Smoking Cessation Interventions in Arab Populations: A Systematic Review
Creators: name: Abraham, Kathryn
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Background: Smoking is the leading preventable cause of death around the world. Arab populations have traditionally high smoking rates, and the influx of Arab immigrants to countries around the world can amplify the health disparities in this population. Primary care providers in areas with prominent Arab populations must develop a clear understanding of how to provide cessation support in a culturally appropriate and effective manner. Objectives: To review the literature on the efficacy and comparative effectiveness of smoking cessation interventions for Arab adults living in the Middle East. Eligibility Criteria: English language smoking cessation trials at clinics treating adult Arab smokers in Middle Eastern countries with follow-up after at least 6 months; behavioral, pharmacological, and combined interventions were eligible. Data Sources: PubMed and Scopus were systematically searched for relevant articles published between January 1990 and December 2015. Data Abstraction: One reviewer abstracted relevant data and performed a quality assessment of each included study. Data Synthesis: The review of the literature yielded 517 unique titles and abstracts; 46 abstracts appeared eligible and were reviewed at the full-text stage. Of these, 7 studies met full eligibility criteria; 2 were rated as good quality and the others were rated as fair quality. Studies enrolled populations from Arab countries and interventions were generally set in outpatient settings. Two were randomized trials and five were pre-post studies. One study assessed a pharmacological intervention and all others assessed combination therapy. Studies assessed a range of pharmacologic agents, including: centrally-acting medicines (varenicline and bupropion), and nicotine replacement therapies, including nicotine patches, gum, and tablets. Behavioral interventions included brief counseling, seminars, weekly meetings, and follow-up activities. Limitations: A small body of literature was available, with very few randomized trials. Interventions and enrolled populations were heterogeneous, which made comparisons of quit rates difficult. This review's scope only included English articles. Conclusions and Implications of Key Findings: Using nicotine gum had a statistically significant improvement compared with the naltrexone and clonidine interventions at 6 months (RR 6.31; 95% CI 2.65, 15.06). 59 No difference was found between the patches, gum, and tablets groups at 12 months. However, the use of patches and gum had a statistically significant improvement compared to a single nicotine replacement therapy (RR 1.86; 95% CI 1.28, 2.72). 58 In the 5 pre-post studies, quit rates from baseline ranged from 12.9% to 34.6% over 6 months to 5 years. In Middle Eastern countries, additional research is needed regarding cultural components of interventions and methods of behavioral work. The development of culturally appropriate smoking cessation programs is vital for the provision of holistic care to Arab migrants and refugees.