National Drug and Alcohol Research Centre (NDARC), University of New South Wales (UNSW), Randwick, Australia.
Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Nicotine Tob Res. 2018 Feb 7;20(3):276-285. doi: 10.1093/ntr/ntw391.
To assess the methodological quality and effectiveness of technology-based smoking cessation interventions in disadvantaged groups.
Four databases (EMBASE, Cochrane, Medline, and PsycInfo) were searched for studies conducted from 1980 to May 2016. Randomized controlled trials that compared a behavioral smoking cessation intervention delivered primarily through a technology-based platform (eg, mobile phone) with a no-intervention comparison group among disadvantaged smokers were included. Three reviewers assessed all relevant studies for inclusion, and one reviewer extracted study, participant and intervention-level data, with a subset crosschecked by a second reviewer.
Thirteen studies targeting disadvantaged smokers (n =4820) were included. Only one study scored highly in terms of methodological rigor on EPOC criteria for judging risk of bias. Of the 13 studies using a technology-based platform, most utilized websites (n = 5) or computer programs (n = 5), and seven additionally offered nicotine replacement therapy. Technology-based interventions increased the odds of smoking cessation for disadvantaged groups at 1 month (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.10, 2.63), 3 months (OR 1.30, 95% CI 1.07, 1.59), 6 months (OR 1.29, 95% CI 1.03, 1.62), and 18 months post-intervention (OR 1.83, 95% CI 1.11, 3.01).
Few methodologically rigorous studies were identified. Mobile phone text-messaging, computer- and website-delivered quit support showed promise at increasing quit rates among Indigenous, psychiatric and inpatient substance use disorder patients. Further research is needed to address the role technology-based interventions have on overcoming health inequalities to meet the needs of disadvantaged groups.
This review provides the first quantitative evidence of the effectiveness of a range of technology-based smoking cessation interventions among disadvantaged smokers, with separate estimates on the basis of intervention type, and cessation outcome measure. Providing cost-effective, easily accessible and real-time smoking cessation treatment is needed, and innovative technology-based platforms will help reach this endpoint. These interventions need to be tested in larger scale randomized controlled trial designs and target broader disadvantaged groups. Data collection beyond 6 months is also needed in order to establish the efficacy of these intervention approaches on long-term cessation rates among disadvantaged population groups.
评估基于技术的戒烟干预措施在弱势群体中的方法学质量和效果。
从 1980 年至 2016 年 5 月，检索了四个数据库（EMBASE、Cochrane、Medline 和 PsycInfo）中的研究。纳入了比较主要通过基于技术的平台（如移动电话）提供的行为戒烟干预与无干预比较组的随机对照试验，这些试验的对象是弱势吸烟者。三名评审员评估了所有相关研究的纳入情况，一名评审员提取了研究、参与者和干预水平的数据，一部分数据由第二名评审员交叉核对。
纳入了 13 项针对弱势吸烟者（n = 4820）的研究。仅有一项研究在 EPOC 标准判断偏倚风险方面得分较高，方法学严谨性较高。在使用基于技术的平台的 13 项研究中，大多数使用了网站（n = 5）或计算机程序（n = 5），还有 7 项研究提供了尼古丁替代疗法。基于技术的干预措施增加了弱势人群在 1 个月（优势比 [OR] 1.70，95%置信区间 [CI] 1.10，2.63）、3 个月（OR 1.30，95% CI 1.07，1.59）、6 个月（OR 1.29，95% CI 1.03，1.62）和 18 个月干预后（OR 1.83，95% CI 1.11，3.01）戒烟的几率。
确定了少数方法学严谨的研究。移动电话短信、计算机和网站提供的戒烟支持显示，在提高原住民、精神科和住院物质使用障碍患者的戒烟率方面有一定效果。需要进一步研究以确定基于技术的干预措施在克服健康不平等方面的作用，以满足弱势群体的需求。
本综述首次提供了一系列基于技术的戒烟干预措施在弱势吸烟者中的有效性的定量证据，根据干预类型和戒烟结果测量方法提供了单独的估计。需要提供具有成本效益、易于获得和实时的戒烟治疗，创新的基于技术的平台将有助于实现这一目标。这些干预措施需要在更大规模的随机对照试验设计中进行测试，并针对更广泛的弱势人群。还需要收集 6 个月以上的数据，以确定这些干预方法对弱势人群长期戒烟率的效果。
