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Smoking-Cessation Interventions in Appalachia: A Systematic Review and Meta-Analysis

Published:November 16, 2019DOI:https://doi.org/10.1016/j.amepre.2019.09.013

      Context

      Appalachia, a socioeconomically disadvantaged rural region in the eastern U.S., has one of the nation's highest prevalence rates of smoking and some of the poorest health outcomes. Effective interventions that lower smoking rates in Appalachia have great potential to reduce health disparities and preventable illness; however, a better understanding of effective interventions is needed.

      Evidence acquisition

      This review included trials that evaluated the impact of smoking-cessation programs among populations living in Appalachia. The search was carried out on October 9, 2018 and comprised the Cochrane Central Register of Controlled Trials, Medline, Embase, and Scopus for academic journal articles published in English, with no date restrictions. After preliminary screening, potentially relevant full-text articles were independently reviewed by the authors with a Cohen's κ of 0.72, leading to the final inclusion of 9 articles.

      Evidence synthesis

      Eligible studies were assessed qualitatively for heterogeneity and risk of bias. Six of the 9 included studies had extractable data related to dichotomous smoking status and reported a measure of association suitable for inclusion in a meta-analysis. For those 6 studies, the pooled RR and pooled OR were estimated using random effects models, with an I2 index demonstrating substantial heterogeneity. A funnel plot of the 6 trials appeared relatively symmetric.

      Conclusions

      Participation in smoking-cessation interventions increased the probability of smoking abstinence among Appalachian smokers by an estimated 2.33 times (pooled RR=2.33, 95% CI=1.03, 5.25, p=0.04). Given the low number of studies, their substantial heterogeneity, and high risk of bias, the evidence of the effectiveness of smoking-cessation interventions in Appalachia must be interpreted with caution.
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      REFERENCES

        • GBD 2015 Tobacco Collaborators
        Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015.
        Lancet. 2017; 389: 1885-1906
        • Centers for Disease Control and Prevention (CDC)
        Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older.
        CDC, Atlanta, GA2018
        • Appalachian Regional Commission
        Appalachia Then and Now: Examining Changes to the Appalachian Region Since 1965.
        Appalachian Regional Commission, Washington, DC2015
        • Appalachian Regional Development Initiative
        Economic assessment of Appalachia.
        Published June 2010
        • Pickle LW
        • Su Y
        Within-state geographic patterns of health insurance coverage and health risk factors in the United States.
        Am J Prev Med. 2002; 22: 75-83
        • Singh GK
        • Kogan MD
        • Slifkin RT
        Widening disparities in infant mortality and life expectancy between Appalachia and the rest of the United States, 1990–2013.
        Health Aff (Millwood). 2017; 36: 1423-1432
        • U.S. Department of Health and Human Services (HHS)
        The Health Consequences of Smoking—50 years of Progress: A Report of the Surgeon General.
        HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
      1. Higgins J, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. Chichester, UK: John Wiley & Sons; 2011.

