Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis

Abhijit Nadkarni; Leena Gaikwad; Miriam Sequeira; Pranay  Javeri; Deepthy  Benoy; Marimilha Grace Pacheco; Richard Velleman; Pratima Murthy; Felix Naughton

doi:10.1093/ntr/ntae259

Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis

Abhijit Nadkarni, Leena Gaikwad, Miriam Sequeira, Pranay Javeri, Deepthy Benoy, Marimilha Grace Pacheco, Richard Velleman, Pratima Murthy, Felix Naughton

Department of Psychology

Research output: Contribution to journal › Article › peer-review

7 Citations (SciVal)

Abstract

Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. Methods: We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up. Results: For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95% CI 1.78 to 3.02) and usual care (RR 4.39; 95% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95% CI 1.28 to 2.44), and usual care (RR 2.37; 95% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes. Conclusions: Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs. Implications: Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.

Original language	English
Pages (from-to)	575-585
Number of pages	11
Journal	Nicotine & Tobacco Research
Volume	27
Issue number	4
Early online date	1 Nov 2024
DOIs	https://doi.org/10.1093/ntr/ntae259 https://doi.org/10.1093/ntr/ntae259
Publication status	Published - 1 Apr 2025

Bibliographical note

Publisher Copyright:
© 2024 The Author(s). Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

Data Availability Statement

The data supporting the findings of this systematic review are derived from publicly available peer-reviewed publications. All relevant data are included in the cited studies within this review. No new primary data were generated or collected during the review process. The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials. For further details on the data used, please refer to the original sources provided in the reference list.

Funding

This work was supported by Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK (Grant number MR/R018456/1).

Funders	Funder number
Medical Research Council
Commonwealth & Development Office
Department of Health and Social Care
Foreign, Commonwealth and Development Office
The Wellcome Trust	MR/R018456/1

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1093/ntr/ntae259Licence: CC BY
10.1093/ntr/ntae259Licence: CC BY

Cite this

Nadkarni, A, Gaikwad, L, Sequeira, M, Javeri, P, Benoy, D, Pacheco, MG, Velleman, R, Murthy, P & Naughton, F 2025, 'Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis ', Nicotine & Tobacco Research, vol. 27, no. 4, pp. 575-585. https://doi.org/10.1093/ntr/ntae259, https://doi.org/10.1093/ntr/ntae259

@article{ec00d6adf8c9452f90ec2941fe95588c,

title = "Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis ",

abstract = "Introduction: An estimated 78\% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88\% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. Methods: We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up. Results: For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95\% CI 1.78 to 3.02) and usual care (RR 4.39; 95\% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95\% CI 1.28 to 2.44), and usual care (RR 2.37; 95\% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes. Conclusions: Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs. Implications: Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.",

author = "Abhijit Nadkarni and Leena Gaikwad and Miriam Sequeira and Pranay Javeri and Deepthy Benoy and Pacheco, \{Marimilha Grace\} and Richard Velleman and Pratima Murthy and Felix Naughton",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.",

year = "2025",

month = apr,

day = "1",

doi = "10.1093/ntr/ntae259",

language = "English",

volume = "27",

pages = "575--585",

journal = "Nicotine \& Tobacco Research",

issn = "1462-2203",

publisher = "Oxford University Press",

number = "4",

}

TY - JOUR

T1 - Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries

T2 - A Systematic Review and Meta-analysis

AU - Nadkarni, Abhijit

AU - Gaikwad, Leena

AU - Sequeira, Miriam

AU - Javeri, Pranay

AU - Benoy, Deepthy

AU - Pacheco, Marimilha Grace

AU - Velleman, Richard

AU - Murthy, Pratima

AU - Naughton, Felix

PY - 2025/4/1

Y1 - 2025/4/1

N2 - Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. Methods: We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up. Results: For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95% CI 1.78 to 3.02) and usual care (RR 4.39; 95% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95% CI 1.28 to 2.44), and usual care (RR 2.37; 95% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes. Conclusions: Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs. Implications: Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.

AB - Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers, including upper aero-digestive tract cancer, stomach cancer, ischemic heart disease and stroke, with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high-income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. Methods: We synthesized the effectiveness of behavioral interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioral intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at 6 months postintervention follow-up. Results: For continuous abstinence at 6 months, the intervention was superior to the active comparator (RR 2.32; 95% CI 1.78 to 3.02) and usual care (RR 4.39; 95% CI 2.38 to 8.11). For point prevalence abstinence at six months, the intervention was superior to the active comparator (RR 1.76; 95% CI 1.28 to 2.44), and usual care (RR 2.37; 95% CI 1.47 to 3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons except for 6-month continuous outcomes. Conclusions: Implementation research is needed to understand factors for programme sustainability and equity of the impact of behavioral interventions in reducing tobacco use in LMICs. Implications: Our review is an important step towards understanding the effectiveness of behavior interventions for tobacco cessation suited for LMICs and which are responsive to the contextual needs of such countries.

UR - https://www.scopus.com/pages/publications/105000962516

U2 - 10.1093/ntr/ntae259

DO - 10.1093/ntr/ntae259

M3 - Article

SN - 1462-2203

VL - 27

SP - 575

EP - 585

JO - Nicotine & Tobacco Research

JF - Nicotine & Tobacco Research

IS - 4

ER -

Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this