The efficacy of smoking cessation interventions in low‐ and middle‐income countries: a systematic review and meta‐analysis

Abstract

Aims To summarize evidence for the efficacy of smoking cessation interventions in low‐ and middle‐income countries (LMICs). Design Systematic review and meta‐analysis of randomized controlled trials Setting LMICs as defined by the World Bank Participants Adult current cigarette smokers residing in LMICs Interventions Behavioral and/or pharmacotherapy smoking cessation interventions. Measurements PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception through 4/4/2018. Only studies with at least 6 months of follow‐up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta‐analysis was done using Mantel‐Haenzel random effect models reporting odds ratios (OR) and 95% confidence interval (CI). Findings Twenty‐four randomized controlled trials were included. Six investigated the efficacy of pharmacologic agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n=1230, OR 1.76, 95% CI 1.30‐2.77, P2= 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g., brief advice); n=5,735, OR 6.87, 95% CI 4.18‐11.29, P2= 67%). There was also evidence of the benefit of brief advice over usual care (n=728, OR 2.46, 95% CI 1.56‐3.88, P< 0.001, I² =0%). Conclusion Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low‐ and middle‐income countries. There is limited rigorous research on other smoking cessation interventions in these regions.