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Special Collection - Free access to reviews

World No Tobacco Day

Special Collection
Every year on the 31st of May, the World Health Organization holds World No Tobacco Day to draw attention to the health risks associated with tobacco consumption, and what can be done to reduce these. The theme of World No Tobacco Day 2017 is “Tobacco – a threat to development”. It focuses on measures that governments and the public can take to promote health and development by confronting global tobacco use.
In support of World No Tobacco Day 2017, this updated Special Collection highlights a selection of new and recently updated, clinically relevant Cochrane Reviews that address tobacco addiction in general, and some specific populations.
Following last year’s theme: ‘Get Ready for Plain Packaging’, the UK passed legislation requiring that all tobacco products be sold in standardised packaging.  As a result, Cochrane Tobacco Addiction Group authors have published a review evaluating the effects of introducing plain tobacco packaging, which you can learn more about in this Special Collection.
Other featured reviews cover self-managed behavioural or lifestyle interventions, help from healthcare professionals for general or special groups, medications and technological interventions, and legislative interventions.
The Cochrane Reviews in this collection are maintained by the Cochrane Tobacco Addiction Group. The Group aims to ensure that interventions to treat or prevent tobacco addiction have been supported by high quality evidence that can inform healthcare policy. You can find more information about the Group here. You can also browse the full list of Cochrane Tobacco Addiction reviews here.

Legislative interventions

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Impact of institutional smoking bans on reducing harms and secondhand smoke exposure
Smoking bans can assist in eliminating exposure to secondhand smoke, and can reduce tobacco consumption amongst smokers themselves. There is evidence for the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important to also review the evidence an organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. This review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities, and also assesses the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking.
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System change interventions for smoking cessation
System change interventions for smoking cessation are policies and practices designed by organizations to integrate the identification of smokers and the subsequent offering of evidence-based nicotine dependence treatments into usual care. Such strategies have the potential to improve the provision of smoking cessation support in healthcare settings, and cessation outcomes among those who use them. This review assesses the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both.
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Tobacco packaging design for reducing tobacco use
Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size), without logos or branding, apart from health warnings and other government-mandated information; and the brand name in a prescribed uniform font, colour and size. This review assesses the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.
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School‐based programmes for preventing smoking
Helping young people to avoid starting smoking is a widely endorsed public health goal, and schools provide a route to communicate with nearly all young people. School-based interventions have been delivered for close to 40 years. The primary aim of this review was to determine whether school smoking interventions prevent youth from starting smoking; while also aiming to determine, which interventions were most effective.

Technological interventions

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Electronic cigarettes for smoking cessation
 Electronic cigarettes (ECs) are devices that heat a liquid - usually comprising propylene glycol and glycerol, with or without nicotine and flavours, stored in disposable or refillable cartridges or a reservoir - into an aerosol for inhalation. Smokers report using ECs to reduce risks of smoking, but some healthcare organisations have been reluctant to encourage smokers to switch to ECs, citing lack of evidence of efficacy and safety. In particular, healthcare providers have an urgent need to know what advice they should give to smokers enquiring about ECs. This review examines the efficacy of ECs in helping people who smoke to achieve long-term abstinence, the efficacy of ECs in helping people reduce cigarette consumption by at least 50% of baseline levels; and aims to assess the occurrence of adverse events associated with EC use.

Behavioural interventions

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Individual behavioural counselling for smoking cessation
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. The review assesses individual counselling is more effective than no treatment or brief advice, or self-help materials in promoting smoking cessation, and whether a more intensive counselling intervention is more effective than a less intensive intervention.
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Group behaviour therapy programmes for smoking cessation
Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support.  This review aims to determine the effect of group-delivered behavioural interventions in achieving long-term smoking cessation.
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Interventions to increase adherence to medications for tobacco dependence
Pharmacological treatments for tobacco dependence, such as nicotine replacement therapy, have been shown to be safe and effective interventions for smoking cessation. Higher levels of adherence to these medications increase the likelihood of sustained smoking cessation, but many smokers use them at a lower dose and for less time than is optimal. It is therefore important to determine the effectiveness of interventions designed specifically to increase medication adherence. This review assesses the effectiveness of interventions to increase adherence to medications for smoking cessation, when compared to a control group, typically representing standard care.

