Non pharmacological and Pharmacological Intervention for

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Authors Chantelle Lachance and Nina Frey, Cite As Non pharmacological and Pharmacological Intervention for Smoking Cessation Programs in Youth A Review of Clinical Effectiveness and Guidelines. Ottawa CADTH 2020 Feb CADTH rapid response report summary with critical appraisal. ISSN 1922 8147 online, Disclaimer The information in this document is intended to help Canadian health care decision makers health care professionals health systems leaders. and policy makers make well informed decisions and thereby improve the quality of health care services While patients and others may access this document. the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular. purpose The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical. judgment in respect of the care of a particular patient or other professional judgment in any decision making process The Canadian Agency for Drugs and. Technologies in Health CADTH does not endorse any information drugs therapies treatments products processes or services. While care has been taken to ensure that the information prepared by CADTH in this document is accurate complete and up to date as at the applicable date. the material was first published by CADTH CADTH does not make any guarantees to that effect CADTH does not guarantee and is not responsible for the. quality currency propriety accuracy or reasonableness of any statements information or conclusions contained in any third party materials used in preparing. this document The views and opinions of third parties published in this document do not necessarily state or reflect those of CADTH. CADTH is not responsible for any errors omissions injury loss or damage arising from or relating to the use or misuse of any information statements or. conclusions contained in or implied by the contents of this document or any of the source materials. This document may contain links to third party websites CADTH does not have control over the content of such sites Use of third party sites is governed by. the third party website owners own terms and conditions set out for such sites CADTH does not make any guarantee with respect to any information. contained on such third party sites and CADTH is not responsible for any injury loss or damage suffered as a result of using such third party sites CADTH. has no responsibility for the collection use and disclosure of personal information by third party sites. Subject to the aforementioned limitations the views expressed herein are those of CADTH and do not necessarily represent the views of Canada s federal. provincial or territorial governments or any third party supplier of information. This document is prepared and intended for use in the context of the Canadian health care system The use of this document outside of Canada is done so at. the user s own risk, This disclaimer and any questions or matters of any nature arising from or relating to the content or use or misuse of this document will be governed by and. interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein and all proceedings shall be subject to the. exclusive jurisdiction of the courts of the Province of Ontario Canada. The copyright and other intellectual property rights in this document are owned by CADTH and its licensors These rights are protected by the Canadian. Copyright Act and other national and international laws and agreements Users are permitted to make copies of this document for non commercial purposes. only provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors. About CADTH CADTH is an independent not for profit organization responsible for providing Canada s health care decision makers with objective evidence. to help make informed decisions about the optimal use of drugs medical devices diagnostics and procedures in our health care system. Funding CADTH receives funding from Canada s federal provincial and territorial governments with the exception of Quebec. Questions or requests for information about this report can be directed to Requests CADTH ca. SUMMARY WITH CRITICAL APPRAISAL Non Pharmacological and Pharmacological Interventions for Smoking Cessation Programs in Youth 2. Abbreviations, AGREE Appraisal of Guidelines for Research and Evaluation. AMSTAR A Measurement Tool to Assess systematic Reviews. CI Confidence interval,CM Contingency management,CO Carbon monoxide.
CRD Centre for Reviews and Dissemination, CTFPHC Canadian Task Force on Preventive Health Care. FTND Fagerstr m Test for Nicotine Dependence,GDG Guideline Development Group. GRADE Grading for Recommendations Assessment Development and. Evaluation,HTA Health Technology Assessment,ITT Intention to treat. MA Meta analysis,MeSH Medical Subject Headings, NICE National Institute for Health and Care Excellence. NoT Not on Tobacco,NRT Nicotine replacement therapy.
NS Non significant,OR Odds ratio,PICO Population Intervention Comparator Outcome. POP Put it Out Project,PPA Point prevalence abstinence. ppm Part per million, PRISMA Preferred Reporting Items for Systematic Reviews and Meta Analyses. RCT Randomized controlled trial,RR Relative risk,SD Standard deviation. SGM Sexual and gender minority,SIGN Scottish Intercollegiate Guidelines Network.
SLT Smokeless tobacco,SMS Short message service,SR Systematic review. TSP Tobacco Status Project,Context and Policy Issues. Smoking is one of the most preventable causes of mortality and morbidity among. Canadians 1 yet the use of tobacco remains an important and challenging public health. issue 1 2 The current Canadian youth are one of the first generations that are more likely to. be aware than not of the health risks associated with traditional tobacco consumption e g. cigarettes chewing tobacco 1 Even though the prevalence of traditional tobacco. consumption by youth may be lower than previous generations 1 3 there are added. concerns with the most recent invention of vaping devices and e cigarettes 4 Vaping is. recognized to be associated with significant adverse events with short term use and the. long term implications of such a novel technology are unknown 5 6 Taken together. preventing tobacco or nicotine consumption in any form among youth is critical. Pharmacological therapy such as nicotine replacement therapy NRT bupropion and. varenicline are effective in helping the general population of smokers quit using tobacco 7. Non pharmacological therapies may also be useful in assisting patients who are ready to. SUMMARY WITH CRITICAL APPRAISAL Non Pharmacological and Pharmacological Interventions for Smoking Cessation Programs in Youth 3. quit smoking 7 Examples of non pharmacological therapies include behavioural therapy. physician advice telephone based interventions and group peer or individual smoking. cessation programs delivered in person or remotely 8 In certain populations such as. pregnant women non pharmacological therapy specifically cognitive behavioural therapy. can be as effective as NRT 7 In addition pharmacological and non pharmacological. therapies can be used alone or as a combined therapy 9 Overall there is less evidence. regarding which interventions are most effective for youth defined by the United Nations as. 15 to 24 years 6 10, To inform policy decisions about using pharmacotherapy and non pharmacotherapy for. smoking cessation among youth specific evidence is required As such this report aims to. review the clinical effectiveness of using a combination of pharmacological and non. pharmacological smoking cessation interventions or non pharmacological smoking. cessation interventions alone for youth The current report also aims to review evidence. based guidelines regarding smoking cessation interventions for youth. Research Questions, 1 What is the clinical effectiveness of pharmacological and non pharmacological. smoking cessation interventions for youth, 2 What is the clinical effectiveness of non pharmacological smoking cessation.
