A systematic review of smoking cessation interventions tested among Indigenous populations in the United States

Abstract

Introduction

Smoking remains highly prevalent among Indigenous populations in the U.S., contributing to cardiovascular and cancer health disparities. Tailored smoking cessation interventions can reduce these disparities among Indigenous people, but the current evidence regarding the effectiveness of such extant interventions is unclear. This review aimed to collate evidence about the smoking cessation interventions tested among Indigenous groups in the U.S.

Methods

The study systematically searched PubMed, EMBASE, and Web of Science in September 2023 for experimental or quasi-experimental studies of smoking cessation interventions among Indigenous adults in the U.S. The Cochrane guidelines assessed study bias. Outcomes included self-reported and bio-verified smoking abstinence.

Results

The review included eight studies, comprising 7 randomized control trials (RCTs) and 1 quasi-experimental trial evaluating multi-component interventions. The interventions included counseling, education, cultural tailoring, pharmacotherapy, mobile medical apps, and social media. The smoking abstinence outcomes varied. Four RCTs found no significant differences in self-reported or bio-verified abstinence between groups. Two RCTs showed significantly higher self-reported abstinence with culturally tailored interventions, while two postpartum RCTs found no difference between groups. The one-group quasi-experimental study showed a retention rate of 71 % and an abstinence rate of 31 % at 6-month follow-up. While results appear promising for tailored, multi-faceted approaches, abstinence differences between interventions and control groups overall remain inconsistent.

Conclusions

This review suggests that culturally tailored, technology-assisted smoking cessation interventions that strategically utilize pharmacotherapies may hold promise for U.S. Indigenous populations. However, the review emphasizes the need to test large-scale interventions that utilize more personalized strategies and community-based participatory approaches as well as the need for experimental trials that bio-verify abstinence.