Effectiveness of tobacco cessation interventions in adolescents: A systematic review and meta-analysis

Globally, around 11% of adolescents aged 13-15 years use tobacco products, and over one-third of users are estimated to be tobacco dependent. Interventions to support adolescents to quit smoking are recommended to mitigate adverse health effects. This study aimed to evaluate the effectiveness of interventions to cease tobacco use in adolescents (aged <18 years old) relative to no intervention, usual practice or an alternative intervention.

This review followed PRISMA 2020 guidelines and Cochrane Handbook recommendations. Randomised controlled trials evaluating tobacco cessation interventions conducted in any setting, targeting current adolescent tobacco users aged under 18 years were included. Electronic databases were searched from inception to 5 November 2025, in addition to searching reference lists of identified systematic reviews. Two review authors independently screened title and abstracts and full text articles for eligibility, and assessed risk of bias using the Cochrane Risk of Bias tool. Certainty of the evidence was assessed using GRADE by one review author and confirmed by a second review author. Random-effects meta-analyses were conducted with data suitable homogenous for pooling. Where data were unsuitable for pooling, data were synthesised narratively following SWiM guidance.

A total of 60 studies were included in the review. Meta-analyses found multicomponent interventions incorporating group counselling increased the odds of tobacco cessation compared with both control [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 1.07-4.58; seven studies; very low certainty evidence] and alternate interventions (OR = 2.33, 95% CI = 1.41-3.84; three studies; very low certainty evidence). There was no clear evidence of benefit for standalone group counselling (OR = 1.07, 95% CI = 0.72-1.61; 11 studies; very low certainty evidence), standalone individual counselling (OR = 1.17, 95% CI = 0.86-1.58; nine studies; very-low certainty evidence), multicomponent pharmacological interventions compared with control (OR = 1.37, 95% CI = 0.69-2.75; four studies; low certainty evidence) or alternate interventions (OR = 1.05, 95% CI = 0.38-2.91; one study; very low certainty evidence).

Evidence for tobacco cessation interventions among adolescents remains limited and with very low certainty. There is a clear need for high-quality trials to inform policy and practice.