisons did not provide any evidence that they enhanced the success of reduction‐to‐quit interventions. Pre‐quit adverse events, serious adverse events and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that adverse events occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the adverse events reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting serious adverse events, or changes in withdrawal symptoms, differed between trial arms.","The authors concluded that:\n- 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 another\n- Evidence comparing the efficacy of reduction‐to‐quit interventions with no treatment was inconclusive and of low certainty\n- There is also low‐certainty evidence to suggest that reduction‐to‐quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast‐acting NRT or varenicline (moderate‐certainty evidence)\n- Evidence for any adverse effects of reduction‐to‐quit interventions was sparse, but available data suggested no excess of pre‐quit serious adverse events or withdrawal symptoms\n- The reviewers downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision\n- Future research should aim to match any additional components of multicomponent reduction‐to‐quit interventions across study arms, so that the effect of reduction can be isolated\n- In particular, well‐conducted, adequately‐powered studies should focus on investigating the most effective features of reduction‐to‐quit interventions to maximise cessation rates"]
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[null,"Lindson N et al. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub4.\nAvailable here. ","Adolescents\nAdults","The reviewers identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. Motivational Interviewing (MI) was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. They judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case ‐ our analysis comparing higher to lower intensity MI. \n\nThey found low‐certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). They judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low‐certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results. \n\nMental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well‐being. \n","The authors concluded that:\n- There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation\n- It is also unclear whether more intensive MI is more effective than less intensive MI\n- All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency\n- Consequently, future trials are likely to change these conclusions\n- There is almost no evidence on whether MI for smoking cessation improves mental well‐being"]
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[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Barnes  J et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD001008. DOI: 10.1002/14651858.CD001008.pub3. \nAvailable here. ","Adults","The reviewers included three new trials in this update, which brings the total to 14 included studies that compared hypnotherapy with 22 different control interventions. The studies included a total of 1926 participants. Studies were diverse and a single meta‐analysis was not possible. They judged only one study to be at low risk of bias overall; they judged 10 studies to be at high risk of bias and three at unclear risk. Studies did not provide reliable evidence of a greater benefit from hypnotherapy compared with other interventions or no treatment for smoking cessation. Most individual studies did not find statistically significant differences in quit rates after six months or longer, and studies that did detect differences typically had methodological limitations. \n\nPooling small groups of relatively comparable studies did not provide reliable evidence for a specific effect of hypnotherapy relative to controls. There was low certainty evidence, limited by imprecision and risk of bias, that showed no statistically significant difference between hypnotherapy and attention‐matched behavioural treatments (RR 1.21, 95% CI 0.91 to 1.61; I2 = 36%; 6 studies, 957 participants). Results were similarly imprecise, and also limited by risk of bias, when comparing hypnotherapy to intensive behavioural interventions (not matched for contact time) (RR 0.93, 95% CI 0.47 to 1.82; I2 = 0%; 2 studies, 211 participants; very low certainty evidence). Results from one small study (40 participants) detected a statistically significant benefit of hypnotherapy compared to no intervention (RR 19.00, 95% CI 1.18 to 305.88), but this evidence was judged to be of very low certainty due to high risk of bias and imprecision. No significant differences were detected in comparisons of hypnotherapy with brief behavioural interventions (RR 0.98, 95% CI 0.57 to 1.69; I² = 0%; 2 studies, 269 participants), rapid/focused smoking (RR 1.00, 95% CI 0.43 to 2.33; I2 = 65%; 2 studies, 54 participants), and pharmacotherapies (RR 1.68, 95% CI 0.88 to 3.20; I2 = 5%; 2 studies, 197 participants). When hypnotherapy was evaluated as an adjunct to other treatments, the pooled result from five studies showed a statistically significant benefit in favour of hypnotherapy (RR 2.10, 95% CI 1.31 to 3.35; I² = 62%; 224 participants); however, this result should be interpreted with caution due to the high risk of bias across studies (four had a high risk or bias, one had an unclear risk), and substantial statistical heterogeneity. \n\nMost studies did not provide information on whether data specifically relating to adverse events were collected, and whether or not any adverse events occurred. One study that did collect such data did not find a statistically significant difference in the adverse event ‘index’ between hypnotherapy and relaxation. \n","The authors concluded that:\n- There is insufficient evidence to determine whether hypnotherapy is more effective for smoking cessation than other forms of behavioural support or unassisted quitting\n- If a benefit is present, current evidence suggests the benefit is small at most\n- There is very little evidence on whether hypnotherapy causes adverse effects, but the existing data show no evidence that it does\n- Further large, high‐quality randomized controlled trials, and more comprehensive assessments of safety, are needed on this topic"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Schuit E et al. Pharmacotherapy for smoking cessation: effects by subgroup defined by genetically informed biomarkers. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011823. DOI: 10.1002/14651858.CD011823.pub2.\nAvailable here.","Adults","This Cochrane review aimed to assess whether quit rates vary by genetically informed biomarkers within pharmacotherapy treatment arms and as compared with placebo. It also aimed to assess the effects of pharmacotherapies for smoking cessation in subgroups of smokers defined by genotype for identified genome wide significant polymorphisms.\n\nAnalyses included 18 trials including 9,017 participants, of whom 6,924 were non hispanic whites (NHW) and 2,093 non Hispanic blacks (NHB) participants. Included data produced a total of 40 active versus placebo comparisons, 16 active versus active comparisons, and 64 between‐genotype comparisons within treatment arms. \n\nResults suggest that smokers with specific genotypes may be more successful at quitting smoking with the use of NRT compared to smokers without the specific genotypes. Smokers whose bodies process nicotine more slowly may also benefit from NRT. Authors failed to see effects of genes on the effectiveness of medicines other than nicotine replacement therapy.\n\nThe results should be interpreted with caution because the included studies di not assign treatments to smokers on the basis of genotype or the rate at which they process nicotine, and because a small number of clinical trials were included in some comparisons.\n\nFor six month abstinence, comparisons of relative treatment effects by genotype were found to have statistically significant heterogeneity between genotypes for NRT versus placebo at six months for NHB participants (p = 0.03; two trials), but not for other biomarkers or treatment comparisons. Six month abstinence was increased in the active NRT group as compared to placebo among participants with a GG genotype (RR 1.47, 95% CI 1.07 to 2.03), but not in the combined group of participants with other genotypes. \n\nFor those receiving active NRT, comparisons of treatment effects between genotype groups within pharmacotherapy randomisation arms, treatment was more effective in achieving six month abstinence among individuals with a slow nicotine metabolite ratio (NMR) than among those with a normal NMR among NHW and NHB combined participants (normal NMR vs slow NMR: RR 0.54, 95% CI 0.37 to 0.78; two trials). The reviewers found no such differences in treatment effects between genotypes at six months for any of the other biomarkers among individuals who received pharmacotherapy or placebo.","The authors did not identify widespread differential treatment effects of pharmacotherapy based on genotype. They concluded that:\n- Some genotype groups within certain ethnic groups may benefit more from NRT or may benefit less from the combination of bupropion with NRT\n- The reader should interpret these results with caution because none of the statistically significant meta‐analyses included more than two trials per genotype comparison, many CIs were wide, and the quality of this evidence (GRADE) was generally moderate\n- Although they found evidence of superior NRT efficacy for NMR slow versus normal metabolisers, because of the lack of heterogeneity between NMR groups, they could not conclude that NRT is more effective for slow metabolisers\n- Access to additional data from multiple trials is needed, particularly for comparisons of different pharmacotherapies"]
