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Contents
Executive Summary ... 1
Evidence Report... 9
Chapter 1. Introduction ... 11
Scope of the Problem ... 11
Tobacco Use and Its Impact ... 11
Need and Purpose of This Systematic Review ... 12
Uses of This Report ... 13
Production of This Evidence Report... 14
Technical Expert Panel ... 14
A Note on Terminology ... 14
Organization of this Report... 14
Chapter 2. Methods... 17
Key Questions and Analytic Framework ... 17
Key Questions... 17
Analytic Frameworks... 18
Previous Reviews... 18
KQ 1. Effective Population- and Community-Based Interventions to Prevent Tobacco Use ... 20
KQ 2. Effective Strategies for Increasing Consumer Demand for and Use of Individually Oriented Cessation Treatments ... 21
KQ 3. Effective Strategies for Increasing Implementation of Population-Level Tobacco Use Cessation Strategies ... 22
KQ 4. Effect of Smokeless Tobacco Product Marketing and Use... 22
KQ 5. Effectiveness of Interventions in Populations with Co-Occurring Morbidities and Risk Behaviors ... 23
KQ 6. Needed Research... 24
Literature Review Methods... 24
Inclusion and Exclusion Criteria... 24
Literature Search and Retrieval Process ... 24
Literature Synthesis ... 26
Development of Evidence Tables and Data Abstraction Process... 26
Quality and Strength of Evidence Evaluation... 28
Peer Review Process ... 29
Chapter 3. Results ... 31
Results of Literature Searches ... 31
KQ 1. Effective Population- and Community-Based Interventions to Prevent Tobacco Use .. 34
Population-Based Interventions to Limit Access and Reduce Initiation ... 34
Community-Based Interventions to Prevent Tobacco Initiation ... 38
KQ 2. Effective Strategies for Increasing Consumer Demand For and Use of Proven Individually Oriented Cessation Treatments ... 49
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Increasing the Number of Users Who Attempt to Quit ... 49
Improving the Success Rate of Quit Attempts... 54
Strategies to Improve the Success Rate for Quit Attempts for Special Populations ... 68
KQ 3. Implementation of Proven Population-Level Tobacco Use Cessation Strategies... 71
Population-Based Strategies ... 71
Provider and Health Care System-Based Strategies ... 74
KQ 4. Effect of Smokeless Tobacco Product Marketing and Use on Population Harm from Tobacco Use ... 84
Effects of Smokeless Tobacco Product Marketing and Use... 84
KQ 5. Effectiveness of Prevention and Cessation Interventions in Populations with Co- Occurring Morbidities and Risk Behaviors... 87
Populations with Psychiatric Conditions ... 87
Populations with Substance Addictions... 91
Chapter 4. Discussion ... 95
Quality of Literature and Strength of Evidence... 95
KQ 1. Effective Population- and Community-based Interventions to Prevent Tobacco Use in Adolescents and Young Adults ... 95
Gaps in Tobacco Prevention Literature ... 97
KQ 2. Effective Strategies for Increasing Consumer Demand for and Use of Proven Individually Oriented Cessation Treatment ... 97
Gaps in the Literature for Increasing Demand for and Use of Cessation Treatments ... 100
KQ 3. Effective Strategies for Increasing the Implementation of Proven Population-Level Tobacco Use Cessation Strategies, Particularly by Health Care Systems and Communities ... 101
Gaps in the Literature for Increasing Implementation of Cessation Strategies ... 102
KQ 4. Effect of Smokeless Tobacco Product Marketing and Use on Population Harm From Tobacco Use... 102
Gaps in Smokeless Tobacco Product Marketing and Use ... 103
KQ 5. Effectiveness of Prevention and of Cessation Interventions in Populations with Co-Occurring Morbidities and Risk Behaviors ... 103
Gaps in the Literature for Effectiveness of Prevention and of Cessation Interventions in Populations with Co-Occurring Morbidities and Risk Behaviors ... 104
Limitations of Evidence Base ... 104
Inadequate Randomization and Concealment Allocation... 104
Deficient Study Designs ... 105
Refusal and Attrition Rates... 105
Construct Validity Problems... 105
Reliability of Results ... 105
Inconsistent Terminology ... 106
Characteristics of Poor-Quality Studies... 106
Future Research Recommendations... 106
KQ 1. Effective Population- and Community-based Interventions to Prevent Tobacco Use in Adolescents and Young Adults ... 106
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KQ 2. Effective Strategies for Increasing Consumer Demand for and Use of Proven
Individually Oriented Cessation Treatment ... 109
KQ 3. Effective Strategies for Increasing the Implementation of Proven Population- level Tobacco Use Cessation Strategies, Particularly by Health Care Systems and Communities ... 109
KQ 4. Effect of Smokeless Tobacco Product Marketing and Use on Population Harm From Tobacco Use... 110
KQ 5. Effectiveness of Prevention and of Cessation Interventions in Populations with Co-Occurring Morbidities and Risk Behaviors ... 110
Methods Recommendations... 111
Conclusions... 111
References and Included Studies ... 113
Figures Figure 1. Overall analytic framework for tobacco use initiation and cessation... 19
Figure 2. Analytic framework for smoking cessation... 20
Figure 3. Tobacco use: prevention, cessation, and control article disposition ... 32
Tables Table 1. Final Key Questions... 17
Table 2. Tobacco use: inclusion/exclusion criteria... 25
Table 3. Medical subject headings and text words* ... 26
Table 4. Modified body of evidence assessment table from Guide to Community Preventive Services... 29
Table 5. Systematic reviews and meta-analysis used for this report ... 33
Table 6. Effective population-based interventions ... 37
Table 7. School-based tobacco prevention program smoking status definitions... 40
Table 8. Effective school-based interventions ... 41
Table 9. Effective provider-based interventions... 48
Table 10. Multicomponent interventions to increase the number of users who quit smoking ... 52
Table 11. Strategies to improve success rates for quit attempts for general and special populations... 58
Table 12. Community strategies to increase the implementation of proven population-level tobacco use cessation strategies ... 72
Table 13. Strategies to increase implementation of population-level tobacco use cessation: provider-based and health care settings ... 75
Table 14. Characteristics and results of studies assessing the effects of smokeless tobacco marketing ... 86
Table 15. Tobacco cessation interventions for persons with co-occurring morbidities and risk behaviors ... 88
Table 16. Characteristics of studies rated poor quality... 107
x Appendixes
Appendix A: Exact Search Strings
Appendix B: Sample Data Abstraction Forms Appendix C: Evidence Tables
Appendix D: List of Excluded Studies Appendix E: Acknowledgments
Appendixes and Evidence Tables for this report are provided electronically at http://www.ahrq.gov/downloads/pub/evidence/pdf/tobaccouse/tobuse.pdf
