Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis

Nina Huynh; Saania Tariq; Catherine Charron; Tavis Hayes; Onkar Bhanushali; Tina Kaur; Sadia Jama; Preshit Ambade; Ted Bignell; Terry Hegarty; Risa Shorr; Smita Pakhale

doi:10.1136/jech-2021-216783

Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis

J Epidemiol Community Health. 2022 May 27;76(8):716-729. doi: 10.1136/jech-2021-216783. Online ahead of print.

Authors

Nina Huynh^{1

2}, Saania Tariq^{1

2}, Catherine Charron³, Tavis Hayes^{1

4}, Onkar Bhanushali^{1

4}, Tina Kaur⁵, Sadia Jama^{1

2}, Preshit Ambade^{1

2}, Ted Bignell¹, Terry Hegarty¹, Risa Shorr⁶, Smita Pakhale^{7

2

8}

Affiliations

¹ The Bridge Engagement Centre, Ottawa, Ontario, Canada.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Department of Medicine, Montfort Hospital, Ottawa, Ontario, Canada.
⁴ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Nursing, University of Toronto, Toronto, Ontario, Canada.
⁶ Learning Services, Ottawa Hospital, Ottawa, Ontario, Canada.
⁷ The Bridge Engagement Centre, Ottawa, Ontario, Canada spakhale@ohri.ca.
⁸ Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.

Abstract

Background: There remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic status (SES) populations is still unknown.

Objective: To assess the effectiveness of multicomponent tobacco dependence interventions for low SES and create a checklist tool examining multicomponent interventions.

Methods: EMBASE and MEDLINE databases were searched to identify randomised controlled trials (RCTs) published with the primary outcome of tobacco smoking cessation measured at 6 months or post intervention. RCTs that evaluated tobacco dependence management interventions (for reduction or cessation) in low SES (experience of housing insecurity, poverty, low income, unemployment, mental health challenges, illicit substance use and/or food insecurity) were included. Two authors independently abstracted data. Random effects meta-analysis and post hoc sensitivity analysis were performed.

Results: Of the 33 included studies, the number of intervention components ranged from 1 to 6, with smoking quit rates varying between 1% and 36.6%. Meta-analysis revealed that both the 6-month and 12-month outcome timepoints, multicomponent interventions were successful in achieving higher smoking quit rates than the control (OR 1.64, 95% Cl 1.41 to 1.91; OR 1.74, 95% Cl 1.30 to 2.33). Evidence of low heterogeneity in the effect size was observed at 6-month (I²=26%) and moderate heterogeneity at 12-month (I²=56%) outcomes.

Conclusion: Multicomponent tobacco dependence interventions should focus on inclusion of social support, frequency and duration of components. Employing community-based participatory-action research approach is essential to addressing underlying psychosocioeconomic-structural factors, in addition to the proven combination pharmacotherapies.

Prospero registration number: CRD42017076650.

Keywords: behavior, addictive; economics; homeless persons; prevention; tobacco.