interventions for youth, 3 What are the evidence based guidelines regarding smoking cessation interventions for. Key Findings, Three systematic reviews nine randomized controlled trials and two guidelines were. identified that addressed the research questions and the results were mixed. One randomized controlled trial was identified and provided results regarding the clinical. effectiveness of pharmacological and non pharmacological smoking interventions for youth. Evidence from this randomized controlled trial suggested that there were no significant. differences in smoking cessation or smoking frequency outcomes between brief advice. nicotine patch therapy and a 6 week text messaging intervention intervention and brief. advice and nicotine patch therapy control, Three systematic reviews and eight randomized controlled trials were identified and. examined the clinical effectiveness a variety of different non pharmacological smoking. interventions for youth Evidence from the systematic reviews did not reveal improved. smoking cessation outcomes for most comparisons two comparisons via meta analyses. did find improved smoking cessation outcomes in favour of the intervention Of the seven. randomized controlled trials that examined smoking cessation outcomes three studies. found reductions in favour of the smoking cessation intervention three did not find. differences between groups and one study found improvements at 3 months in favour of. the intervention but not at 6 month follow up Mixed findings were found for other key. clinical outcomes such as smoking behaviour and quitting outcomes. Two evidence based guidelines regarding smoking cessation interventions for youth were. identified one guideline was commissioned by National Institute for Health and Care. SUMMARY WITH CRITICAL APPRAISAL Non Pharmacological and Pharmacological Interventions for Smoking Cessation Programs in Youth 4. Excellence and the other by the Canadian Task Force on Preventive Health Care The. National Institute for Health and Care Excellence guideline recommends the consideration. of nicotine replacement therapy for young people who are dependent on nicotine strength. of recommendation weak if nicotine replacement therapy is prescribed the guideline. recommends offering it with behavioural support strength of recommendation strong The. Canadian Task Force on Preventive Health Care guidelines recommend asking children. and youth smokers or their parents about tobacco use by the child or youth and offering. brief information and advice during primary care visits strength of recommendation weak. Both guidelines used rigorous methodology to inform their recommendations but the. studies included to inform the recommendations were of varying quality ranging from low to. moderate quality, It may be premature to draw conclusions about pharmacological and non pharmacological. smoking cessation interventions for youth given the mixed findings identified in this report. Literature Search Methods, A limited literature search was conducted by an information specialist on key resources.
including Medline the Cochrane Library the University of York Centre for Reviews and. Dissemination CRD databases the websites of Canadian and major international health. technology agencies as well as a focused internet search The search strategy was. comprised of both controlled vocabulary such as the National Library of Medicine s MeSH. Medical Subject Headings and keywords The main search concepts were Smoking. Cessation and Youth Search filters were applied to limit retrieval to randomized controlled. trials RCTs systematic reviews SRs and clinical practice guidelines Where possible. retrieval was limited to the human population The search was also limited to English. language documents published between January 1 2017 and January 17 2020 Internet. links were provided where available,Selection Criteria and Methods. One reviewer screened citations and selected studies In the first level of screening titles. and abstracts were reviewed and potentially relevant articles were retrieved and assessed. for inclusion The final selection of full text articles was based on the inclusion criteria. presented in Table 1,Table 1 Selection criteria, Population Youth 15 to 24 years of age a who smoke including chewing tobacco vaping e cigarettes. Intervention Q1 Pharmacological smoking cessation interventions e g Nicotine replacement therapy NRT and. non pharmacological smoking cessation interventions. Q2 Non pharmacological smoking cessation interventions. Q3 Pharmacological smoking cessation intervention non pharmacological smoking intervention. pharmacological and non pharmacological combined, Comparator Q1 2 No treatment usual care another pharmacological or non pharmacological intervention. Q3 Not applicable, Outcomes Q1 2 Clinical effectiveness e g reduction in smoking vaping quality of life relapse quit attempts. adverse events, SUMMARY WITH CRITICAL APPRAISAL Non Pharmacological and Pharmacological Interventions for Smoking Cessation Programs in Youth 5.
Q3 Recommendations regarding the use of pharmacological and or non pharmacological interventions. for smoking cessation, Study Designs Q1 2 Health technology assessments systematic reviews randomized controlled trials. SUMMARY WITH CRITICAL APPRAISAL Non Pharmacological and Pharmacological Interventions for Smoking Cessation Programs in Youth 4 quit smoking 7 Examples of non pharmacological therapies include behavioural therapy physician advice telephone based interventions and group peer or individual smoking cessation programs delivered in person or remotely 8 In certain populations such as

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