Interventions for smokeless tobacco use cessation.
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.
Ebbert
J O
JO
Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. ebbert.jon@mayo.edu
Rowland
L C
LC
Montori
V
V
Vickers
K S
KS
Erwin
P C
PC
Dale
L C
LC
Stead
L F
LF
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
D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine