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. To evaluate the effectiveness of strategies that help young
people to stop smoking tobacco. 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. 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. 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. 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. 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. Background Worldwide, between 80,000
and 100,000 young people start smoking every day. Many adolescent tobacco programmes
focus on preventing teenagers from starting to smoke, but some programmes have been
aimed at helping those teenagers who are already smoking to quit. We set out to investigate
whether these programmes can help young people quit smoking for six months or longer.
Searches are up to date as of June 2017. Study characteristics We identified 41 studies
(around 13,000 participants) that researched ways of helping teenagers to quit smoking.
These studies were of mixed quality and looked at various methods for stopping smoking,
including one‐to‐one counselling, counselling as part of a group, methods using computers
or text messaging, or a combination of these. Four studies used drug treatments such
as nicotine patches. Most studies recruited participants from schools, and 29 of the
studies were carried out in North America. Key results Although some programmes showed
promise, especially those that used group counselling and those that combined a variety
of approaches, there was no strong evidence that any particular method was effective
in helping young people to stop smoking. Trials differed in how they measured whether
a person had quit smoking, and many trials did not have enough participants for us
to be confident about wider application of the results. Medications such as nicotine
replacement and bupropion were not shown to be successful with adolescents, and some
adverse events were reported, although these events were generally mild and findings
were based on studies with small numbers of participants. Based on these findings
we cannot currently identify a programme for helping adolescents to stop smoking that
is more successful than trying to stop unaided. Quality of the evidence The quality
of evidence was low or very low for all of the outcomes in this review. This is because
of issues with the quality of some of the studies, the small number of studies and
participants for some outcomes, and the differences between the studies.