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[null,"Chamberlain C et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub5.\nAvailable here.","Pregnant women and Women in post partum period","This Cochrane review aimed to assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. \n\nThe overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.\n\nIn separate comparisons, there is high‐quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average RR 1.44, 95% CI 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small. \n\nEvidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention. \n\nThere was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20). \n\nHigh‐quality evidence suggests incentive‐based interventions are effective when compared with an alternative (non‐contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I² = 93%). \n\nHigh‐quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health. \n\nThe effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32). \n\nImportantly, high‐quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions. \n\nThe intensity of support women received in both the intervention and comparison groups has increased over time, with higher‐intensity interventions more likely to have higher‐intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta‐regression analyses. Among meta‐regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio‐economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self‐reported abstinence. It was unclear whether incorporating use of self‐help manuals or telephone support increased the effectiveness of interventions. ","The authors concluded that:\n- Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight\n- Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered\n- The effect of health education and social support is less clear \n\nNew trials have been published during the preparation of this review and will be included in the next update. "]
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[null,"Rice VH et al. Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD001188. DOI: 10.1002/14651858.CD001188.pub5.\nAvailable here.","Young Children (18- 24 years)","This Cochhrane review aimed to determine the effectiveness of nursing‐delivered smoking cessation interventions in adults. It also, tried to establish whether nursing‐delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow‐ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. \n\nFifty‐eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I² = 50%) and not explained by subgroup analysis. Because of this, the reviewers judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, they did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. \n\nSubgroup analyses found no evidence that high‐intensity interventions, interventions with additional follow‐up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow‐up or aids. \n\nThere was no evidence that the effect of support differed by patient group or across healthcare settings. ","The authors reported that there is:\n- Moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence\n- Insufficient evidence to assess whether more intensive interventions, those incorporating additional follow‐up, or those incorporating pathophysiological feedback are more effective than one‐off support\n-No evidence that the effect of support differed by patient group or across healthcare settings"]
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[null,"Fanshawe TR et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD003289. DOI: 10.1002/14651858.CD003289.pub6.\nAvailable here.\n","Adolescents and\nYoung children (≤ 20years)","This Cochrane review aimed to evaluate the effectiveness of strategies that help young people to stop smoking tobacco. \n\nForty‐one trials involving more than 13,000 young people met the inclusion criteria (26 individually RCTs and 15 cluster‐randomised trials). The reviewers judged the majority of studies to be at high or unclear risk of bias in at least one domain. \n\nInterventions 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). \n\nThere was evidence of an intervention effect for group counselling (9 studies, RR 1.35, 95% 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 CIs were wide (NRT 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. \n\nStudies 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.  The 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. ","The authors concluded that:\n- 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\n- Findings are most promising for group‐based behavioural interventions, but evidence remains limited for all intervention types\n- There continues to be a need for well‐designed, adequately powered, RCTs of interventions for this population of smokers"]
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[null,"Hefler M, Liberato SC and Thomas DP. Incentives for preventing smoking in children and adolescents. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008645. DOI: 10.1002/14651858.CD008645.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review aimed to assess the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke. It also aimed to assess, where possible, the dose‐response of incentives, the costs of incentive programmes, whether incentives are more or less effective in combination with other interventions to prevent smoking initiation, and any unintended consequences arising from the use of incentives. \n\nThe reviewers identified three eligible RCTs and five controlled trials, including participants aged 11 to 14 years, who were non‐smokers at baseline. Of the eight trials identified, six had analyzable data relevant for this review, which contributed to meta‐analyses (7275 participants in total: 4003 intervention; 3272 control; 2484 participants after adjusting for clustering). All except one of the studies tested the 'Smokefree Class Competition' (SFC), which has been widely implemented throughout Europe. In this competition, classes with youth generally between the ages of 11 and 14 years commit to being smoke‐free for a six‐month period, and report their smoking status regularly. If 90% or more of the class are non‐smokers at the end of the six months, the class goes into a competition to win prizes. The one study that was not a trial of the SFC was a controlled trial in which schools in two communities were assigned to the intervention, with schools in a third community acting as controls. Students in the intervention community with lower smoking rates at the end of the project (one school year) received rewards.\n \nMost studies resulted in statistically non‐significant results. Only one study of the SFC reported a significant effect of the competition on the prevention of smoking at the longest follow‐up. However, this study was at risk of multiple biases, and when the adjusted RR was calculated, the difference was statistically insignificant. The pooled RR for the more robust RCTs (3 studies, n =   3056 participants/1107 adjusted for clustering) suggests that there is no statistically significant effect of incentives, in the form of the SFC, to prevent smoking initiation among children and adolescents in the long term (RR 1.00, 95% CI 0.84 to 1.19). Pooled results from the non‐randomised trials also did not detect a significant effect of the SFC, and the reviewers were unable to extract data on the outcome of interest from the one trial that did not study the SFC. There is little robust evidence to suggest that unintended consequences (such as making false claims about their smoking status and bullying of smoking students) are consistently associated with such interventions, although this has not been the focus of much research. There was insufficient information to assess the dose‐response relationship or to report costs of incentives for preventing smoking uptake. \n\nThe reviewers judged the included RCTs to be at unclear risk of bias, and the non‐RCTs to be at high risk of bias. Using GRADE, they rated the overall quality of the evidence for our primary outcome as 'low' (for RCTs) and 'very low' (for non‐RCTs), because of imprecision (all studies had wide CIs), and for the risks of bias identified. They further downgraded the non‐RCT evidence, due to issues with the non‐RCT study design, likely to introduce further bias.","The authors concluded that:\n- Very limited evidence currently available suggests that incentive programmes do not prevent smoking initiation among youth. However, there are relatively few published studies and these are of variable quality\n- Trials included in the meta‐analyses were all studies of the SFC, which distributed small to moderately‐sized prizes to whole classes, usually through a lottery system. It is therefore possible that other incentive programmes could be more successful at preventing smoking uptake in young people\n- Future studies might investigate the efficacy of a wider range of incentives, including those given to individual participants to prevent smoking uptake, whilst considering both the effect of incentives on smoking initiation and the progression to smoking. \n- It would be useful if incentives were evaluated in varying populations from different socioeconomic and ethnic backgrounds, and if intervention components were described in detail "]
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[null,"McNeill A et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011244. DOI: 10.1002/14651858.CD011244.pub2.\nAvailable here.","Adolescents\nAdults\n\n","This Cochrane review aimed to assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction. \n\nFifty‐one studies met the inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between‐ and within‐participant experimental studies, cohort and cross‐sectional studies, and time‐series analyses. Few studies assessed behavioural outcomes in youth and non‐smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross‐sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non‐behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall most studies were judged to be at high or unclear risk of bias in at least one domain. \n\nThe one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 %age point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. \n\nFindings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. \n\nOne national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post‐implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. \n\nStudies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye‐tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non‐behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. The reviewers found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse‐tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. ","The authors concluded that:\n- The available evidence suggests that standardised packaging may reduce smoking prevalence\n- Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect\n- A reduction in smoking behaviour is supported by routinely collected data by the Australian government\n- Data on the effects of standardised packaging on non‐behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence\n- As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake\n- No evidence suggesting standardised packaging may increase tobacco use was found"]
