Comparative Effects of Smoking Cessation Intervention for Adolescents: A Systematic Review and Network Meta-Analysis
Author(s)
Kansak Boonpattharatthiti, PharmD1, Kanchana Mueangfa, PharmD2, Natchaya Aiumtanaporn, PharmD3, Chanchanok Koomsri, PharmD4, Junpen Chantara, PharmD5, Teerapon Dhippayom, PharmD, PhD1.
1The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 2Uttaradit Hospital, Uttaradit, Thailand, 3Department of pharmacy, Golden Jubilee Medical Center, Nakhon Pathom, Thailand, 4Chonburi hospital, Chonburi, Thailand, 5Bangkok Pattaya hospital, Chonburi, Thailand.
1The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand, 2Uttaradit Hospital, Uttaradit, Thailand, 3Department of pharmacy, Golden Jubilee Medical Center, Nakhon Pathom, Thailand, 4Chonburi hospital, Chonburi, Thailand, 5Bangkok Pattaya hospital, Chonburi, Thailand.
OBJECTIVES: Adolescent smoking is associated with a risk of long-term nicotine dependence and requires effective, tailored interventions. We aimed to compare the efficacy of different smoking cessation interventions for adolescents using a network meta-analysis (NMA) approach.
METHODS: We searched PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and PsycINFO from inception to February 28, 2024. Randomized controlled trials comparing smoking cessation interventions for adolescents and reported biochemical verification of smoking abstinence were included. The cessation interventions were classified based on the main active components reported in the trials. Two pairs of researchers independently screened and selected studies in duplicate. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A network meta-analysis was conducted using a random-effects model in a frequentist framework. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Certainty of evidence was assessed using the CINeMA platform.
RESULTS: Fourteen studies, involving 2,630 participants, met the eligibility criteria. Nine of these studies had some concerns risk of bias. While no overall significant differences were found between interventions, cognitive behavioral therapy (CBT)-based interventions showed a potential trend toward higher abstinence rates compared to usual care (UC). At 6 months post intervention, CBT, nicotine replacement therapy (NRT) combined with CBT, and non-NRT interventions were associated with significantly higher smoking cessation rates compared to UC with RRs (95%CI; and certainty of evidence) of 2.31 (95%CI: 1.59-3.35; very low), 2.44 (95%CI: 1.16-5.16; very low), and 1.56 (95%CI: 1.06-2.30; low), respectively. No significant differences were found between interventions at 6 months or across delivery formats and settings
CONCLUSIONS: Although no intervention showed a clear benefit in helping adolescents quit smoking, CBT-based and non-NRT interventions may improve short-term abstinence. However, the low-certainty evidence underscores the need for high-quality trials to confirm these findings, enhance real-world applicability, and support long-term cessation
METHODS: We searched PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and PsycINFO from inception to February 28, 2024. Randomized controlled trials comparing smoking cessation interventions for adolescents and reported biochemical verification of smoking abstinence were included. The cessation interventions were classified based on the main active components reported in the trials. Two pairs of researchers independently screened and selected studies in duplicate. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A network meta-analysis was conducted using a random-effects model in a frequentist framework. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Certainty of evidence was assessed using the CINeMA platform.
RESULTS: Fourteen studies, involving 2,630 participants, met the eligibility criteria. Nine of these studies had some concerns risk of bias. While no overall significant differences were found between interventions, cognitive behavioral therapy (CBT)-based interventions showed a potential trend toward higher abstinence rates compared to usual care (UC). At 6 months post intervention, CBT, nicotine replacement therapy (NRT) combined with CBT, and non-NRT interventions were associated with significantly higher smoking cessation rates compared to UC with RRs (95%CI; and certainty of evidence) of 2.31 (95%CI: 1.59-3.35; very low), 2.44 (95%CI: 1.16-5.16; very low), and 1.56 (95%CI: 1.06-2.30; low), respectively. No significant differences were found between interventions at 6 months or across delivery formats and settings
CONCLUSIONS: Although no intervention showed a clear benefit in helping adolescents quit smoking, CBT-based and non-NRT interventions may improve short-term abstinence. However, the low-certainty evidence underscores the need for high-quality trials to confirm these findings, enhance real-world applicability, and support long-term cessation
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD256
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)