The efficacy of smoking cessation interventions in low‐ and middle‐income countries: a systematic review and meta‐analysis

AIMS: To summarize evidence for the efficacy of smoking cessation interventions in low‐ and middle‐income countries (LMICs). DESIGN: Systematic review and meta‐analysis of randomized controlled trials. SETTING: LMICs as defined by the World Bank. PARTICIPANTS: Adult current cigarette smokers residing in LMICs. INTERVENTIONS: Behavioral and/or pharmacotherapy smoking cessation interventions. MEASUREMENTS: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow‐up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta‐analysis was performed using Mantel–Haenzel random‐effect models reporting odds ratios (OR) and 95% confidence intervals (CI). FINDINGS: Twenty‐four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30–2.77, P < 0.001, I (2) = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18–11.29, P < 0.001, I (2) = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56–3.88, P < 0.001, I (2) = 0%). CONCLUSION: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low‐ and middle‐income countries. There is limited rigorous research on other smoking cessation interventions in these regions.