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[null,"Cahill K et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub7.\nAvailable here.","Adults\n","Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow‐up, with a pooled RR of 3.98 (95% CI 2.01 to 7.87; low‐quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).\n \nOne trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development. \n\nThe reviewers identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with NRT. Nine studies tested variations in varenicline dosage, and 13 tested usage in disease‐specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline. \n\nThe pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high‐quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high‐quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate‐quality evidence). Four trials which tested the use of varenicline beyond the 12‐week standard regimen found the drug to be well‐tolerated during long‐term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). \n\nThe most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of serious adverse events among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high‐quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow‐up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of serious adverse events among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta‐analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but the reviewers await the findings of the CATS trial, which should establish whether or not this is a valid concern. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials\n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Thomas RE et al. Family‐based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004493. DOI: 10.1002/14651858.CD004493.pub3.\nAvailable here.","Adolescents and children (5-18 years)","This Cochrane review aimed to assess the effectiveness of interventions to help families stop children starting smoking. \n\nTwenty‐seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow‐up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty‐three interventions were tested in the USA, two in Europe, one in Australia and one in India. \n\nThe control conditions fell into two main groups: no intervention or usual care; or school‐based interventions provided to all participants. These two groups of studies were considered separately.\n \nMost studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta‐analysis. \n\nThere was moderate quality evidence family‐based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non‐smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (RR 0.76, 95% CI 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but CIs were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17). \n\nEight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta‐analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n =   388). \n\nNo studies identified any adverse effects of intervention.","The authors concluded that:\n- There is moderate quality evidence to suggest that family‐based interventions can have a positive effect on preventing children and adolescents from starting to smoke\n- There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons\n- The evidence is therefore strongest for high intensity programmes used independently of school interventions\n- Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%\n- These findings should be interpreted cautiously because effect estimates could not include data from all studies\n- The authors' interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting) which is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting"]
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[null,"Maziak W et al. Interventions for waterpipe smoking cessation. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD005549. DOI: 10.1002/14651858.CD005549.pub3.\nAvailable here.\n","Adults","This Cochrane review aimed to evaluate the effectiveness of tobacco cessation interventions for waterpipe users.\n\nThe literature search retrieved 1311 unique citations, of which 1289 were excluded after title and abstract screening. Of the remaining 22, the reviewers excluded 19 because the studies were empirical studies that were not randomised, quasi‐randomised or cluster‐RCTs (n = 12), review articles (n = 3), described protocols only (n = 2), were conducted among cigarette smokers only (n = 1), or had only a three‐month follow‐up (n = 1).\n\nThey identified three controlled trials which tested cessation interventions for waterpipe smokers. Studies were carried out in Egypt, Pakistan, and the US. One was an RCT and two were cluster‐randomised trials. Two studies tested individual‐level interventions, and one tested a community‐level intervention. Two studies included only behavioural interventions, and one study included two intervention groups: one behavioural, and the other behavioural with bupropion. Two studies delivered waterpipe‐specific interventions, while the third study delivered a non‐specific tobacco intervention. Due to study variation the reviewers did not pool results, and intervention effects are reported descriptively. Compared to control groups, waterpipe smoking cessation rates were higher in the intervention groups in all three studies, with a significant difference in two studies. For one study, the RRs for waterpipe smoking abstinence at 25 weeks among waterpipe‐only smokers were 2.2 (95% CI 1.3 to 3.8; 180 participants) in the behavioural group, and 2.5 (95% CI 1.3 to 4.7; 84 participants) in the behavioural plus bupropion group. In the analysis, the reviewers have combined both groups, to give a RR of 2.28 (95% CI 1.36 to 3.83; 200 participants). Another study delivered a RR in male waterpipe‐smokers at one year in favour of the intervention of 3.25 (95% CI 1.19 to 8.89). ","The authors concluded that:\n- Although the literature on waterpipe cessation interventions remains sparse, the reviewed studies provide a basis for developing interventions in this area\n- The lack of statistically significant effects in one of the three studies is not unexpected, given the small and pilot nature of the studies\n- The studies highlight important design and content issues that need to be considered for future cessation trials in waterpipe smokers\n- These include building on the vast experience developed in the study of smoking cessation interventions in cigarette smokers, whilst including components and assessment tools that address the specific aspects of waterpipe smoking, such as its social dimension, unique experiences, and cues"]
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[null,"Ussher MH, Taylor AH and Faulkner GEJ. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub5.\nAvailable here.","Adolescents\nAdults\nPregnant women  ","This Cochrane review aimed to determine whether exercise‐based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. \n\nThe reviewers identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three‐month follow‐up and a benefit for exercise of borderline significance (p = 0.05) at the 12‐month follow‐up. Another study reported significantly higher abstinence rates at six month follow‐up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three‐month follow‐up but not at the end of treatment or 12‐month follow‐up. The other studies showed no significant effect for exercise on abstinence. ","The authors reported that:\n- Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term\n- All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise\n- Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups "]
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[null,"Coppo A et al. School policies for preventing smoking among young people. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD009990. DOI: 10.1002/14651858.CD009990.pub2.\nAvailable here.","Young people (age group not specified)","This Cochrane review aimed to  assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools. \n\nThe reviewers found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow‐up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face‐to‐face interviews with school staff members, and the outcome evaluation was performed using self‐administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal school tobacco policies (STPs) when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies. ","The authors concluded that: \n- Despite a comprehensive literature search, and rigorous evaluation of studies, no evidence was found to support STPs\n- The absence of reliable evidence for the effectiveness of STPs is a concern in public health\n- Well‐designed RCTs or quasi‐experimental studies are needed to evaluate the effectiveness of school tobacco policies"]
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[null,"van der Meer RM, Willemsen  MC, Smit  F and Cuijpers  P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006102. DOI: 10.1002/14651858.CD006102.pub2.\nAvailable here.","Adults with Pre-existing health condition: Depression or history of depression","This Cochrane review aimed to evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. \n\nForty‐nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta‐analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, n =  1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, n =  1496, RR 1.41, 95% CI 1.13 to 1.77). Meta‐analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, n =  410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, n =  404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long‐term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression. \n\nTwenty‐three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared NRT versus placebo in smokers with current depression and found a positive, although not significant, effect (n =  196, RR 2.64, 95% CI 0.93 to 7.45). Meta‐analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, n =  432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials the reviewers did not estimate pooled effects. ","The authors concluded that:\n- Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long‐term cessation rates in smokers with both current and past depression when compared with the standard intervention alone\n- Pooled results from four trials suggest that use of bupropion may increase long‐term cessation in smokers with past depression\n- There was no evidence found for the use of bupropion in smokers with current depression\n- There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression\n- There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions "]
