title: Interventions for smokeless tobacco use cessation.
abstract: BACKGROUND
  Use of smokeless tobacco (ST) can lead to nicotine addiction and health problems including periodontal disease and oral cancer
  
  
  OBJECTIVE
  To assess the effects of behavioural and pharmacotherapeutic interventions to treat ST use.
  
  
  METHODS
  We searched the Cochrane Tobacco Addiction Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966-February 2004), EMBASE (1988-January 2004), CINAHL (1982-February 2004), PsycINFO (1984-February 2004), Database of Abstract of Reviews of Effectiveness (DARE, The Cochrane Library, Issue 1, 2004).
  
  
  METHODS
  Randomized trials of behavioural or pharmacological interventions to help users of ST to quit, with follow-up of at least six months.
  
  
  METHODS
  Two authors independently extracted data.
  
  
  RESULTS
  One trial of bupropion did not detect a benefit of treatment after six months (Odds Ratio (OR) 1.00, 95% Confidence Interval (CI): 0.23 to 4.37). Three trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to 1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to 1.63). There was statistical heterogeneity among the results of eight trials of behavioural interventions included in the meta-analysis. Three trials showed significant benefits of intervention. In a post-hoc analysis the trials of interventions which included an oral examination and feedback about ST-induced mucosal changes had homogeneous results and when pooled showed a significant benefit (OR 2.41 95% CI: 1.79 to 3.24).
  
  
  CONCLUSIONS
  Behavioural interventions should be used to help ST users to quit. Pharmacotherapies have not been shown to affect long-term abstinence but larger trials are needed.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. ebbert.jon@mayo.edu
authors.forename: J O
authors.initials: JO
authors.lastname: Ebbert
authors.forename: L C
authors.initials: LC
authors.lastname: Rowland
authors.forename: V
authors.initials: V
authors.lastname: Montori
authors.forename: K S
authors.initials: KS
authors.lastname: Vickers
authors.forename: P C
authors.initials: PC
authors.lastname: Erwin
authors.forename: L C
authors.initials: LC
authors.lastname: Dale
authors.forename: L F
authors.initials: LF
authors.lastname: Stead
mesh_terms: D016642:Bupropion / Q000627:therapeutic use; D003376:Counseling; D006801:Humans; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D020340:Tobacco Use Cessation / Q000379:methods*; D014030:Tobacco, Smokeless
chemical_list: D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine