Mersha Amanual Getnet, Eftekhari Parivash, Bovill Michelle, Tollosa Daniel Nigusse, Gould Gillian Sandra
School of Medicine, College of Medicine and Health Sciences, University of Gondar, Chechela street, kebele 16, Gondar, Amhara region, Ethiopia.
School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia.
Arch Public Health. 2021 Mar 4;79(1):26. doi: 10.1186/s13690-021-00550-2.
Nicotine replacement therapy (NRT) has proven effect in assisting smoking cessation. However, its effectiveness varies across studies and population groups. This may be due to differences in the rate of adherence. Hence, this review aims to examine the level of adherence to NRT and to assess if the level of adherence to NRT affects success of smoking cessation.
A systematic review and meta-analysis was conducted using studies retrieved from five electronic databases (MEDLINE, Scopus, EMBASE, Web of science, and PsycINFO) and grey literature. Pooled analysis was conducted using Stata version 16 software. Methodological quality and risk of bias were assessed using the NIH Quality Assessment Tool. Analyses were done among those studies that used similar measurements to assess level of adherence and successful smoking cessation. Heterogeneity of studies was assessed using the Higgins' I statistical test. Funnel plots and Egger's regression asymmetry test were used to affirm presence of significant publication bias.
A total of 7521 adult participants of 18 years old and above from 16 studies were included in the analysis. Level of adherence to NRT among participants of randomised controlled trials were found to be 61% (95% CI, 54-68%), p-value of < 0.001 and I = 85.5%. Whereas 26% of participants were adherent among participants of population-based studies with 95% CI, 20-32%, p-value of < 0.001 and I = 94.5%. Level of adherence was the lowest among pregnant women (22%) with 95% CI, 18-25%, p-value of 0.31 and I = 15.8%. Being adherent to NRT doubles the rate of successful quitting (OR = 2.17, 95% CI, 1.34-3.51), p-value of < 0.001 and I = 77.6%.
This review highlights a low level of adherence to NRT among participants of population-based studies and pregnant women as compared to clinical trials. Moreover, the review illustrated a strong association between adherence and successful smoking cessation. Hence, it is recommended to implement and assess large scale interventions to improve adherence. Health programs and policies are recommended to integrate the issue of adherence to NRT as a core component of smoking cessation interventions.
PROSPERO registration number: CRD42020176749 . Registered on 28 April 2020.
尼古丁替代疗法（NRT）已被证明在辅助戒烟方面有效。然而，其有效性在不同研究和人群中存在差异。这可能是由于依从率的不同。因此，本综述旨在研究NRT的依从水平，并评估NRT的依从水平是否会影响戒烟的成功率。
使用从五个电子数据库（MEDLINE、Scopus、EMBASE、科学网和PsycINFO）以及灰色文献中检索到的研究进行系统综述和荟萃分析。使用Stata 16软件进行汇总分析。使用美国国立卫生研究院质量评估工具评估方法学质量和偏倚风险。对那些使用相似测量方法来评估依从水平和成功戒烟情况的研究进行分析。使用希金斯I统计检验评估研究的异质性。使用漏斗图和埃格回归不对称检验来确认是否存在显著的发表偏倚。
分析纳入了来自16项研究的总共7521名18岁及以上的成年参与者。随机对照试验参与者中NRT的依从水平为61%（95%置信区间，54 - 68%），p值<0.001，I = 85.5%。而在基于人群的研究参与者中，26%的参与者依从，95%置信区间为20 - 32%，p值<0.001，I = 94.5%。孕妇中的依从水平最低（22%），95%置信区间为18 - 25%，p值为0.31，I = 15.8%。坚持使用NRT可使成功戒烟率翻倍（比值比=2.17，95%置信区间，1.34 - 3.51），p值<0.001，I = 77.6%。
本综述强调，与临床试验相比，基于人群的研究参与者和孕妇中NRT的依从水平较低。此外，该综述表明依从性与成功戒烟之间存在密切关联。因此，建议实施并评估大规模干预措施以提高依从性。建议健康项目和政策将NRT的依从性问题作为戒烟干预措施的核心组成部分。
PROSPERO注册号：CRD42020176749。于2020年4月28日注册。