Combined interventions

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Combined pharmacotherapy and behavioural interventions for smoking cessation
Both behavioural support (including brief advice and counselling) and pharmacotherapies (including nicotine replacement therapy (NRT), varenicline and bupropion) are effective in helping people to stop smoking. Combining both treatment approaches is recommended where possible, but the size of the treatment effect with different combinations and in different settings and populations is unclear. This review assesses the effect of combining behavioural support and medication to aid smoking cessation, when compared to minimal intervention or usual care.

Interventions for specific populations

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Interventions for tobacco use cessation in people living with HIV and AIDS
Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.  This review assesses the effectiveness of interventions to motivate and assist tobacco use cessation for PLWHA, and to evaluate the risks of any harms associated with those interventions.
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Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders
Smoking rates in people with alcohol and other drug dependencies are two to four times those of the general population. Concurrent treatment of tobacco dependence has been limited due to concern that these interventions are not successful in this population or that recovery from other addictions could be compromised if tobacco cessation was combined with other drug dependency treatment. This review evaluates whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence.
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Interventions for smoking cessation in hospitalised patients
Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting. This review’s objective is to determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.
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Interventions for waterpipe smoking cessation
One traditional method of smoking tobacco, especially in the Eastern Mediterranean Region (EMR), is the waterpipe, in which smoke passes through a reservoir of water before inhalation by the smoker. The waterpipe, known as narjeela in formal Arabic, goes by various local names such as shisha, narghile, arghile, and hookah. Although waterpipe use was uncommon in most of the world before the 1990s, it has enjoyed a recent resurgence, and is now spreading into areas where there was no previous tradition of use. Many waterpipe smokers believe that waterpipe smoking is a safer alternative to cigarettes; which is an apparent misperception, given the available evidence. Given the global increase in waterpipe smoking, and evidence that many users become dependent and have difficulty quitting on their own, waterpipe-specific tobacco cessation interventions are required. This review aims to summarize the evidence available regarding smoking cessation interventions for waterpipe smokers.

Lifestyle management interventions

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Exercise interventions for smoking cessation
Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. This review determines whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone. See also: podcast.
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Interventions to reduce harm from continued tobacco use
Although smoking cessation is currently the only guaranteed way to reduce the harm caused by tobacco smoking, a secondary tobacco control approach may be to try and reduce the harm from continued tobacco use amongst smokers unable or unwilling to quit. Possible approaches to reduce exposure to toxins from smoking include reducing the amount of tobacco used, and using less toxic products, such as pharmaceutical nicotine and potential reduced-exposure tobacco products (PREPs), as alternatives to cigarettes. This review aims to assess the effects of interventions intended to reduce the harm to health of continued tobacco use.

Self-help interventions

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Print‐based self‐help interventions for smoking cessation
Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully. The aims of this review are to determine the effectiveness of different forms of print-based self-help materials, compared with no treatment and with other minimal contact strategies.

Pharmacotherapy interventions

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Nicotine receptor partial agonists for smoking cessation
Nicotine receptor partial agonists, including varenicline and cytisine, may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). Varenicline was developed as a nicotine-receptor partial agonist with similarities to cytisine, a drug widely used for smoking cessation in some eastern and central European countries. The first trial reports of varenicline were released in 2006, and further trials have now been published or are currently under way. This recent update assesses the efficacy and tolerability of nicotine-receptor partial agonists for smoking cessation, and includes the most recent evidence on the adverse events profile associated with their use.
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Nicotine replacement therapy for smoking cessation
The aim of nicotine replacement therapy (NRT) is to temporarily replace much of the nicotine from cigarettes. This reduces both the motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. This review determines the effect of NRT compared to placebo in aiding smoking cessation, and considers whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers, and tablets/lozenges) in achieving abstinence from cigarettes. The review also examines whether the effect is influenced by the dosage, form, and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated.
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Pharmacological interventions for smoking cessation: an overview and network meta‐analysis
Some medications have been proven to help people to quit smoking, with three licensed for this purpose in Europe and the USA: nicotine replacement therapy (NRT), bupropion, and varenicline. Cytisine (a treatment pharmacologically similar to varenicline) is also licensed for use in Russia and some of the former socialist economy countries. Other therapies, including nortriptyline, have also been tested for effectiveness. This overview addresses the following questions: How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long-term abstinence (six months or longer)? How do the remaining treatments compare with placebo in achieving long-term abstinence? How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits? See also: podcast.