Primary tobacco prevention in China--a systematic review

This systematic review of randomized controlled trials aims to identify and describe primary tobacco prevention programs conducted in China and to evaluate their quality and effectiveness.

Published studies in English or Chinese were searched in MEDLINE, EMBASE, GLOBAL HEALTH, PsycINFO, Wanfang and CNKI. Eligible studies were randomized controlled trials tailored for a Chinese population. Primary preventive non-pharmacological interventions for smoking cessation or reduction were evaluated. Trials were included if they applied at least one predefined outcome suited for measuring the reduction of smoking rates or the reduction of smoking related morbidity. Two reviewers independently assessed studies for inclusion. The risk of bias in individual studies was evaluated by determining the adequacy of methodological quality criteria.

A total of 21 eligible studies investigating 53,520 patients (range 88 - 30,544) an age between 9.6 and 65 years were identified. All interventions were based on some kind of health education programs. In most cases standard health advice was given and booklets were distributed. The overall methodological quality of the studies was low. Seven studies (33%) showed a statistical significant effect of the described intervention in all predefined outcomes.

The documentation of smoking prevention interventions in China is not sufficient to develop effective and reliable action programs. A lack of quality in the design can be discerned rather than a lack in starting interventions. We therefore recommend future interventions to be planned, implemented and conducted in compliance with high quality standards for example Guideline for Good Clinical Practice. Furthermore for preparing reports of RCT findings we recommend the Consolidated Standards of Reporting Trials.