Review: behavioural interventions promote tobacco cessation in users of smokeless tobacco.

QUESTIONDo behavioural and pharmacological interventions promote tobacco cessation in users of smokeless tobacco?REVIEW SCOPEStudies selected compared a behavioural or pharmacological intervention with a control intervention (usual care, placebo, or a less intensive intervention) or a different intervention for promoting tobacco abstinence in adolescent or adult users of smokeless tobacco (tobacco placed in the mouth and not burned, including moist snuff, chewing tobacco, and betel quid). Outcomes were tobacco abstinence >/= 6 months after the intervention began. Preferred outcomes were total tobacco abstinence (rather than abstinence from smokeless tobacco alone), biochemical validation (rather than self-reported abstinence), and continuous abstinence (rather than point prevalence) at longest follow-up.REVIEW METHODSCochrane Tobacco Addiction Group specialised register, Cochrane Central Register of Controlled Trials, Medline, CINAHL, EMBASE/Excerpta Medica, PsycINFO, Web of Science, Dissertation Abstracts Online, and Scopus (to Mar 2007); Healthstar, Educational Resources Information Center, National Technical Information Service, and Current Contents (to 2003); reference lists; conference proceedings; and personal reference files were searched for randomised, quasi-randomised, and cluster-randomised controlled trials. Experts were consulted. 20 trials (range of mean ages 17-39 y, 99% men) met the selection criteria, providing 14 comparisons (n = 8557) of behavioural interventions and 8 comparisons (n = 1635) of pharmacological interventions.MAIN RESULTSMeta-analysis showed that behavioural interventions were more effective than control interventions for tobacco cessation (table). Nicotine patch, nicotine gum, and buproprion did not differ from placebo (table).CONCLUSIONSBehavioural interventions promote tobacco cessation in users of smokeless tobacco. Pharmacological interventions were not shown to be effective.