Livingstone-Banks Jonathan, Lindson Nicola, Hartmann-Boyce Jamie, Aveyard Paul
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Addiction. 2022 Jun;117(6):1573-1588. doi: 10.1111/add.15769. Epub 2021 Dec 28.
To summarize evidence on tobacco addiction interventions published by the Cochrane Tobacco Addiction Group (CTAG) from 2019 to 2020.
Narrative summary of all new and updated Cochrane Reviews published by CTAG in 2019 and 2020, outlining key results and promising avenues for future research.
CTAG published six new reviews and updated 15 reviews. There is high-certainty evidence that combining fast-acting nicotine replacement therapy (NRT) with transdermal patches helped more people to quit than single-form NRT [risk ratio (RR) = 1.25, 95% confidence interval (CI) = 1.15-1.36, 14 studies, n = 11 356; I = 4%] and moderate-certainty evidence that using NRT before quitting can increase quit rates more than using NRT from quit day onwards (RR = 1.25, 95% CI = 1.08-1.44, nine studies, n = 4395; I = 0%). Reducing smoking in order to quit completely results in similar quit rates to abrupt quitting (RR = 1.01, 95% CI= 0.87-1.17; I = 29%; 22 studies, n = 9219; moderate-certainty). Electronic cigarettes may help more people quit than NRT (RR = 1.53, 95% CI = 1.21-1.93; I = 0%; four studies, n = 1924; moderate certainty), nicotine-free electronic cigarettes (RR = 1.94, 95% CI = 1.21-3.13; I = 0%; five studies, n = 1447; moderate-certainty) and behavioural/no support (RR = 2.61, 95% CI = 1.44-4.74; I = 0%; six studies, n = 2886; very low-certainty). Varenicline may help prevent relapse in abstainers (RR = 1.23, 95% CI = 1.08-1.41; I = 82%; 11 studies, n = 1297; moderate-certainty), but behavioural support did not prevent relapse (RR = 0.98, 95% CI = 0.87-1.11; I = 52%; 11 studies, n = 5523; moderate-certainty). Financial incentives increased quit rates in the general population (RR = 1.49, 95% CI = 1.28-1.73; I = 33%; 30 studies, adjusted n = 20 097; high-certainty) and during pregnancy (RR = 2.38, 95% CI = 1.54-3.69; I = 41%; nine studies, n = 2273; moderate-certainty). This overview also provides detail on a wider range of interventions.
There is high certainty that using nicotine replacement therapy from quit day increases smoking abstinence and no further research is required. Evidence is less certain that nicotine replacement increases abstinence when used in higher doses tailored to particular groups of smokers or use prior to quit day, and further research would be helpful. There is moderate-certainty evidence to support the use of e-cigarettes as cessation aids, but research on their role in preventing relapse would be particularly helpful.
总结Cochrane烟草成瘾小组（CTAG）在2019年至2020年发表的关于烟草成瘾干预措施的证据。
对CTAG在2019年和2020年发表的所有新的和更新的Cochrane系统评价进行叙述性总结，概述关键结果和未来研究的有前景的途径。
CTAG发表了6篇新的系统评价并更新了15篇。有高确定性证据表明，速效尼古丁替代疗法（NRT）与透皮贴剂联合使用比单一形式的NRT能帮助更多人戒烟[风险比（RR）=1.25，95%置信区间（CI）=1.15 - 1.36，14项研究，n = 11356；I² = 4%]，且有中等确定性证据表明，在戒烟前使用NRT比从戒烟日起使用NRT能提高戒烟率（RR = 1.25，95% CI = 1.08 - 1.44，9项研究，n = 4395；I² = 0%）。为完全戒烟而逐渐减少吸烟量与突然戒烟的戒烟率相似（RR = 1.01，95% CI = 0.87 - 1.17；I² = 29%；22项研究，n = 9219；中等确定性）。电子烟可能比NRT帮助更多人戒烟（RR = 1.53，95% CI = 1.21 - 1.93；I² = 0%；4项研究，n = 1924；中等确定性），无尼古丁电子烟（RR = 1.94，95% CI = 1.21 - 3.13；I² = 0%；5项研究，n = 1447；中等确定性）和行为干预/无支持措施（RR = 2.61，95% CI = 1.44 - 4.74；I² = 0%；6项研究，n = 2886；极低确定性）。伐尼克兰可能有助于防止戒烟者复发（RR = 1.23，95% CI = 1.08 - 1.41；I² = 82%；11项研究，n = 1297；中等确定性），但行为支持并不能防止复发（RR = 0.98，95% CI = 0.87 - 1.11；I² = 52%；11项研究，n = 5523；中等确定性）。经济激励措施提高了普通人群的戒烟率（RR = 1.49，95% CI = 1.28 - 1.73；I² = 33%；30项研究，校正后n = 20097；高确定性）以及孕期的戒烟率（RR = 2.38，95% CI = 1.54 - 3.69；I² = 41%；9项研究，n = 2273；中等确定性）。本综述还详细介绍了更广泛的干预措施。
有高确定性证据表明，从戒烟日起使用尼古丁替代疗法可提高戒烟率，无需进一步研究。对于针对特定吸烟人群量身定制的高剂量使用尼古丁替代疗法或在戒烟日前使用时，其提高戒烟率的证据不太确定，进一步研究将有所帮助。有中等确定性证据支持将电子烟用作戒烟辅助工具，但研究其在预防复发中的作用将特别有帮助。
