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Interventions for Tobacco Cessation in Adults, Including Pregnant Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Journal

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Volume 325, Issue 3, Pages 280-298

Publisher

AMER MEDICAL ASSOC
DOI: 10.1001/jama.2020.23541

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This systematic review examined the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation among adults, including pregnant persons. The results showed that a variety of interventions are effective in increasing smoking cessation rates in nonpregnant adults, while behavioral interventions are effective in pregnant women, but data on pharmacotherapy are limited.
ImportanceIt has been estimated that in 2018 nearly 20% of adults in the US were currently using a tobacco product. ObjectiveTo systematically review the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation among adults, including pregnant persons, to inform the US Preventive Services Task Force. Data SourcesPubMed, PsycInfo, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination of Health Technology Assessment; surveillance through September 25, 2020. Study SelectionSystematic reviews of tobacco cessation interventions and randomized clinical trials that evaluated the effects of electronic cigarettes (e-cigarettes) or pharmacotherapy among pregnant persons. Data Extraction and SynthesisIndependent critical appraisal and data abstraction; qualitative synthesis and random-effects meta-analyses. Main Outcomes and MeasuresHealth outcomes, tobacco cessation at 6 months or more, and adverse events. ResultsSixty-seven reviews addressing pharmacotherapy and behavioral interventions were included as well as 9 trials (N=3942) addressing e-cigarettes for smoking cessation and 7 trials (N=2285) of nicotine replacement therapy (NRT) use in pregnancy. Combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83 [95% CI, 1.68-1.98]), NRT (RR, 1.55 [95% CI, 1.49-1.61]), bupropion (RR, 1.64 [95% CI, 1.52-1.77]), varenicline (RR, 2.24 [95% CI, 2.06-2.43]), and behavioral interventions such as advice from clinicians (RR, 1.76 [95% CI, 1.58-1.96]) were all associated with increased quit rates compared with minimal support or placebo at 6 months or longer. None of the drugs were associated with serious adverse events. Five trials (n=3117) reported inconsistent findings on the effectiveness of electronic cigarettes on smoking cessation at 6 to 12 months among smokers when compared with placebo or NRT, and none suggested higher rates of serious adverse events. Among pregnant persons, behavioral interventions were associated with greater smoking cessation during late pregnancy (RR, 1.35 [95% CI, 1.23-1.48]), compared with no intervention. Rates of validated cessation among pregnant women allocated to NRT compared with placebo were not significantly different (pooled RR, 1.11 [95% CI, 0.79-1.56], n=2033). Conclusions and RelevanceThere is strong evidence that a range of pharmacologic and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in nonpregnant adults. In pregnancy, behavioral interventions are effective for smoking cessation, but data are limited on the use of pharmacotherapy for smoking cessation. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are also limited and results are inconsistent. This systematic review to support the 2021 US Preventive Services Task Force Recommendation Statement on interventions for tobacco cessation in adults summarizes published evidence on the benefits and harms of interventions for tobacco cessation in adults, including pregnant persons.

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