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Nicotine Tob Res. 2019 Jun 28. pii: ntz107. doi: 10.1093/ntr/ntz107. [Epub ahead of print]

Behavioural interventions for smokeless tobacco cessation.

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ICMR- National Institute of Cancer Prevention and Research (NICPR) Noida (U.P.), India.
School of Preventive Oncology, Patna (Bihar), India.
ICMR- National Institute of Cancer Prevention and Research (NICPR); WHO FCTC Global Knowledge Hub on Smokeless Tobacco (ICMR-NICPR), Noida (U.P.), India.



Consumption of smokeless tobacco (SLT) is on the rise (especially in the WHO South-East Asian region) and has numerous repercussions over the consumer's health. This paper reviews studies performed for SLT cessation utilizing behavioural interventions, worldwide till 2017.


A systematic review by PICO (Problem, intervention, comparison, outcome) of behavioural intervention-based SLT cessation studies with minimum 6 months' follow-up, reporting outcomes in terms of risk ratios (RR) and 95% confidence interval (CI), published between1992-2017 was performed. This was followed by a meta-analysis of the outcomes of these studies by deriving the pooled estimates by the random effect model, for those on adults and youth, categorized according to the type of country where the study was performed i.e. in terms of developed or developing. Publication bias among the included studies was assessed by the Begg test.


Nineteen eligible studies comprising 24,498 participants, from all over the world were included. Behavioural interventions showed overall efficacy in SLT cessation in adults (RR=1.63, 95% CI:1.32-1.94) both in the developed (RR=1.39, 95% CI:1.16-1.63) and developing (RR=2.79, 95% CI:2.32-3.25) countries. However, these interventions did not prove effective for SLT cessation among youth overall (RR=1.07, 95% CI:0.73-1.41), either in the developed (RR=1.39, 95% CI:0.58-2.21) or the developing (RR=0.87, 95% CI:0.68-1.07) countries. Publication bias was noted in all the studies among adults (p=0.22) and youth (p=0.05).


Behavioural interventions as a single modality are effective in SLT cessation, both in the developed and developing countries. Healthcare providers should be sensitized to provide the same.


A recent literature survey by Cochrane1 reviewed studies on interventions for smokeless tobacco cessation (SLT), including behavioural interventions, which included only those from the developed countries. The current analysis provides a broader, global update on the same by including studies performed both in the developed and developing countries (specifically the South East Asian Region - the high burden countries of SLT products).


behavioural interventions; cessation; developed countries; developing countries; smokeless tobacco


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