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[null,"David SP et al. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD003086. DOI: 10.1002/14651858.CD003086.pub3.\nAvailable here.","Adults","This Cochrane review aimed to evaluate the efficacy of opioid antagonists in promoting long‐term smoking cessation. The drugs include naloxone and the longer‐acting opioid antagonist naltrexone. \n\nEight trials of naltrexone met inclusion criteria for meta‐analysis of long‐term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus NRT versus placebo plus NRT. Results from 250 participants in one long‐term trial remain unpublished. No significant difference was detected between naltrexone and placebo (RR 1.00; 95% CI 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes. ","The authors concluded that:\n- Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long‐term smoking abstinence, with a point estimate strongly suggesting no effect and CIs that make a clinically important effect of treatment unlikely\n- Although further trials might narrow the CIs they are unlikely to be a good use of resources"]
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[null,"Thomas RE, McLellan J and Perera R. School‐based programmes for preventing smoking. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD001293. DOI: 10.1002/14651858.CD001293.pub3.\nAvailable here.","Adolescents and Children (5-18 years)","This Cochrane review primarily aimed to determine whether school smoking interventions prevent youth from starting smoking. Its secondary objective was to determine which interventions were most effective. This included evaluating the effects of theoretical approaches; additional booster sessions; programme deliverers; gender effects; and multifocal interventions versus those focused solely on smoking.\n\nOne hundred and thirty‐four studies involving 428,293 participants met the inclusion criteria. Some studies provided data for more than one group.\n \nPure Prevention cohorts (Group 1) included 49 studies (n =  142,447). Pooled results at follow‐up at one year or less found no overall effect of intervention curricula versus control (OR 0.94, 95% CI 0.85 to 1.05). In a subgroup analysis, the combined social competence and social influences curricula (six RCTs) showed a statistically significant effect in preventing the onset of smoking (OR 0.49, 95% CI 0.28 to 0.87; seven arms); whereas significant effects were not detected in programmes involving information only (OR 0.12, 95% CI 0.00 to 14.87; one study), social influences only (OR 1.00, 95% CI 0.88 to 1.13; 25 studies), or multimodal interventions (OR 0.89, 95% CI 0.73 to 1.08; five studies). In contrast, pooled results at longest follow‐up showed an overall significant effect favouring the intervention (OR 0.88, 95% CI 0.82 to 0.96). Subgroup analyses detected significant effects in programmes with social competence curricula (OR 0.52, 95% CI 0.30 to 0.88), and the combined social competence and social influences curricula (OR 0.50, 95% CI 0.28 to 0.87), but not in those programmes with information only, social influence only, and multimodal programmes. \n\nChange in Smoking Behaviour over time (Group 2) included 15 studies (n =  45,555). At one year or less there was a small but statistically significant effect favouring controls (SMD 0.04, 95% CI 0.02 to 0.06). For follow‐up longer than one year there was a statistically nonsignificant effect (SMD 0.02, 95% CI ‐0.00 to 0.02). \n\nTwenty‐five studies reported data on the Point Prevalence of Smoking (Group 3), though heterogeneity in this group was too high for data to be pooled. \n\nThe reviewers were unable to analyse data for 49 studies (n =  152,544).\n\nSubgroup analyses (Pure Prevention cohorts only) demonstrated that at longest follow‐up for all curricula combined, there was a significant effect favouring adult presenters (OR 0.88, 95% CI 0.81 to 0.96). There were no differences between tobacco‐only and multifocal interventions. For curricula with booster sessions there was a significant effect only for combined social competence and social influences interventions with follow‐up of one year or less (OR 0.50, 95% CI 0.26 to 0.96) and at longest follow‐up (OR 0.51, 95% CI 0.27 to 0.96). Limited data on gender differences suggested no overall effect, although one study found an effect of multimodal intervention at one year for male students. Sensitivity analyses for Pure Prevention cohorts and Change in Smoking Behaviour over time outcomes suggested that neither selection nor attrition bias affected the results. ","The authors concluded that:\n- Pure Prevention cohorts showed a significant effect at longest follow‐up, with an average 12% reduction in starting smoking compared to the control groups. However, no overall effect was detected at one year or less\n- The combined social competence and social influences interventions showed a significant effect at one year and at longest follow‐up\n- Studies that deployed a social influences programme showed no overall effect at any time point; multimodal interventions and those with an information‐only approach were similarly ineffective\n- Studies reporting Change in Smoking Behaviour over time did not show an overall effect, but at an intervention level there were positive findings for social competence and combined social competence and social influences interventions"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants)  "]
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[null,"Lancaster  T and Stead  LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000191. DOI: 10.1002/14651858.CD000191.pub2. \nAvailable here.","Adults","This Cochrane review aimed to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation. \n\nTwo studies provided long‐term follow‐up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled RR for quitting for silver acetate vs placebo was 1.04 (95% CI 0.69 to 1.57). ","The authors concluded that:\n- Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation\n- The CI for the ratio are quite wide but the upper limit of the CI for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%\n- Any effect of this agent is therefore likely to be smaller than NRT\n- The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus "]
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[null,"Stead  LF, Hughes  JR. Lobeline for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD000124. DOI: 10.1002/14651858.CD000124.pub2. \nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of lobeline on long term smoking cessation. \n\nThe reviewers identified no trials meeting the full inclusion criteria including long term follow‐up. One large trial failed to detect any effect on short‐term abstinence. ","The authors concluded that:\n- There is no evidence available from long term trials that lobeline can aid smoking cessation, and the short‐term evidence suggests there is no benefit "]
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[null,"Carson  KV et al. Interventions for tobacco use prevention in Indigenous youth. Cochrane Database of Systematic Reviews 2012b, Issue 8. Art. No.: CD009325. DOI: 10.1002/14651858.CD009325.pub2.\nAvailable here.","Indigenous population: Adolescents and Young children (aged 25 or less)\n ","This Cochrane review aimed to evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. \n\nTwo studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi‐component community‐based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow‐up in the one study assessing this outcome (skills‐community group versus control: RR 0.95, 95% CI 0.78 to 1.14; skills‐only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills‐community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills‐only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow‐up (change score ‐0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10). ","The authors concluded that:\n- Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth\n- This review highlights the paucity of data and the need for more research in this area\n- Smoking prevalence in Indigenous youth is twice that of the non‐Indigenous population, with tobacco experimentation commencing at an early age\n- As such, a significant health disparity exists where Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality\n- Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco‐related health disparities in Indigenous and non‐Indigenous populations "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Pharmacologic-Based Strategies for Smoking Cessation: Clinical and Cost-Effectiveness Analyses. Ottawa: CADTH; 2012.\nAvailable here.","Adults","This CADTH HTA report aimed to compare the pharmacological agents (drug-based smoking cessation aids) to determine which of these works best (clinical effectiveness) at six months and 12 months after patients attempt to quit smoking. It also aimed to perform an economic analysis to determine which smoking cessation\ntherapy was the most cost-effective for patients, drug plans, and the Canadian health care system.\n\nEighty-one trials (from August 1982 to June 2009) were identified, involving a total of 40,317 participants. Varenicline, bupropion, and all six NRTs (patch, gum, lozenge, inhaler, spray, and sublingual) were found to be more efficacious than placebo after six months and one year of follow-up. Use of NRTs (OR 1.89, CredI 95% 1.63 to 2.18) or use of bupropion (OR 1.95, CredI 95% 1.58 to 2.41) was found to approximately double the odds of quitting successfully and maintaining abstinence for at least 12 months compared with placebo. Use of varenicline (OR 2.78, CredI 95% 2.17 to 3.57) also improved the odds of success between two- and three-fold. The use of mixed treatment comparisons in the review found varenicline to be superior to conventional NRT use and bupropion. There were no differences in efficacy between bupropion and NRT or between the various forms of NRT alternatives.\n\nNicotine gum, nicotine patch, and bupropion were shown to be superior compared with placebo at 12 months of follow-up in five trials (n = 1,673) assessing five different interventions for smoking cessation in smokers with cardiovascular or smoking-related diseases. For patients with chronic obstructive pulmonary disease, nicotine sublingual (one trial, n = 370) and bupropion (two trials, n = 579) were superior to placebo.\n\nThere were few RCTs of combined therapy versus monotherapy. The addition of nicotine gum to nicotine patch was superior compared with nicotine patch alone for the six-month continuous abstinence rate, but not at one year of follow-up (one RCT, n = 374). The combined therapies of nicotine patch and inhaler or bupropion and NRT did not provide an added effect compared with monotherapy (four RCTs). Thus, combined therapy should be prescribed with caution because the evidence is scarce and the adverse effects unknown.