Interventions for smokeless tobacco use cessation
ABSTRACT Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease.
To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: October 2010.
Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow up of at least six months.
Two authors independently extracted data. We summarised as odds ratios. For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method.
Data from one study suggest that varenicline increases ST abstinence rates (Odds Ratio [OR] 1.6, 95% Confidence Interval (CI) 1.08 to 2.36) among Swedish snus users.Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (OR 0.86, 95% CI 0.47 to 1.57). Nicotine replacement therapy (patch, gum, and lozenge) was not observed to increase tobacco abstinence rates (OR 1.14, 95% CI: 0.91 to 1.42). There was statistical heterogeneity among the 14 trials of behavioural interventions; seven of them reported statistically and clinically significant benefits, four suggested benefit but with wide CIs, whilst two had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by the design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. Most trials included either telephone counselling, an oral examination and feedback about any ST induced mucosal changes, or both. In a post-hoc subgroup analysis there was some evidence that behavioural interventions which include telephone counselling might increase abstinence rates more than interventions with less contact. In one trial an interactive website increased abstinence more than a static website.
Varenicline and behavioural interventions may help ST users to quit. Behavioural interventions incorporating telephone counselling or an oral examination are likely to increase abstinence rates.
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ABSTRACT: AimsThis paper provides a concise review of the efficacy, effectiveness and affordability of healthcare interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support.Methods Cochrane reviews of randomised controlled trials (RCTs) of major healthcare tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6–12 month continuous abstinence rates. This was combined with analysis and evidence from ‘real world’ studies to form a judgement on the likely effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on WHO criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita Gross Domestic Product for that category of country.ResultsBrief advice from a healthcare worker given opportunistically to smokers attending healthcare services can promote smoking cessation and is affordable for countries in all World Bank income categories (i.e., globally). Proactive telephone support, automated text messaging programmes, and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle and high income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these cytisine and nortriptyline are affordable globally.Conclusions Brief advice from a healthcare worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable healthcare interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation. This article is protected by copyright. All rights reserved.Addiction 05/2015; DOI:10.1111/add.12998 · 4.60 Impact Factor
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ABSTRACT: Use of non-cigarette tobacco and nicotine containing products (TNCPs) is increasing in the US. Telephone tobacco quit lines (QLs) are one of the most widely disseminated tools for providing cessation services to cigarette smokers, but the range of QL treatment services offered to non-cigarette TNCP users needs to be determined. We surveyed QLs across 50 US states, Washington D.C., and Guam for the number of treatment protocols offered, products they were intended to treat, and how telephone counselors triaged patients reporting the use of non-cigarette TNCPs. Thirteen organizations provided US QL interventions of which eleven agreed to be interviewed regarding their treatment services (84.6%). Seven of the eleven QL providers (63.6%) used a single intervention protocol adapted to the type of non-cigarette TNCP used. Two of the eleven QLs (18.2%) referred hookah users to another provider and one QL (9.1%) referred electronic cigarette users to third party resources for cessation support; otherwise a single intervention protocol was used for all other TNCP users. Only one QL (9.1%) had a specialized protocol for smokeless tobacco users in addition to a standard protocol for all other callers. QL providers do not have access to tailored protocols for non-cigarette TNCP users, and it remains uncertain whether a common tobacco protocol will be efficacious for these users. Future research should both validate potential common protocols for non-cigarette TNCP users and address the need for and the development of specialized QL interventions for TNCP users to help them quit. Copyright © 2015 Elsevier Ltd. All rights reserved.Addictive Behaviors 02/2015; 45C:259-262. DOI:10.1016/j.addbeh.2015.02.015 · 2.44 Impact Factor
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ABSTRACT: Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495.03/2015; 13(2). DOI:10.1016/j.invent.2015.02.005