A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit.

Abstract

The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel–Haenszel random effects meta-analyses when ≥2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I2 = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I2 = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco.

Implementation of Specialty Tobacco Use Disorder Services in a Community Health Setting: Support for Enhanced Prescription Practices

“…36 Nicotine replacement therapies in the form of gum, lozenges, and patches, also have established efficacy, particularly when combined with other medications for tobacco treatment. 14,35,37,38 In this community served by safety-net clinics, access to NRT at no cost is critical to ensure that prescriptions are filled and pharmacotherapies are used. Likewise, no cost access to varenicline, which only recently went off patent, is highly beneficial to individuals served by these clinics.…”

“…Despite the recall of varenicline in July 2021, DMH data demonstrate increases in its prescriptions through the remainder of the year, in contrast to nationwide reductions in Chantix prescriptions 36 . Nicotine replacement therapies in the form of gum, lozenges, and patches, also have established efficacy, particularly when combined with other medications for tobacco treatment 14,35,37,38 . In this community served by safety-net clinics, access to NRT at no cost is critical to ensure that prescriptions are filled and pharmacotherapies are used.…”

Trends in daily cigarette consumption among smokers: a population study in England, 2008-2023

“…19–22 There is mixed evidence as to whether reducing the number of cigarettes smoked per day increases smokers’ odds of making a quit attempt or successfully quitting, with evidence that reduction is more effective when supported by varenicline or nicotine replacement therapy (NRT). 23–28…”

“…[19][20][21][22] There is mixed evidence as to whether reducing the number of cigarettes smoked per day increases smokers' odds of making a quit attempt or successfully quitting, with evidence that reduction is more effective when supported by varenicline or nicotine replacement therapy (NRT). [23][24][25][26][27][28] Data from representative population surveys in England have shown a decline in cigarette consumption over recent years. The Health Survey for England (HSE) recorded a fall in the median number of cigarettes smoked per day among adult smokers aged ≥16 years, from 15 cigarettes per day in 1993 to 9 cigarettes per day in 2021.…”

Use of the Therapy App Prescinde for Increasing Adherence to Smoking Cessation Treatment

“…The treatment for quitting cannabis and/or tobacco use continues to pose challenges (cognitive behavioral therapy, nicotine replacement therapy, or nicotine patches), as indicated by low treatment adherence rates ranging from 13% to 50% [10,17,18], while high treatment relapse rates ranging from 40% to 60%, even as high as 86% [19,20], seem to further compound the issue. Only one in six people with addiction to these substances seek treatment to stop using them.…”