Stjepanović Daniel, Phartiyal Preeti, Leung Janni, Lim Carmen C W, Sun Tianze, Chung Jack Yiu Chak, Gartner Coral E, Hall Wayne D, Chan Gary C K
National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia.
Tob Control. 2023 Nov;32(6):757-768. doi: 10.1136/tobaccocontrol-2021-057019. Epub 2022 Feb 23.
Smoking remains prevalent in many countries despite rigorous tobacco control strategies. The use of Swedish snus, a type of low-nitrosamine smokeless tobacco, has been promoted as a tobacco harm reduction strategy.
Three databases were searched for studies that assessed the effectiveness of snus in promoting smoking abstinence. A total of 28 studies were reviewed (5 randomised controlled trials (RCTs), 7 longitudinal and 16 cross-sectional studies).
Separate meta-analyses were conducted by study type, pooling effect estimates where outcome measures and design were sufficiently comparable. Study details and quality assessment (Risk of Bias 2 for RCTs, Newcastle-Ottawa Scale for observational studies) are provided for each study.
While the meta-analysis of RCTs did not show a significant association between snus use and smoking cessation (risk ratio (RR)=1.33, 95% CI 0.71 to 2.47 and RR=0.62, 95% CI 0.27 to 1.41), the results of the meta-analysis of longitudinal cohort studies (RR=1.38, 95% CI 1.05 to 1.82, p=0.022) and cross-sectional studies (OR=1.87, 95% CI 1.29 to 2.72, p=0.001) indicated that use of snus was associated with an increased likelihood of quitting or having quit smoking. There was significant heterogeneity in the cross-sectional studies, and leave-one-out analysis indicated that the longitudinal cohort results were driven by one study. Most studies examined were subject to an elevated risk of bias.
There is weak evidence for the use of snus for smoking cessation. Better RCTs and longitudinal studies are needed; meanwhile, existing cessation aids may be better placed than snus to promote abstinence.
尽管实施了严格的烟草控制策略，但吸烟在许多国家仍然很普遍。瑞典鼻烟是一种低亚硝胺无烟烟草，其使用已被推广为一种烟草危害降低策略。
检索了三个数据库，以查找评估鼻烟在促进戒烟方面有效性的研究。共审查了28项研究（5项随机对照试验（RCT）、7项纵向研究和16项横断面研究）。
按研究类型进行单独的荟萃分析，在结局测量和设计充分可比的情况下合并效应估计值。为每项研究提供了研究细节和质量评估（RCT的偏倚风险2，观察性研究的纽卡斯尔-渥太华量表）。
虽然RCT的荟萃分析未显示使用鼻烟与戒烟之间存在显著关联（风险比（RR）=1.33，95%置信区间0.71至2.47，RR=0.62，95%置信区间0.27至1.41），但纵向队列研究的荟萃分析结果（RR=1.38，95%置信区间1.05至1.82，p=0.022）和横断面研究结果（OR=1.87，95%置信区间1.29至2.72，p=0.001）表明，使用鼻烟与戒烟或已戒烟的可能性增加有关。横断面研究存在显著异质性，留一法分析表明纵向队列研究结果由一项研究驱动。大多数被审查的研究存在较高的偏倚风险。
使用鼻烟辅助戒烟的证据不足。需要更好的随机对照试验和纵向研究；同时，现有的戒烟辅助手段可能比鼻烟更有利于促进戒烟。
