© 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006. Objectives: To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. Search methods: We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO. Selection criteria: We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline. Data collection and analysis: Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up. Main results: Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias. Authors' conclusions: There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

Tobacco cessation interventions for young people

Approach bias modification training and consumption: A review of the literature.

Cognitive Bias Modification (CBM) refers to a family of interventions targeting substance-related cognitive biases, which have been found to play a role in the maintenance of addictive behaviors. In this study, we conducted a Bayesian meta-analysis of individual patient data from studies investigating the effects of CBM as a behavior change intervention for the treatment of alcohol and tobacco use disorders, in individuals aware of the behavior change goal of the studies. Main outcomes included reduction in the targeted cognitive biases after the intervention and in substance use or relapse rate at the short-to-long term follow-up. Additional moderators, both at the study-level (type of addiction and CBM training) and at the participant-level (amount of completed training trials, severity of substance use), were progressively included in a series of hierarchical mixed-effects models. We included 14 studies involving 2435 participants. CBM appeared to have a small effect on cognitive bias (0.23, 95% credible interval = 0.06–0.41) and relapse rate (−0.27, 95% credible interval = −0.68 – 0.22), but not on reduction of substance use. Increased training practice showed a paradoxical moderation effect on relapse, with a relatively lower chance of relapse in the control condition with increased practice, compared to the training condition. All effects were associated with extremely wide 95% credible intervals, which indicate the absence of enough evidence in favor or against a reliable effect of CBM on cognitive bias and relapse rate in alcohol and tobacco use disorders. Besides the need for a larger body of evidence, research on the topic would benefit from a stronger adherence to the current methodological standards in randomized controlled trial design and the systematic investigation of shared protocols of CBM.

https://link.springer.com/content/pdf/10.1007%2Fs11065-018-9386-4.pdf

Cognitive Bias Modification for Behavior Change in Alcohol and Smoking Addiction: Bayesian Meta-Analysis of Individual Participant Data.

Biased approach-avoidance tendencies in psychopathology: A systematic review of their assessment and modification.

OBJECTIVE: To assess the efficacy of a multiple-sessions Web-based Attentional Bias Modification (ABM) self-help intervention in 434 smokers who made a quit-attempt. METHOD: Respondents were randomized to receive 6 sessions of ABM- or placebo-training in a period of 2 weeks. Smoking-related cognitions (e.g., self-efficacy and intention to quit) and cognitive biases (i.e., attentional and approach bias) for smoking-cues were assessed before training (pretest). Primary outcome-variable was continued abstinence, 6 months after baseline. Bias reduction at the posttraining assessment was the secondary outcome. A 2 × 2 mixed analysis of variance (ANOVA) and logistic regression analyses were conducted using the whole sample (N = 434) as well as subsamples of light to moderate smokers (<15 cigarettes, N = 115) and heavy smokers (15 or more cigarettes, N = 319). Conservative analyses (coding drop-outs as smokers) as well as complete case analyses were conducted. RESULTS: The ABM training had no significant effect regarding bias reduction and no behavioral effects in the whole sample of smokers. Subsample analyses revealed a significant positive effect on continued abstinence in heavy smokers only (complete case analyses: odds ratio [OR] = 3.15; p = .02; confidence interval [CI] = 1.24-7.99; conservative analyses: OR = 2.49; p = .02; CI = 1.13-5.48). CONCLUSION: Web-based ABM training is ineffective in fostering cognitive bias reduction and continued smoking abstinence. However, the positive effects in heavy smokers-as indicated by exploratory subsample analyses-warrant further research into the potential of multiple sessions ABM training to foster continued smoking abstinence in heavy smokers who make a quit-attempt. (PsycINFO Database Record

/pdf/a-randomized-controlled-trial-of-web-based-attentional-bias-45q6lpikev.pdf

A randomized controlled trial of Web-based Attentional Bias Modification to help smokers quit.

Background: This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) c...

/pdf/re-training-automatic-action-tendencies-to-approach-4zc23k3c9o.pdf

Annemat Collot D’Escury-Koenigs

Papers

Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study

Cognitive bias modification combined with cognitive behavioral therapy: A smoking cessation intervention for adolescents