        • Appalachian Regional Commission
        Counties in Appalachia.
        Published 2019
        • McHugh ML
        Interrater reliability: the kappa statistic.
        Biochem Med (Zagreb). 2012; 22: 276-282
        • Rao JN
        • Scott AJ
        A simple method for the analysis of clustered binary data.
        Biometrics. 1992; 48: 577-585
        • Donner A
        • Klar N
        Issues in the meta-analysis of cluster randomized trials.
        Stat Med. 2002; 21: 2971-2980
        • Harris M
        • Reynolds B
        A pilot study of home-based smoking cessation programs for rural, Appalachian, pregnant smokers.
        J Obstet Gynecol Neonat Nurs. 2015; 44: 236-245
        • Wewers ME
        • Ferketich AK
        • Harness J
        • Paskett ED
        Effectiveness of a nurse-managed, lay-led tobacco cessation intervention among Ohio Appalachian women.
        Cancer Epidemiol Biomarkers Prev. 2009; 18: 3451-3458
        • Stoops WW
        • Dallery J
        • Fields NM
        • et al.
        An internet-based abstinence reinforcement smoking cessation intervention in rural smokers.
        Drug Alcohol Depend. 2009; 105: 56-62
        • Schoenberg NE
        • Studts CR
        • Shelton BJ
        • et al.
        A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents.
        Prev Med Rep. 2016; 3: 317-323
        • Siddiqui O
        • Hedeker D
        • Flay BR
        • Hu FB
        Intraclass correlation estimates in a school-based smoking prevention study. Outcome and mediating variables, by sex and ethnicity.
        Am J Epidemiol. 1996; 144: 425-433
        • Hannan PJ
        • Murray DM
        • Jacobs Jr, DR
        • McGovern PG
        Parameters to aid in the design and analysis of community trials: intraclass correlations from the Minnesota Heart Health Program.
        Epidemiology. 1994; 5: 88-95
        • Huedo-Medina TB
        • Sánchez-Meca J
        • Marín-Martínez F
        • Botella J
        Assessing heterogeneity in meta-analysis: Q statistic or I2 index?.
        Psychol Methods. 2006; 11: 193-206
        • L'Abbe KA
        • Detsky AS
        • O'Rourke K
        Meta-analysis in clinical research.
        Ann Intern Med. 1987; 107: 224-233
        • Song F
        Exploring heterogeneity in meta-analysis: is the L'Abbe plot useful?.
        J Clin Epidemiol. 1999; 52: 725-730
        • Rothman KJ
        • Greenland S
        • Lash TL
        Modern Epidemiology.
        Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, PA2008
        • Schwarzer G
        meta: an R package for meta-analysis.
        R News. 2007; 7: 40-45
        • Wewers ME
        • Shoben A
        • Conroy S
        • et al.
        Effectiveness of two community health worker models of tobacco dependence treatment among community residents of Ohio Appalachia.
        Nicotine Tob Res. 2017; 19: 1499-1507
        • Reynolds B
        • Harris M
        • Slone SA
        • et al.
        A feasibility study of home-based contingency management with adolescent smokers of rural Appalachia.
        Exp Clin Psychopharmacol. 2015; 23: 486-493
        • Cropsey KL
        • Hendricks PS
        • Jardin B
        • et al.
        A pilot study of Screening, Brief Intervention, and Referral for Treatment (SBIRT) in non-treatment seeking smokers with HIV.
        Addict Behav. 2013; 38: 2541-2546
        • Ferketich AK
        • Pennell M
        • Seiber EE
        • et al.
        Provider-delivered tobacco dependence treatment to Medicaid smokers.
        Nicotine Tob Res. 2014; 16: 786-793
        • Horn K
        • Branstetter S
        • Zhang J
        • et al.
        Understanding physical activity outcomes as a function of teen smoking cessation.
        J Adolesc Health. 2013; 53: 125-131
        • Taylor GMJ
        • Dalili MN
        • Semwal M
        • Civljak M
        • Sheikh A
        • Car J
        Internet-based interventions for smoking cessation.
        Cochrane Database Syst Rev. 2017; 9CD007078
        • Lancaster T
        • Stead LF
        Individual behavioural counselling for smoking cessation.
        Cochrane Database Syst Rev. 2017; 3CD001292
        • Hartmann-Boyce J
        • Chepkin SC
        • Ye W
        • Bullen C
        • Lancaster T
        Nicotine replacement therapy versus control for smoking cessation.
        Cochrane Database Syst Rev. 2018; 5CD000146
        • Richardson M
        • Garner P
        • Donegan S
        Cluster randomised trials in Cochrane Reviews: evaluation of methodological and reporting practice.
        PLoS One. 2016; 11e0151818
        • Cornuz J
        Smoking cessation interventions in clinical practice.
        Eur J Vasc Endovasc Surg. 2007; 34: 397-404
        • Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff
        A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report.
        Am J Prev Med. 2008; 35: 158-176
        • Roberts ME
        • Doogan NJ
        • Stanton CA
        • et al.
        Rural versus urban use of traditional and emerging tobacco products in the United States, 2013–2014.
        Am J Public Health. 2017; 107: 1554-1559
        • Cheng YC
        • Rostron BL
        • Day HR
        • et al.
        Patterns of use of smokeless tobacco in US adults, 2013–2014.
        Am J Public Health. 2017; 107: 1508-1514