Interventions for smoking cessation in Indigenous populations

Background Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that of the non‐Indigenous population. A disproportionate burden of substance‐related morbidity and mortality exists as a result. Objectives To evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. Search methods The Cochrane Tobacco Addiction Group Specialised Register of Trials was searched (April 2011), with additional searches of MEDLINE (May 2011). Online clinical trial databases and publication references were also searched for potential studies. Selection criteria We included randomized and non‐randomized controlled trials for smoking cessation interventions in Indigenous populations. Interventions could include pharmacotherapies, cognitive and behavioural therapies, alternative therapies, public policy and combination therapies. No attempts were made to re‐define Indigenous status for the purpose of including a study in this review. Data collection and analysis Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst methodological quality was extracted independently by two reviewers. Studies were assessed by qualitative narrative synthesis and where possible meta‐analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content. Main results Four studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with cognitive and behavioural therapies, whilst the remaining two used cognitive and behavioural therapy through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (risk ratio 1.43, 95%CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non‐significant but clinically significant effect was observed in favour of the intervention (risk ratio 1.33, 95%CI 0.95 to 1.85, p=NS) . Authors' conclusions A significant health disparity exists, whereby Indigenous populations, a minority, are over‐represented in the burden of smoking‐related morbidity an