Interventions for smokeless tobacco use cessation.
BACKGROUND
Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease and cancer.


OBJECTIVE
To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: March, 2007.


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
Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (Odds Ratio (OR) 0.86, 95% Confidence Interval (CI): 0.47 to 1.57). Four 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 12 behavioural interventions included in the meta-analyses. Six trials showed significant benefits of intervention. In post-hoc subgroup analyses, behavioural interventions which include telephone counselling or an oral examination may increase abstinence rates more than interventions without these components.


CONCLUSIONS
Behavioural interventions should be used to help ST users to quit and telephone counselling or an oral examination may increase abstinence rates. Pharmacotherapies have not been shown to affect long-term abstinence.
Ebbert
J O
JO
Mayo Clinic, Department of Internal Medicine, 200 1st Street Southwest, Rochester, MN 55905, USA. ebbert.jon@mayo.edu
Montori
V
V
Vickers
K S
KS
Erwin
P C
PC
Dale
L C
LC
Stead
L F
LF
D016642:Bupropion / Q000627:therapeutic use; D002638:Chewing Gum; 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
D002638:Chewing Gum; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine