Reducing smoking among indigenous populations: new evidence from a review of trials

Previous reviews have concluded that to be effective, evidence-based tobacco control interventions should be culturally adapted to indigenous populations. We undertook a systematic review to critically examine this hitherto conclusion.

We searched MEDLINE, PsychInfo, EMBASE, and Cochrane databases from 1980 to May 2012 for controlled trials. We included studies that recruited nonindigenous and indigenous participants to assess differences in impact of nonadapted interventions across ethnic groups and whether adapted interventions are more effective for indigenous participants.

Five studies were included. Three tested the effectiveness of enhanced Quitline protocols with cessation products over usual Quitline care, and two trialed a culturally adapted cessation counseling intervention using mobile phones. Three studies did not demonstrate a significant effect of the intervention for both indigenous and nonindigenous participants; two were pharmacotherapy studies using nicotine replacement therapy and the third was a trial of a multimedia phone intervention. The fourth study found a significant effect of a behavioral intervention using text messaging for indigenous and nonindigenous participants. The final study found a significant effect in favor of very low nicotine cigarettes compared with usual care; results were similar across ethnic groups.

There is likely no significant difference between indigenous and nonindigenous populations regarding the efficacy of smoking cessation products, and we provide some promising evidence on the efficacy of behavioral interventions delivered via mobile phone technology. We demonstrate that not all tobacco control interventions can or necessarily need to be culturally adapted for indigenous populations although there are circumstances when this is important.