Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
Nicotine Tob Res. 2023 Sep 4;25(11):1709-1718. doi: 10.1093/ntr/ntad098.
Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence.
Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings.
Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy.
Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered.
Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.
与城市相比，高收入国家的农村、地区和偏远地区（RRR）的烟草吸烟率更高。然而，针对 RRR 吸烟者的干预措施知之甚少。本综述描述了针对 RRR 吸烟者的戒烟干预措施在支持戒烟方面的有效性。
从七个学术数据库（成立至 2022 年 6 月）中搜索了戒烟干预研究，以纳入报告澳大利亚、加拿大或美国 RRR 居民的研究，并报告短期（<6 个月）或长期（≥6 个月）吸烟戒断结果的研究。两名研究人员评估了研究质量，并进行了叙述性总结。
纳入的研究（n=26）主要为随机对照（12 项）或前后对照（7 项）设计，来自美国（16 项）或澳大利亚（8 项）。有 5 项系统改变干预措施。干预措施包括戒烟教育或简短建议，很少包括尼古丁单一疗法、戒烟咨询、动机访谈或认知行为疗法。干预措施对 RRR 吸烟戒断的短期效果有限，6 个月后效果明显下降。通过应急、奖励和在线戒烟干预措施可以最好地支持短期戒烟，而药物治疗则可以支持长期戒烟。
针对 RRR 吸烟者的戒烟干预措施应包括药物治疗和心理戒烟咨询，以建立短期戒烟，并确定维持 6 个月以上戒烟的有效方法。应急设计是为吸烟的 RRR 人群提供心理和药物治疗支持的合适载体，应明确考虑干预措施的针对性。
吸烟对 RRR 居民造成了不成比例的伤害，他们可能会遇到戒烟支持的获取障碍。仍需要高质量的干预证据和结果标准化，以支持 RRR 人群的长期戒烟。