\n\nA review of existing economic analyses showed that varenicline (with or without behavioural interventions) seemed to be the most cost-effective therapy, followed by bupropion and NRT. However, the results should be interpreted with caution because most of the studies comparing varenicline with bupropion or NRT were funded by the manufacturer of varenicline.\n\nThe economic analyses targeting a general population showed that, for all ages and gender, bupropion and varenicline dominated (i.e., cost less and was more effective) nicotine gum, patch, lozenge, and inhaler. If providers' willingness to pay was greater than $10,000 per QALY, then varenicline was preferred.","Based on the included evidence, this HTA report cnsludes that:\n- All pharmacotherapies under review (NRT, bupropion, and varenicline) are efficacious in helping the general population (relatively healthy smokers) quit smoking for at least six to 12 months and therefore, could all be used as aids for smoking cessation in the general population of smokers\n- Bupropion or NRT were found to be effective for those with cardiovascular disease or chronic obstructive pulmonary disease who wanted to quit smoking\n- For pharmacological interventions targeting a general population, bupropion and varenicline were dominating options (cost less and were more effective) over nicotine gum, patch, lozenge, and inhaler. If a provider's willingness to pay was greater than $10,000 per QALY gained, varenicline was the optimal treatment choice compared with NRT and bupropion"]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]

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[null,"WORKPLACE SETTING"]
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[null,"GUIDANCE - WORKPLACE SETTING"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Stop smoking interventions and services. NG92. London: NICE; 2018. Available here.\n\nUnderpinning evidence review:\n\nNational Institute for Health and Care Excellence. Smoking cessation interventions and service: Systematic reviews. London: NICE; 2017. \nAvailable here.","This guideline is for: \n- Commissioners and providers of stop smoking interventions or services, including those in the voluntary and community sectors who have a role or responsibility for this\n- Health, social care and other frontline staff with links to stop smoking services who engage with people who smoke\n- Health and wellbeing boards\n- Members of the public who want to stop smoking or who want to help others to stop","This guideline covers stop smoking interventions and services delivered in primary care and community settings for everyone over the age of 12. It aims to ensure that everyone who smokes is advised and encouraged to stop and given the support they need. It emphasises the importance of targeting vulnerable groups who find smoking cessation hard or who smoke a lot.\n\nIt includes recommendations on:\n- Commissioning and providing stop smoking interventions and services\n- Monitoring stop smoking services\n- Evidence-based stop smoking interventions\n- Engaging with people who smoke\n- Advice on e-cigarettes\n- People who want to quit\n- People who are not ready to quit\n- Telephone quitlines\n- Education and training\n- Campaigns to promote awareness of local stop smoking services\n- Closed institutions\n- Employers"]
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[null,"National Institute for Health and Care Excellence. Smoking: reducing and preventing tobacco use. QS82. London: NICE; 2015. \nAvailable here.\n","This quality standard is relevant to:\n- Local authorities\n- Schools and colleges\n- Employers\n- NHS service providers","This quality standard covers reducing and preventing tobacco use in adults, young people and children. It includes interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It is particularly relevant to local authorities, schools and colleges, employers and NHS service providers. It describes high-quality care in priority areas for improvement.\n\nIt includes the following quality statements:\n- Statement 1 Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences\n- Statement 2 Schools and colleges do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 3 Trading standards identify and take action against retailers that sell tobacco products to people under 18\n- Statement 4 Employers allow employees to access evidence‑based 'stop smoking' support during working hours without loss of pay\n- Statement 5 Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee\n- Statement 6 Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking\n- Statement 7 Secondary healthcare settings ensure that a range of licensed nicotine‑containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees\n- Statement 8 Local authorities use regional and local media channels to reinforce national tobacco reduction campaigns\n- Statement 9 (placeholder). Preventing access to, demand for and supply of, illicit tobacco"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 1: review of current NICE guidance and recommendations.  London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change\nExternal evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: Bazian Ltd; 2012. Available here.\n\nBazian. Individual-Level Behaviour Change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. London: Bazian Ltd; 2012. Available here.","This guideline is for:\n- Healthcare professionals\n- Commissioners and providers\n- Young people and adults, and their families and carers","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nIt includes recommendations on:\n- Developing local behaviour change policy and strategy\n- Commissioning interventions\n- Planning interventions that take account of local needs\n- Ensuring interventions meet individual needs\n- Delivering interventions\n- Commissioning and providing training\n- Monitoring and evaluating interventions\n\nThis guideline was checked in March 2019."]
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[null,"National Institute for Health and Care Excellence. Smoking: acute, maternity and mental health services.PH48. London: NICE; 2013.\nAvailable here.\n\nUnderpinning evidence reviews:\n\nMcRobbie H, Hajek P and Myers K. Smoking cessation in Secondary Care. Review 1 (Component 5): Review of effects of nicotine in secondary care. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nMyers K, McRobbie H and Hajek P. Smoking cessation in Secondary Care. Review 2 (Component 1): Smoking cessation interventions  in acute and maternity services: Review of effectiveness. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here.\n\nMyers K, McRobbie H, Oliver W and Hajek P. Smoking cessation in Secondary Care. Review 3 (Component 1): Smoking cessation interventions in acute and maternity services: Review of Barriers and Facilitators. London: Tobacco Dependence Research Unit, Queen Mary University of London; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 4: Effectiveness of Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nLeonardi-Bee J et al. Smoking Cessation in Mental Health Services. Review 5: Barriers and facillitators for Smoking cessation interventions in Mental health. UK Centre for Tobacco Control Studies; 2012. Available here. \n\nAngus K et al. A review of the effectiveness of smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 6. 2013. Available here.\n\nEadie D et al. A review of the barriers to and facilitators for implementing smokefree strategies and interventions in secondary care settings. National Institute for Health and Care Excellence (NICE). PH48 Smoking cessation - acute, maternity and mental health services, Review 7. 2013. Available here.","This guidleine is for:\n- Health and social care professionals, including clinical leads in secondary care services and managers of clinical services\n- Commissioners, leaders of the local health and care system and Trust boards\n- Estate managers and other managers\n- People using secondary care services and their families and carers","This guideline covers helping people to stop smoking in acute, maternity and mental health services. It promotes smokefree policies and services and recommends effective ways to help people stop smoking or to abstain from smoking while using or working in secondary care settings.\n\nIt includes recommendations on:\n- Identifying people who smoke and offering help to stop, including intensive support in acute and mental health services, and maternity services\n- Providing information and advice for carers, family, other household members and hospital visitors\n- Advising on and providing stop smoking pharmacotherapies, and making these available in hospital\n- Adjusting drug dosages for people who have stopped smoking\n- Putting referral systems in place for people who smoke\n- Developing smokefree policies and commissioning smokefree secondary care services\n- Supporting staff to stop smoking and providing stop smoking training for frontline staff\n\n"]
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[null,"National Institute for Health and Care Excellence. Smoking: workplace interventions. PH5. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nBell K, Richardson L, McCullough L and Greaves L. NICE Rapid review: Workplace interventions to pormote smoking cessation. British Columbia: Centre of excellence for Women's health; 2007. Available here.\n\n","This guideline is for:\n- Employers, including local authorities and the community, voluntary and private sectors\n- Employee and trade union representatives\nHealthcare professionals\n- Commissioners and providers\n- People who work at smoking cessation services\n- People over 16 who smoke and are in paid or voluntary employment outside their own home\n- Members of the public","This guideline covers how employers can encourage and support employees to stop smoking. It aims to reduce the number of people who smoke or are exposed to second-hand smoke and the rate of diseases and conditions caused by smoking.\n\nIt includes recommendations on:\n- Providing information, advice, guidance and support to employees\n- Allowing staff to attend smoking cessation services during working hours\n- Developing a smoking cessation policy\n- Offering smoking cessation interventions, including psychological and pharmacological interventions\n- Offering support to employers who want to help their employees to stop smoking\n\nThis guideline was checked in July 2014."]
