A Scoping Review of Implementation Science in Planning and Delivering Tobacco Control Interventions in the United States from 2000 to 2020: Frameworks, Intervention Characteristics, and Health Equity Considerations.

Abstract

Introduction: Evidence-based interventions to reduce tobacco-related morbidity and mortality are not widely or effectively implemented, thereby failing to equitably address disparities in tobacco-related health outcomes. Implementation science (IS) has the potential to advance the impact of tobacco control programs, but its use in this field has not been previously explored. To identify opportunities for expanding tobacco intervention impact, this scoping review investigated the use of IS tools in tobacco control research in the United States.

Method: Using Arksey and O'Malley's approach, seven databases were searched to identify tobacco control studies published from 2000 to 2020 that included implementation frameworks, strategies, outcomes, or other relevant tools. Study titles, abstracts, and full texts were screened for eligibility using dual independent review. Data were extracted in duplicate regarding IS tools, intervention goals and characteristics, and health equity considerations. Results were categorized according to the research questions and then analyzed using descriptive statistics.

Results: A total of 58 papers representing 51 studies met inclusion criteria. The most frequently described IS tools were strategies (n = 51) and outcomes (n = 50), followed by models or frameworks (n = 37). Smoking cessation was the most frequent tobacco control goal (n = 45), followed by prevention (n = 10), and reducing secondhand exposure (n = 10). Twenty studies reported interventions with disadvantaged populations, including two in rural settings.

Conclusions: IS tools were unevenly utilized in tobacco control research in the United States reported from 2000 to 2020. Expanded use of implementation frameworks, strategies, and consistent terminology, and prioritizing health equity could reduce disparities associated with tobacco use in the United States.

Implications: This scoping review provides an overview of implementation science contributions during two decades of tobacco control research. We identified limited use of implementation science frameworks and insufficient information about implementation strategies, whereas attention to context and perspectives of key participants were reported more frequently. Greater integration of implementation science tools and attention to health equity in tobacco control research could enhance the effectiveness of tobacco control interventions and reduce health disparities. Clarifying details of intervention components and strategies could improve the ability to replicate studies and lead to significant improvements in tobacco control outcomes and the field of implementation science.