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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 this. The theme of World No Tobacco Day 2018 is 'Tobacco and heart disease'. It focuses on the link between tobacco and cardiovascular diseases, and what governments and the public can do to reduce the risks to heart health posed by tobacco.
In support of World No Tobacco Day 2018, this updated Special Collection highlights a selection of new and recently updated clinically relevant Cochrane Reviews that address tobacco addiction in the general, and some specific populations.
Our featured reviews cover behavioural and medical interventions, independently and in combination, help from healthcare professionals and for specific populations, and technological and legislative interventions.
The Cochrane Reviews in this collection are maintained by the Cochrane Tobacco Addiction Group, and you can find more information about the Cochrane Tobacco Addiction Group’s work to ensure that interventions to treat or prevent tobacco addiction are supported by good-quality evidence that can inform healthcare policy at their website. You can browse the full list of Cochrane Tobacco Addiction reviews here.

Legislative interventions

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Healthcare financing systems for increasing the use of tobacco dependence treatment
Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. This review assesses the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking.
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Impact of institutional smoking bans on reducing harms and secondhand smoke exposure
Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our 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. This review assesses the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health-related outcomes.
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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
Tobacco use is the largest single preventable cause of death and disease worldwide. 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) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging. This review assesses the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.

Technological interventions

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Internet‐based interventions for smoking cessation
The Internet is now an indispensable part of daily life for the majority of people in many parts of the world. It offers an additional means of effecting changes to behaviour such as smoking, and this review aims to determine the effectiveness of Internet-based interventions for smoking cessation.
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Mass media interventions for smoking cessation in adults
Mass media tobacco control campaigns can reach large numbers of people. Much of the literature is focused on the effects of tobacco control advertising on young people, but there are also a number of evaluations of campaigns targeting adult smokers, which show mixed results. Campaigns may be local, regional or national, and may be combined with other components of a comprehensive tobacco control policy. This review assesses the effectiveness of mass media interventions in reducing smoking among adults.
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Mass media interventions for preventing smoking in young people
Mass media interventions can be used as a way of delivering preventive health messages. They have the potential to reach and modify the knowledge, attitudes and behaviour of a large proportion of the community. This review assesses the effects of mass media interventions on preventing smoking in young people, and whether it can reduce smoking uptake among youth (under 25 years), improve smoking attitudes, intentions and knowledge, self-efficacy/self-esteem, and improve perceptions about smoking, including the choice to follow positive role models.
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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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Nursing interventions for smoking cessation
Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. This review assesses the effectiveness of nursing-delivered smoking cessation interventions in adults. 
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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.

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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Tobacco cessation interventions for young people
Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This review evaluates the effectiveness of strategies that help young people to stop smoking tobacco.
See also: podcast

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Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke
Children's exposure to other people's cigarette smoke (environmental tobacco smoke) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to environmental tobacco smoke. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. This review evaluates the effectiveness of interventions aiming to reduce exposure of children to environmental tobacco smoke.
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Incentives for preventing smoking in children and adolescents
Adult smoking usually has its roots in adolescence. If individuals do not take up smoking during this period it is unlikely that they ever will. Further, once smoking becomes established, cessation is challenging; the probability of subsequently quitting is inversely proportional to the age of initiation. One novel approach to reducing the prevalence of youth smoking is the use of incentives. This review assesses the effect of incentives on preventing children and adolescents (aged 5 to 18 years) from starting to smoke.

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 versus control 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.