ABSTRACT
Aims: A systematic review and meta-analysis was conducted to assess the methodological quality and effectiveness of behavioural smoking cessation interventions targeted at six disadvantaged groups; the homeless, prisoners, indigenous populations, at risk youth, individuals with low socio-economic status, and individuals with a mental illness.
Methods: Medline, EMBASE, the Cochrane Library and PsycInfo databases were searched using MeSH and keywords for studies conducted in developed countries prior to October 2010. Included studies were assessed for methodological quality. A DerSimonian and Laird random effects meta-analysis was conducted where possible to explore the effectiveness of interventions for the different sub-groups. A narrative review was conducted for studies unable to be included in meta-analysis. Outcomes examined were abstinence rates at short term (up to 3 months) and long term (6 months or the longest) follow-up.
Results: 32 relevant studies were identified. The majority (N= 20) were rated low in methodological quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at low income female smokers at short term follow up (RR 1.68, CI 1.21-2.33), and behavioural support interventions targeted at individuals with a mental illness at long term follow-up (RR 1.35, CI 1.01-1.81). Results of the narrative review showed several promising interventions that increased cessation rates at 6 months or longer follow-up.
Conclusions: Few well-controlled trials have examined the most effective smoking cessation strategies for highly disadvantaged groups, especially among the homeless, indigenous smokers and prisoners. The use of behavioural smoking cessation interventions for some socially disadvantaged groups appears promising, however overall findings are inconsistent. Further research is needed to establish the most effective interventions for vulnerable high risk groups. Special attention should be given to increasing sample size and power, and to sound evaluation methodology to overcome methodological limitations of conducting research with these high risk groups.