Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis

Abstract

Introduction Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. Methods Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). Results 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest odds ratio (pooled OR=9.90; 95%CI: 2.01-48.86) in terms of tobacco cessation rate followed by group counselling (pooled OR=3.61; 95%CI: 1.48-8.78) and individual counselling (pooled OR=3.43; 95%CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. Conclusion E-Health intervention was the best intervention followed by group intervention and individual face-to-face counselling intervention for tobacco cessation in India. Nonetheless, more high-quality large scale RCTs either individual or by combining the e-Health, individual or group counselling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. Implications of the study This study would aid the policymakers, clinicians and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (i.e., concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.

Determinants of Quit Attempts and Short-Term Abstinence among Smokeless Tobacco Users in India: Global Adult Tobacco Survey, 2016-17

“…Mobile text messaging intervention have shown promise [17][18][19] and could potentially be studied for scale-up. Multi-pronged approach has shown efficacy among patients of non-communicable diseases [20] and there is indeed need of integrating smokeless tobacco cessation in all health programmes [21].…”

“…Ensuring follow-up of clients at tobacco cessation centres through outward calls from quitlines may be an approach worth attempting to scale up the behavioural interventions. Mobile text messaging intervention have shown promise [ 17 - 19 ] and could potentially be studied for scale-up. Multi-pronged approach has shown efficacy among patients of non-communicable diseases [ 20 ] and there is indeed need of integrating smokeless tobacco cessation in all health programmes [ 21 ].…”