Individual-level behavioural smoking cessation interventions tailored for disadvantaged socioeconomic position: a systematic review and meta-regression

Abstract

Background Socioeconomic inequalities in smoking cessation have led to development of interventions that are specifically tailored for smokers from disadvantaged groups. We aimed to assess whether the effectiveness of interventions for disadvantaged groups is moderated by tailoring for socioeconomic position.Methods For this systematic review and meta-regression, we searched MEDLINE, PsycINFO, Embase, Cochrane Central Register, and Tobacco Addiction Register of Clinical Trials and the IC-SMOKE database from their inception until Aug 18, 2019, for randomised controlled trials of socioeconomic-position-tailored or non-socioeconomicposition-tailored individual-level behavioural interventions for smoking cessation at 6 months or longer of follow-up in disadvantaged groups. Studies measured socioeconomic position via income, eligibility for government financial assistance, occupation, and housing. Studies were excluded if they were delivered at the community or population level, did not report differential effects by socioeconomic position, did not report smoking cessation outcomes from 6 months or longer after the start of the intervention, were delivered at a group level, or provided pharmacotherapy with standard behavioural support compared with behavioural support alone. Individual patient-level data were extracted from published reports and from contacting study authors. Random-effects meta-analyses and mixed-effects meta-regression analyses were done to assess associations between tailoring of the intervention and effectiveness. Meta-analysis outcomes were summarised as risk ratios (RR). Certainty of evidence was assessed within each study using the Cochrane risk-of-bias tool version 2 and the grading of recommendations assessment, development, and evaluation approach. The study is registered with PROSPERO, CRD42018103008. FindingsOf 2376 studies identified by our literature search, 348 full-text articles were retrieved and screened for eligibility. Of these, 42 studies (26 168 participants) were included in the systematic review. 30 (71%) of 42 studies were done in the USA, three (7%) were done in the UK, two (5%) each in the Netherlands and Australia, and one (2%) each in Switzerland, Sweden, Turkey, India, and China. 26 (62%) of 42 studies were trials of socioeconomicposition-tailored interventions and 16 (38%) were non-socioeconomic-position-tailored interventions. 17 (65%) of 26 socioeconomic-position-tailored interventions were in-person or telephone-delivered behavioural interventions, four (15%) were digital interventions, three (12%) involved financial incentives, and two (8%) were brief interventions. Individuals who participated in an intervention, irrespective of tailoring, were significantly more likely to quit smoking than were control participants (RR 1•56, 95% CI 1•39-1•75; I²=54•5%). Socioeconomic-position-tailored interventions did not yield better outcomes compared with non-socioeconomic-position-tailored interventions for disadvantaged groups (adjusted RR 1•01, 95% CI 0•81-1•27; β=0•011, SE=0...

COVID-19, smoking and inequalities: a study of 53 002 adults in the UK

“…Existing research shows that tailored interventions and messages to date have had little success in this area, but there is potential to achieve equity-positive smoking cessation outcomes through improvements in tailored intervention development. 50 …”

“…Existing research shows that tailored interventions and messages to date have had little success in this area, but there is potential to achieve equity-positive smoking cessation outcomes through improvements in tailored intervention development. 50 This study had a number of strengths. The sample size was much larger than any other study of smoking and COVID-19 and a broad range of data were collected, permitting the first analysis of smoking and COVID-19 infection in the population with adjustment for important confounding variables.…”

Smoking Cessation in Lower Socioeconomic Groups: Adaptation and Pilot Test of a Rolling Group Intervention

“…Therefore, it has been repeatedly recommended to develop smoking cessation interventions that are tailored-or adapted-to the specific needs of lower SES smokers [2,7,10,11]. Although evidence about cessation programs that specifically work for disadvantaged smokers is sparse [10,12], we are aware of two extensively tailored interventions [13,14], which showed equity-positive effects [15,16].…”

“…Although evidence about cessation programs that specifically work for disadvantaged smokers is sparse [10,12], we are aware of two extensively tailored interventions [13,14], which showed equity-positive effects [15,16]. However, a recent review and metaregression found that tailored interventions were as effective as nontailored interventions in bringing about smoking cessation in lower SES groups [11]. This finding led to the conclusion that tailored individual-level smoking cessation approaches do not yet fulfill their expected important aim in reducing smoking-related health inequalities [11].…”

“…However, a recent review and metaregression found that tailored interventions were as effective as nontailored interventions in bringing about smoking cessation in lower SES groups [11]. This finding led to the conclusion that tailored individual-level smoking cessation approaches do not yet fulfill their expected important aim in reducing smoking-related health inequalities [11]. One explanation may be that lower SES smokers still face more barriers to achieving long-term abstinence than higher SES smokers [12].…”