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A6253 - A Systematic Review of Interventions for Smoking Tobacco in Low Socio-Economic Populations
Author Block: C. B. Charron1, T. Hayes2, S. Pakhale3; 1Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada, 2School of Medicine, University of Ottawa, Ottawa, ON, Canada, 3Division of Respirology, The Ottawa Hospital, Ottawa, ON, Canada.
Background: There is a large amount of evidence confirming that smoking tobacco prevalence is much greater in the homeless, poly-substance user population than in the general population. The health inequities between these populations are widened due to the increased morbidity and mortality related to all smoking related diseases in the lower socio-economic status populations. Spontaneous quitting is negligible in this population. There are to date no well-established interventions to promote tobacco smoking cessation in this vulnerable population.
Objective: To conduct a systematic review to assess the efficacy of smoking tobacco reduction and cessation interventions in populations experiencing homelessness or poverty.
Methods: We conducted data base search in November 2016 and updated it in April 2017, to identify Randomized Controlled Trials (RCT) with the primary outcome of smoking tobacco cessation in low socioeconomic populations. The search was conducted in Embase and Medline and included RCT published between 1946 and 2017.
Results: The search yielded 1340 articles, 32 of which met inclusion and exclusion criteria (Inclusion: 1. RCT, 2. Low income/homeless/lower socio-economic status 3.Tobacco dependence intervention, end point is quitting or reducing tobacco smoking 4. Tobacco dependant adults. Exclusion: 1.No abstract or article available 2. Secondary analysis or study protocol 3. Not active smokers 4. In treatment centres (rehab, hospitals). Two independent reviewers selected articles after screening the titles and abstracts; and then they extracted the data. A third reviewer resolved any discrepancy. We also examined the back references of the included articles for any new studies. Due to significant heterogeneity, meta-analysis could not be performed. A variety of interventions were studied in this population, some of which included nicotine replacement therapy, counselling sessions, and behavioural interventions. Several of these interventions demonstrated significantly increased biochemically-verified smoking abstinence rates. Some studies, such an internet-based smoking cessation advice intervention, were specifically tailored for low-socioeconomic-status populations and demonstrated efficacy while being economically viable.
Conclusions: While the smoking cessation interventions were heterogenous, there were interventions that demonstrated significant improvement in tobacco smoking abstinence rates among homeless, polysubstance using populations. These interventions have the potential to reduce the health inequity between this group and the general population. Future projects should include community-based participatory research to determine which interventions are the most acceptable and feasible to specific communities and should assess the long-term sustainability of interventions.