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[null,"SYSTEMATIC REVIEWS - WORKPLACE SETTING"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Notley C et al. Incentives for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD004307. DOI: 10.1002/14651858.CD004307.pub6. \nAvailable here. ","Adults\nPregnant women","Thirty‐three mixed‐population studies met the reviewers' inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. The reviewers judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty‐four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow‐up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long‐term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease. \n\nAlthough not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self‐deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self‐deposits. \n\nThe reviewers included 10 studies of 2571 pregnant women. They judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow‐up (up to 24 weeks post‐partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. ","The authors concluded that:\n- Overall there is high‐certainty evidence that incentives improve smoking cessation rates at long‐term follow‐up in mixed population studies\n- The effectiveness of incentives appears to be sustained even when the last follow‐up occurs after the withdrawal of incentives\n- There is also moderate‐certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post‐partum\n- Current and future research might explore more precisely differences between trials offering low or high cash incentives and self‐incentives (deposits), within a variety of smoking populations"]
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[null,"Fanshawe TR et al. Competitions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD013272. DOI: 10.1002/14651858.CD013272.\nAvailable here.","Adolescents\nAdults\nPregnant Women","This Cochrane review aimed to determine whether competitions lead to higher long‐term smoking quit rates. We also aimed to examine the impact on the population, the costs, and the unintended consequences of smoking cessation competitions.\n\nTwenty studies met the reviewers' inclusion criteria. Five investigated performance‐based reward, where groups of smokers competed against each other to win a prize (n = 915). The remaining 15 used performance‐based eligibility, where cessation resulted in entry into a prize draw (n = 10,580). Five of these used Quit & Win contests (n = 4282), of which three were population‐level interventions. Fourteen studies were RCTs, and the remainder quasi‐randomised or controlled trials. Six had suitable abstinence data for a meta‐analysis, which did not show evidence of effectiveness of performance‐based eligibility interventions (Risk ratio (RR) 1.16, 95% Confidence interval (CI) 0.77 to 1.74, n = 3201, I² = 57%). No trials that used performance‐based rewards found a beneficial effect of the intervention on long‐term quit rates. \n\nThe three population‐level Quit & Win studies found higher smoking cessation rates in the intervention group (4% to 16.9%) than the control group at long‐term follow‐up, but none were RCTs and all had important between‐group differences in baseline characteristics. These studies suggested that fewer than one in 500 smokers would quit because of the contest.\n \nReported unintended consequences in all sets of studies generally related to discrepancies between self‐reported smoking status and biochemically‐verified smoking status. More serious adverse events were not attributed to the competition intervention. \n\nUsing the GRADE system the reviewers rated the overall quality of the evidence for smoking cessation as ‘very low', because of the high and unclear risk of bias associated with the included studies, substantial clinical and methodological heterogeneity, and the limited population investigated. \n\nWithin performance‐based eligibility studies, the reviewers aimed to perform subgroup analyses of studies conducted in pregnant women, studies conducted in adolescents, and studies that used Quit & Win competitions, although they decided the latter was unfeasible because the Quit & Win studies were highly clinically heterogeneous and in most cases not RCTs. They also considered grouping studies dependent on other common features of the competitions tested, such as the amount and type of prize offered; however they decided that the studies in this review were insufficient to support this approach. There was very limited evidence investigating the effectiveness of competition interventions in adolescents and pregnant women. In adolescents, there were no eligible studies, while of the four studies conducted in pregnant women, only one allowed the effectiveness of the competition component to be estimated, the results of this study have only been published via a conference abstract and did not show the competition to be beneficial.","The authors concluded that:\n- Due to a lack of well‐designed comparative studies, presently, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions, \n- Smoking cessation competitions have not been shown to enhance long‐term cessation rates\n- The limited evidence suggesting that population‐based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs\n- It is also unclear whether the value or frequency of possible cash reward schedules influence the success of competitions\n- Future studies should be designed to compensate for the substantial biases in the current evidence base "]
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[null,"Livingstone‐Banks J et al. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No.: CD003999. DOI: 10.1002/14651858.CD003999.pub5.\nAvailable here.","Adults\nPregnant Women ","This Cochrane review aimed to assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking.\n\nThe reviewers included 77 studies (67,285 participants), 15 of which are new to this update. They judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty‐eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty‐six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. \n\nThe reviewers focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses they conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, RR 1.23, 95% CI 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and NRT in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide CIs with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow‐up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population.","The authors concluded that:\n- Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means they are only moderately certain of this\n- In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard\n- Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity\n- Moderate‐certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though CIs mean they could not rule out a clinically important benefit at this stage\n- Low‐certainty evidence, limited by imprecision, did not show a benefit of extended treatment with NRT in preventing relapse in assisted abstainers\n-  More research is needed in this area, especially as the evidence for extended NRT in unassisted abstainers did suggest a benefit"]
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[null,"Hartmann‐Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub5.\nAvailable here.","Adults\n","This Cochrane review aimed to determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long‐term smoking cessation, compared to placebo or 'no NRT' interventions.\n\nIt identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non‐NRT control group. \nThe majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. \n\nThe reviewers judged the evidence to be of high quality; they judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. \n\nThe RR of abstinence for any form of NRT relative to control was 1.55 (95% CI 1.49 to 1.61). \nThe pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. \n\nAdverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. \nAttempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. ","The authors concluded that:\n- There is high‐quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking\n- NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect\n- The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual\n- Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT\n- NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non‐ischaemic chest pain and palpitations"]
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[null,"Stead LF, Carroll AJ and Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD001007. DOI: 10.1002/14651858.CD001007.pub3.\nAvailable here.","Adults","This Cochrane review aimed to determine the effect of group‐delivered behavioural interventions in achieving long‐term smoking cessation. \n\nThe reviewers identified sixty‐six trials to meet their inclusion criteria for one or more of the comparisons in the review. Thirteen trials compared a group programme with a self‐help programme; there was an increase in cessation with the use of a group programme (n =  4395, RR 1.88, 95% CI 1.52 to 2.33, I² = 0%). They judged the GRADE quality of evidence to be moderate, downgraded due to there being few studies at low risk of bias. Fourteen trials compared a group programme with brief support from a health care provider. There was a small increase in cessation (n =  7286, RR 1.22, 95% CI 1.03 to 1.43, I² = 59%). They judged the GRADE quality of evidence to be low, downgraded due to inconsistency in addition to risk of bias. \n\nThere was also low quality evidence of benefit of a group programme compared to no‐intervention controls, (9 trials, n =  1098, RR 2.60, 95% CI 1.80 to 3.76 I² = 55%). They did not detect evidence that group therapy was more effective than a similar intensity of individual counselling (6 trials, n =  980, RR 0.99, 95% CI 0.76 to 1.28, I² = 9%). Programmes which included components for increasing cognitive and behavioural skills were not shown to be more effective than same‐length or shorter programmes without these components. ","The authors conclulded that:\n- Group therapy is better for helping people stop smoking than self‐help, and other less intensive interventions\n- There is not enough evidence to evaluate whether groups are more effective, or cost‐effective, than intensive individual counselling\n- There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included "]
