Effectiveness of family-based behavioral intervention for smoking cessation in low-income households: a systematic review and meta-analysis

Abstract

<h3>Background</h3><p>Smoking-attributable harms are substantial in low-income households. The effectiveness of family-based behavioral interventions for smoking cessation in this population remains uncertain. This review aims to assess the effectiveness of family-based behavioral interventions on smoking cessation in low-income households.</p><h3>Methods</h3><p>This systematic review and meta-analysis were conducted by searching six databases and one clinical trial registry for studies published from inception to 30 January 2024 (with an updated search conducted until 1st January 2025). Randomized controlled trials of family-based behavioral interventions for smoking parents from low-income households, co-living children aged ≤18 years, were included. Data extraction and analysis were independently performed by two investigators following the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Primary outcomes were self-reported 7-day point prevalence abstinence (PPA) or biochemically validated abstinence at 3 months or longer. The Mantel-Haenszel method was used to calculate the relative risk (RR) with random-effect model. The study was registered on PROSPERO (CRD42023466096).</p><h3>Findings</h3><p>Among 22 trials (N = 5292) included in the review, 12 (N = 2782) were analyzed in the meta-analysis. Most of trials (17/22) were of moderate or high quality. Family-based behavioral interventions significantly increased self-reported 7-day PPA (RR:1.70, 95%CI: 1.16–2.48) compared with usual care at follow-ups of 3 months or longer. Behavioral counseling combined with nicotine replacement therapy (NRT) was most effective (RR: 2.45, 95% CI: 1.28–4.68) and for 12-month follow-up (RR: 1.96, 95% CI: 1.44–2.66). Further significant effects were observed in parents of non-asthmatic children (RR: 1.88, 95% CI: 1.39–2.53), parents both smoked (RR: 1.79, 95% CI: 1.23–2.60), and interventions including NRT provision (RR: 1.78, 95% CI: 1.15–2.74).</p><h3>Interpretation</h3><p>Family-based behavioral interventions significantly increased abstinence in low-income households where both parents smoked and pharmacotherapy was included. Interventions that incorporated behavioral counseling with NRT and implemented with a long-term follow-up tended to be more effective.</p>