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Tobacco Use
Evidence Reports/Technology Assessments, No. 140
Invetigators: Leah Ranney, PhD, MA, Cathy Melvin, MPH, PhD, Linda Lux, MPA, Erin McClain, MA, MPH, Laura Morgan, MA, and Kathleen N Lohr, PhD.
Structured Abstract
Objectives:
The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed the evidence on (a) the effectiveness of community- and population-based interventions to prevent tobacco use and to increase consumer demand for and implementation of effective cessation interventions; (b) the impacts of smokeless tobacco marketing on smoking, use of those products, and population harm; and (c) the directions for future research.
Data Sources:
We searched MEDLINE®, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane libraries, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts from January 1980 through June 10, 2005. We included English-language randomized controlled trials, other trials, and observational studies, with sample size and follow-up restrictions. We used 13 Cochrane Collaboration systematic reviews, 5 prior systematic reviews, and 2 meta-analyses as the foundation for this report.
Review Methods:
Trained reviewers abstracted detailed data from included articles into evidence tables and completed quality assessments; other senior reviewers confirmed accuracy and resolved disagreements.
Results:
We identified 1,288 unique abstracts; 642 did not meet inclusion criteria, 156 overlapped with prior reviews, and 2 were not published articles. Of 488 full-text articles retrieved and reviewed, we excluded 298 for several reasons, marked 88 as background, and retained 102. Evidence (consistent with previous reviews) showed that (a) school-based prevention interventions have short-term (but not long-term) effects on adolescents; (b) multicomponent approaches, including telephone counseling, increase the number of users who attempt to quit; (c) self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve success rates of quit attempts; and (d) provide training and academic detailing improve provider delivery of cessation treatments, but evidence is insufficient to show that these approaches yield higher quit rates.
Recent evidence on the following topics was insufficient to change prior review findings: (a) effectiveness of population-based prevention interventions; (b) effectiveness of provider-based interventions to reduce tobacco initiation; (c) effectiveness of community- and provider-based interventions to increase use of proven cessation strategies; (d) effectiveness of marketing campaigns to switch tobacco users from smoking to smokeless tobacco products; and (e) effectiveness of interventions in populations with comorbidities and risk behaviors (e.g., depression, substance and alcohol abuse). No evidence was available on the way in which smokeless tobacco product marketing affects population harm.
Conclusions:
The evidence base has notable gaps and numerous study deficiencies. We found little information to address some of the issues that previous authoritative reviews had not covered, some information to substantiate earlier conclusions and recommendations from those reviews, and no evidence that would overturn any previous recommendations.
Contents
- Preface
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Results of Literature Searches
- KQ 1. Effective Population- and Community-Based Interventions to Prevent Tobacco Use
- KQ 2. Effective Strategies for Increasing Consumer Demand For and Use of Proven Individually Oriented Cessation Treatments
- KQ 3. Implementation of Proven Population-Level Tobacco Use Cessation Strategies
- KQ 4. Effect of Smokeless Tobacco Product Marketing and Use on Population Harm from Tobacco Use
- KQ 5. Effectiveness of Prevention and Cessation Interventions in Populations with Co-Occurring Morbidities and Risk Behaviors
- 4. Discussion
- Appendixes
- References and Included Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0016. Prepared by: RTI International-University of North Carolina, Research Triangle Park, North Carolina.
Suggested citation:
Ranney L, Melvin C, Lux L, McClain E, Morgan L, Lohr K. Tobacco Use: Prevention, Cessation, and Control. Evidence Report/Technology Assessment No. 140. (Prepared by the RTI International-University of North Carolina Evidence-Based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 06-E015. Rockville, MD: Agency for Healthcare Research and Quality. June 2006.
This report is based on research conducted by the RTI International-University of North Carolina at Chapel Hill, North Carolina (RTI-UNC) Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0016). The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers; patients and clinicians, health system leaders, and policymakers, make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
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