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[null,"Stead LF et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.\nAvailable here.","Adults","This Cochrane review aimed to assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take‐up of treatment. \n\nFifty‐three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%). \n\nThe pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community‐based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take‐up of treatment. ","The authors concluded that:\n- Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care\n- Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate\n- Although trials differed in the details of their populations and interventions, no factors that modified treatment effects apart from the recruitment setting were identified\n- No evidence from indirect comparisons was found that offering more intensive behavioural support was associated with larger treatment effects"]
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[null,"Frazer K et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016a, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3.\nAvailable here.","Not specified","This Cochrane review aimed to assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. \n\nThere are 77 studies included in this updated review. The reviewers retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes RCTs. Thirty‐six studies used an interrupted time series study design, 23 studies use a controlled before‐and‐after design and 18 studies are before‐and‐after studies with no control group; six of these studies use a cohort design. Seventy‐two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking‐related diseases. A number of the studies report multiple health outcomes. \n\nThere is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking‐related illnesses. Effects on respiratory and perinatal health were less consistent. The reviewers found 24 studies evaluating the impact of national smoke‐free legislation on smoking behaviour. \n\nEvidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long‐term change in existing trends in prevalence.","The authors concluded that:\n- The current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in secondhand smoke for countries and their populations\n- The clearest evidence is observed in reduced admissions for acute coronary syndrome\n- There is evidence of reduced mortality from smoking‐related illnesses at a national level\n- There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption"]
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[null,"Frazer K et al. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database of Systematic Reviews 2016b, Issue 5. Art. No.: CD011856. DOI: 10.1002/14651858.CD011856.pub2.\nAvailable here.","Not specified","This Cochrane review aimed to assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health‐related outcomes. \n\nThe reviewers included 17 observational studies in this review. They found no RCTs. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before‐and‐after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before‐and‐after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group. \n\nThe four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking‐related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (RR 0.71, 95% CI 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking‐related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16). \n\nThe reviewers judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. ","The authors concluded that:\n- There is evidence of an effect of settings‐based smoking policies on reducing smoking rates in hospitals and universities\n- In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported\n- The evidence base was rated as low quality, therefore more robust studies assessing the evidence for smoking bans and policies in these important specialist settings are needed"]
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[null,"Hollands GJ et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011045. DOI: 10.1002/14651858.CD011045.pub2.\nAvailable here.","Adolescents \nAdults","This Cochrane review aimed to assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children; and to assess the extent to which these effects may be modified by study, intervention and participant characteristics. However, we (OES) have only reported the information relevant to this map.\n\nThe current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Only four % of included studies (3/72) manipulated cigarettes. A meta‐analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (standardised mean difference (SMD) 0.25, 95% CI ‐0.14 to 0.65). ","The authors reported that:\n- Due to identified gaps in the current evidence base, they are unable to highlight clear implications for tobacco policy "]
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[null,"Cahill K and Lancaster T. Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD003440. DOI: 10.1002/14651858.CD003440.pub4. \nAvailable here.","Adults","This Cochrane review aimed to firstly, categorize workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking; and secondly, to collect and evaluate data on costs and cost effectiveness associated with workplace interventions. \n\nThe reviewers included 57 studies (61 comparisons) in this updated review. They found 31 studies of workplace interventions aimed at individual workers, covering group therapy, individual counselling, self‐help materials, NRT, and social support, and 30 studies testing interventions applied to the workplace as a whole, i.e. environmental cues, incentives, and comprehensive programmes. The trials were generally of moderate to high quality, with results that were consistent with those found in other settings. Group therapy programmes (OR for cessation 1.71, 95% CI 1.05 to 2.80; eight trials, 1309 participants), individual counselling (OR 1.96, 95% CI 1.51 to 2.54; eight trials, 3516 participants), pharmacotherapies (OR 1.98, 95% CI 1.26 to 3.11; five trials, 1092 participants), and multiple intervention programmes aimed mainly or solely at smoking cessation (OR 1.55, 95% CI 1.13 to 2.13; six trials, 5018 participants) all increased cessation rates in comparison to no treatment or minimal intervention controls. Self‐help materials were less effective (OR 1.16, 95% CI 0.74 to 1.82; six trials, 1906 participants), and two relapse prevention programmes (484 participants) did not help to sustain long‐term abstinence. Incentives did not appear to improve the odds of quitting, apart from one study which found a sustained positive benefit. There was a lack of evidence that comprehensive programmes targeting multiple risk factors reduced the prevalence of smoking. ","The authors reported that:\n- They found strong evidence that some interventions directed towards individual smokers increase the likelihood of quitting smoking. These include individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome. All these interventions show similar effects whether offered in the workplace or elsewhere\n- Self‐help interventions and social support are less effective. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low\n- They failed to detect an effect of comprehensive programmes targeting multiple risk factors in reducing the prevalence of smoking, although this finding was not based on meta‐analysed data\n- There was limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer, although one trial demonstrated a sustained effect of financial rewards for attending a smoking cessation course and for long‐term quitting. Further research is needed to establish which components of this trial contributed to the improvement in success rates\n- Further research would be valuable in low‐income and developing countries, where high rates of smoking prevail and smoke‐free legislation is not widely accepted or enforced"]
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[null,"Cahill K, Stevens S, Perera R and Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.\nAvailable here.","Adults\n","This Cochrane review aimed to answer the following research questions:\n1. How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long‐term abstinence (six months or longer)?\n2. How do the remaining treatments compare with placebo in achieving long‐term abstinence?\n3. How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?\n\nThe reviewers identified 12 treatment‐specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (OR 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head‐to‐head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).\n\nVarenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).\n\nCytisine (a nicotine receptor partial agonist) returned positive findings (RR 3.98; 95% CI 2.01 to 7.87), without significant adverse events or serious adverse events.\nAcross the 82 included and excluded bupropion trials, the reviewers estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. Serious adverse events meta‐analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta‐analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).\n\nNortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose‐dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments. ","The authors concluded that:\n- Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials \n- Varenicline at standard dose increased the chances of successful long‐term smoking cessation between two‐ and three‐fold compared with pharmacologically unassisted quit attempts\n- Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events\n- More participants quit successfully with varenicline than with bupropion or with NRT\n- Limited evidence suggests that varenicline may have a role to play in relapse prevention\n- The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time\n- Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research\n- Future trials of cytisine may test extended regimens and more intensive behavioural support"]
