title: A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups.
abstract: OBJECTIVE
  A systematic review and meta-analysis was conducted to assess the methodological quality and effectiveness of behavioural smoking cessation interventions targeted at six disadvantaged groups; the homeless, prisoners, indigenous populations, at-risk youth, individuals with low socio-economic status and individuals with a mental illness.
  
  
  METHODS
  Medline, EMBASE, the Cochrane Library and PsycInfo databases were searched using MeSH and keywords for studies conducted in developed countries prior to October 2010. Included studies were assessed for methodological quality. A DerSimonian and Laird random effects meta-analysis was conducted where possible to explore the effectiveness of interventions for the different subgroups. A narrative review was conducted for studies unable to be included in the meta-analysis. Outcomes examined were abstinence rates at short-term (up to 3 months) and long-term (6 months or the longest) follow-up.
  
  
  RESULTS
  Thirty-two relevant studies were identified. The majority (n = 20) were rated low in methodological quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at low-income female smokers at short-term follow-up [relative risk (RR) 1.68, confidence interval (CI) 1.21-2.33], and behavioural support interventions targeted at individuals with a mental illness at long-term follow-up (RR 1.35, CI 1.01-1.81). Results of the narrative review showed several promising interventions that increased cessation rates at 6-month or longer follow-up.
  
  
  CONCLUSIONS
  Few well-controlled trials have examined the most effective smoking cessation strategies for highly disadvantaged groups, especially among the homeless, indigenous smokers and prisoners. The use of behavioural smoking cessation interventions for some socially disadvantaged groups appears promising; however, overall findings are inconsistent. Further research is needed to establish the most effective interventions for vulnerable high-risk groups. Special attention should be given to increasing sample size and power, and to sound evaluation methodology to overcome methodological limitations of conducting research with these high-risk groups.
authors.affiliation: Centre for Health Research and Psycho-oncology (CHeRP), The Cancer Council NSW, University of Newcastle and Hunter Medical Research Institute, Callaghan, NSW, Australia. jamie.bryant@newcastle.edu.au
authors.forename: Jamie
authors.initials: J
authors.lastname: Bryant
authors.forename: Billie
authors.initials: B
authors.lastname: Bonevski
authors.forename: Chris
authors.initials: C
authors.lastname: Paul
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: John
authors.initials: J
authors.lastname: Attia
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D018849:Controlled Clinical Trials as Topic; D016206:Databases, Bibliographic; D054624:Health Status Disparities; D006703:Ill-Housed Persons; D006801:Humans; D028642:Persons with Psychiatric Disorders; D009520:New Zealand; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D044382:Population Groups; D011203:Poverty; D011329:Prisoners; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D006113:United Kingdom; D014481:United States; D035862:Vulnerable Populations