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Interventions for smokeless tobacco use cessation.

Jonathan Livingstone-Banks1, Aishwarya Lakshmi Vidyasagaran2, Ray Croucher3

  • 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

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Smokeless tobacco cessation aids like counseling, brief advice, and varenicline show effectiveness. Nicotine replacement therapy (NRT) may also aid quitting, but bupropion does not currently show benefits for smokeless tobacco users.

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Area of Science:

  • Public Health
  • Addiction Medicine
  • Evidence-Based Interventions

Background:

  • Smokeless tobacco products are highly detrimental and contribute to global health disparities.
  • Research on smokeless tobacco cessation is less extensive than for combustible tobacco.
  • Identifying effective cessation aids is crucial for public health.

Purpose of the Study:

  • To evaluate the efficacy of behavioral and pharmacological interventions for smokeless tobacco cessation.
  • To synthesize evidence from randomized controlled trials (RCTs) on quitting smokeless tobacco.

Main Methods:

  • Systematic review and meta-analysis of 43 RCTs involving 20,346 participants.
  • Interventions included behavioral approaches (counseling, brief advice) and pharmacotherapies (NRT, varenicline, bupropion).
  • Outcomes measured were abstinence from all tobacco or smokeless tobacco use at ≥6 months.

Main Results:

  • Moderate-certainty evidence indicates counseling and brief advice increase quit rates compared to minimal/no support.
  • Varenicline shows moderate-certainty evidence of increased quit rates versus placebo.
  • Nicotine replacement therapy (NRT) shows low-certainty evidence of benefit; bupropion shows no benefit.

Conclusions:

  • Cessation counseling, brief advice, and varenicline are likely effective for smokeless tobacco cessation.
  • NRT may be beneficial, while bupropion is not currently supported by evidence.
  • Future research should prioritize trials in regions with high smokeless tobacco use, such as South and Southeast Asia.