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[null,"Stead LF, Hartmann‐Boyce J, Perera R and Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3.\nAvailable here.","Adults\n","This Cochrane review aimed to evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. \n\nSeventy‐seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall the reviewers did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, RR for cessation at longest follow‐up 1.37, 95% CI 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.\n \nTelephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta‐regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually NRT) than when the control group only received self‐help material or a brief intervention. \n\nA further eight studies were too diverse to contribute to meta‐analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change, and none detected evidence of effect. ","The authors concluded that:\n- Proactive telephone counselling aids smokers who seek help from quitlines\n- Telephone quitlines provide an important route of access to support for smokers, and call‐back counselling enhances their usefulness\n- There is limited evidence about the optimal number of calls\n- Proactive telephone counselling also helps people who receive it in other settings\n- There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit\n- Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self‐help materials, or brief advice, or compared to pharmacotherapy alone "]
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[null,"The Community Preventive Services Task Force. Tobacco use and secondhand smoke exposure: Smoke-free policies. Atlanta: CPTSF; 2012b. \nAvailable here.","Adolescents\nAdults","This CPSTF finding is based on evidence from an SR of legislative smoke-free policies published in 2010 (Callinan et al., 50 studies, search period through-July 2009) combined with more recent evidence and evidence on additional outcomes (82 studies, search period January 2000-December 2011). The SR was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice and policy related to reducing tobacco use and secondhand smoke exposure. The finding updates and replaces two previous CPSTF findings on smoke-free policies and smoking bans and restrictions.\n\nIn this review, most of the included studies evaluated smoke-free policies in the United States. Studies also evaluated policies from Canada, England, Scotland, Wales, Australia, New Zealand, and several countries in Europe. Smoke-free policies were shown to be effective for one or more outcomes in all countries studied. Additionally, favorable results were found for studies that considered smoke-free policies implemented at national, state, and local levels. \n\nMost studies evaluated tobacco use outcomes using large, population-based surveys with representative samples of working age adults or young people. Although few studies compared outcomes by demographic characteristics, the Task Force considers the overall evidence of effectiveness in reducing exposure to secondhand smoke in protected settings to be applicable to the U.S. population. \n\nMost studies in the updated search period evaluated strong or comprehensive smoke-free policies covering most indoor occupational settings. Only a few studies compared different smoke-free policies. These studies found greater reductions in exposure to secondhand smoke with comprehensive smoke-free policies as compared to weaker restrictions on smoking or policies exempting specific indoor settings, such as bars.\n\nOverall, the Task Force considers the evidence on effectiveness to be broadly applicable to the range of public and private smoke-free policy decisions in the U.S. Strong evidence of effectiveness supports the use of comprehensive smoke-free policies protecting patrons and employees in all indoor worksites and indoor public venues. Expanding smoke-free policies to cover additional settings will reduce exposure to secondhand smoke, and may also encourage efforts by tobacco users to quit and discourage initiation of tobacco use among young people.\n\nMore research is needed to examine the effectiveness of state and local smoke-free policies on tobacco use among young people. Comparisons over time may provide additional evidence on the impact of smoke-free policies on the initiation of tobacco use among youth, and evaluate the influence of smoke-free policies on young adults as they enter the workforce. Additional research should examine the effects of smoke-free polices on tobacco product substitution among tobacco users who do not quit (e.g., adding or switching to smokeless tobacco, including recently introduced forms such as snus and dissolvables). Future policy evaluations should include assessments of dual or multiple product use among tobacco users. ","The CPSTF concluded that:\n- Smoke-free policies to reduce secondhand smoke exposure and tobacco use are recommended on the basis of strong evidence of effectiveness\n- Evidence is considered strong based on results from studies that showed effectiveness of smoke‑free policies in reducing exposure to secondhand smoke, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, reducing the initiation of tobacco use among young people and reducing tobacco-related morbidity and mortality, including acute cardiovascular events\n- Evidence was lacking regarding effectiveness of smoking bans in high schools, universities and child-care settings in reducing secondhand smoke exposure and/or tobacco use in adolescents\n- Economic evidence indicates that smoke-free policies can reduce healthcare costs substantially\n- In addition, the evidence shows smoke-free policies do not have an adverse economic impact on businesses, including bars and restaurants"]
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[null,"Bize R et al. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub4.\nAvailable here.","Adults","This Cochrane review aimed to determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. \n\nThe reviewers  included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested carbon monoxide feedback alone and carbon monoxide combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used carbon monoxide measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of carbon monoxide and spirometry feedback in different settings. ","The authors concluded that:\n- There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation\n- Of the fifteen included studies, only two detected a significant effect of the intervention\n- Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal\n- A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect\n- Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta‐analyses; neither of these found evidence of an effect\n- Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment\n- There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment"]
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[null,"Marcano Belisario  JS et al. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2. \nAvailable here.","Adolescents\nAdults\n","This Cochrane review primarily aimed to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. \n\nThis review includes 19 studies with a total of 14,890 participants. The reviewers categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method. \n\nThey identified three studies that made head‐to‐head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive‐proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes. \n\nOut of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non‐significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). \n\nThe reviewers had initially intended to analyse studies on adolescents separately.  However, only two of our included studies were conducted on this population. Given the high degree of clinical heterogeneity, data from these studies could not be combined. They had also intended to look at the demographic characteristics of the smokers being recruited via the different strategies. However, due to the lack of sufficient data in the included studies they were unable to do so. ","The authors concluded that:\n- The substantial heterogeneity across the included studies restricts their ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants with different demographic characteristics into smoking cessation programmes or levels of smoking cessation\n- The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants) "]
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[null,"Carson  KV et al. Community interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001291. DOI: 10.1002/14651858.CD001291.pub2.\nAvailable here.","Adolescents and Young children less than equal to 25 years)\nAdults (Less than equal to 25 years)\n","This Cochrane review aimed to determine the effectiveness of multi‐component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. \n\nTwenty‐five studies were included in the review and sixty‐eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short‐term smoking prevalence (twelve months or less), while nine studies detected significant long‐term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. ","The authors concluded that:\n- There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws"]

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["ABBREVIATIONS WITH FULL FORMS (IN ALPHABETIC ORDER)"]
["Abbreviation","Full Form"]
["CADTH","CANADIAN AGENCY FOR DRUGS AND TECHNOLOGIES IN HEALTH"]
["CBT","COGNITIVE BEHAVIOURAL THERAPY"]
["CI","CONFIDENCE INTERVAL"]
["CPSTF","COMMUNITY PREVENTIVE SERVICES TASK FORCE"]
["CredI","CREDIBLE INTERVAL"]
["CVD","CARDIOVASCULAR DISEASE"]
["EC","ELECTRONIC CIGARETTE"]
["GAD","GENERALISED ANXIETY DISORDER"]
["GRADE","GRADING OF RECOMMENDATIONS ASSESSMENT, DEVELOPMENT AND EVELUATION"]
["HIV","HUMAN IMMUNODEFICIENCY VIRUS"]
["HTA","HEALTH TECHNOLOGY ASSESSMENT"]
["I2","MEASURE OF HETEROGENEITY"]
["IQI","INTERQUARTILE INTERVAL"]
["MD","MEAN DIFFERENCE"]
["MDD","MAJOR DEPRESSIVE DISORDER"]
["MI","MOTIVATIONAL INTERVIEWING"]
["n","SAMPLE SIZE"]
["NHB ","NON HISPANIC BLACKS"]
["NHS","NATIONAL HEALTH SERVICE"]
["NHW"," NON HISPANIC WHITES"]
["NMR","NICOTINE METABOLITE RATIO"]
["NRT","NICOTINE REPLACEMENT SERVICE"]
["OES","OBSERVATORY EVIDENCE SERVICE"]
["OR","ODDS RATIO"]
["PLWHA","PEOPLE LIVING WITH HIV/AIDS"]
["PTSD ","POST-TRAUMATIC STRESS DISORDER"]
["QALY","QUALITY-ADJUSTED LIFE YEARS"]
["RCT","RANDOMISED CONTROLLED TRIALS"]
["RR","RISK RATIO"]
["SAMe","S‐ADENOSYL‐L‐METHIONINE"]
["SFC","SMOKE FREE CLASS COMPETION"]
["SMD","STANDARDISED MEAN DIFFERENCE"]
["SR","SYSTEMATIC REVIEW"]
["TB","TUBERCULOSIS"]