Interventions for smoking cessation in Indigenous populations
Abstract
Background
Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that of the non‐Indigenous population. A disproportionate burden of substance‐related morbidity and mortality exists as a result.
Objectives
To evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research.
Search methods
The Cochrane Tobacco Addiction Group Specialised Register of Trials was searched (April 2011), with additional searches of MEDLINE (May 2011). Online clinical trial databases and publication references were also searched for potential studies.
Selection criteria
We included randomized and non‐randomized controlled trials for smoking cessation interventions in Indigenous populations. Interventions could include pharmacotherapies, cognitive and behavioural therapies, alternative therapies, public policy and combination therapies. No attempts were made to re‐define Indigenous status for the purpose of including a study in this review.
Data collection and analysis
Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst methodological quality was extracted independently by two reviewers. Studies were assessed by qualitative narrative synthesis and where possible meta‐analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content.
Main results
Four studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with cognitive and behavioural therapies, whilst the remaining two used cognitive and behavioural therapy through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (risk ratio 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (risk ratio 1.33, 95%CI 0.95 to 1.85, p=NS) .
Authors' conclusions
A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity and mortality. This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non‐Indigenous populations. Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results. The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence. However this evidence base is not strong with a small number of methodologically sound trials investigating these interventions. More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non‐Indigenous populations.
Plain language summary
Can smoking cessation interventions targeted at Indigenous populations achieve smoking abstinence?
In Indigenous populations, rates of smoking have not fallen as they have in the wider communities around them and the associated health harms are unacceptable. This review of four studies found that published studies evaluating smoking cessation interventions specifically aiming to reduce and/or stop the use of tobacco in Indigenous people are significantly lacking. The limited evidence reported in this review does indicate some benefit in these interventions to help Indigenous people stop smoking. However, the change in attitudes after one study was negative with fewer people 'ready to quit' after the smoking cessation intervention was completed. Consideration needs to be given to cultural differences and traditions when tailoring interventions for Indigenous people. Modified or innovative interventions and careful outcomes research are needed to improve the usefulness of smoking cessation interventions aimed at Indigenous populations.
