The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals.

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Investigating alexithymia in autism: A systematic review and meta-analysis

European Psychiatry ◽

10.1016/j.eurpsy.2018.09.004 ◽

2019 ◽

Vol 55 ◽

pp. 80-89 ◽

Cited By ~ 29

Author(s):

Emma Kinnaird ◽

Catherine Stewart ◽

Kate Tchanturia

Keyword(s):

Systematic Review ◽

Emotional Processing ◽

Meta Analysis ◽

Autism Spectrum ◽

Autistic People ◽

Increased Risk ◽

Popu Lations ◽

Specific Subgroup ◽

New Research ◽

Meta Analyses

AbstractBackground:New research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).Methods:Online scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.Results:15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.Conclusions:This review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.

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Abstract 16037: Hybrid Convergent Ablation for Atrial Fibrillation: Updated Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.16037 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

suvash shrestha ◽

David DeLurgio ◽

Andy Kiser ◽

Saumil Oza ◽

Yisachar Greenberg ◽

...

Keyword(s):

Systematic Review ◽

Patient Monitoring ◽

Event Rate ◽

Meta Analysis ◽

Adverse Event Rate ◽

Likelihood Estimator ◽

Search Terms ◽

Limited Effectiveness ◽

One Year ◽

Meta Analyses

Introduction: Hybrid convergent epicardial/endocardial ablation was developed in response to the limited effectiveness of endocardial catheter ablation for persistent (PersAF) and longstanding PersAF (LSPAF). The objective of this study was to perform a systematic review and meta-analysis of reported safety and efficacy outcomes with convergent procedures. Methods: Predefined search terms were used in PubMed; the initial search was performed in June 2019 and updated in May 2020. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test. Results: The updated search yielded 325 unique results. Two articles from meta-analyses were added. Nineteen articles met inclusion with safety and/or efficacy data. Three overlapping studies were excluded. Results from the randomized CONVERGE trial were added, for a total of 1084 patients in 17 studies; 94% had PersAF or LSPAF. The 30-day major adverse event rate was 3.1% (95% CI 1.9% - 4.3%; n=1084; 17 studies), excluding pericardial effusions (PE) (non-emergent inflammatory response) and 5.1% (95% CI 3.6% - 6.6%) overall. The PEs may be mitigated by anti-inflammatory prophylaxis, pericardial drainage and appropriate patient monitoring. Freedom from AF/atrial arrhythmia at one year or later was 75.0% (95% CI 66.0%-83.9%; n=805; 14 studies) regardless of anti-arrhythmic drugs (AAD) and 64.9% (95% CI 54.7%-75.1%; n=494; 8 studies) off AADs/ absent increased dosage of failed AADs. Heterogeneity across studies was detected for effectiveness (p<0.0001), but not for safety (p=0.12). Conclusions: This meta-analysis shows high efficacy of hybrid convergent ablation at one year, even off AADs, and a reasonable safety in mostly persistent or long-standing persistent AF.

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Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.182717 ◽

2017 ◽

Vol 210 (6) ◽

pp. 387-395 ◽

Cited By ~ 113

Author(s):

Gregory Carter ◽

Allison Milner ◽

Katie McGill ◽

Jane Pirkis ◽

Nav Kapur ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Meta Analysis ◽

Modifiable Risk Factors ◽

High Quality ◽

Policy Makers ◽

Predictive Values ◽

Effective Interventions ◽

Self Harm ◽

Meta Analyses

BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3–22.3%) for high-quality studies, 32.5% (95% CI 26.1–39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5–35.6%) for psychiatric in-patients.ConclusionsNo ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.

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Reciprocity explains food sharing in humans and other primates independent of kin selection and tolerated scrounging: a phylogenetic meta-analysis

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2013.1615 ◽

2013 ◽

Vol 280 (1768) ◽

pp. 20131615 ◽

Cited By ~ 78

Author(s):

Adrian V. Jaeggi ◽

Michael Gurven

Keyword(s):

Meta Analysis ◽

Relative Effect ◽

Independent Study ◽

Food Sharing ◽

Effect Sizes ◽

Cognitive Constraints ◽

Helping Behaviour ◽

Weighted Effect Size ◽

Weighted Effect ◽

Meta Analyses

Helping, i.e. behaviour increasing the fitness of others, can evolve when directed towards kin or reciprocating partners. These predictions have been tested in the context of food sharing both in human foragers and non-human primates. Here, we performed quantitative meta-analyses on 32 independent study populations to (i) test for overall effects of reciprocity on food sharing while controlling for alternative explanations, methodological biases, publication bias and phylogeny and (ii) compare the relative effects of reciprocity, kinship and tolerated scrounging, i.e. sharing owing to costs imposed by others. We found a significant overall weighted effect size for reciprocity of r = 0.20–0.48 for the most and least conservative measure, respectively. Effect sizes did not differ between humans and other primates, although there were species differences in in-kind reciprocity and trade. The relative effect of reciprocity in sharing was similar to those of kinship and tolerated scrounging. These results indicate a significant independent contribution of reciprocity to human and primate helping behaviour. Furthermore, similar effect sizes in humans and primates speak against cognitive constraints on reciprocity. This study is the first to use meta-analyses to quantify these effects on human helping and to directly compare humans and other primates.

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Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.18255 ◽

2020 ◽

Author(s):

Alexandra Rhodes ◽

Andrea D. Smith ◽

Paul Chadwick ◽

Helen Croker ◽

Clare H. Llewellyn

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Weight Gain ◽

Meta Analysis ◽

Risk Of Bias ◽

Dietary Behaviors ◽

User Engagement ◽

Digital Interventions ◽

Effective Interventions ◽

Meta Analyses

BACKGROUND Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. OBJECTIVE This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. METHODS A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. RESULTS In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the <i>goals and planning</i>, and <i>feedback and monitoring</i> domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. CONCLUSIONS In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.

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Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/18255 ◽

2020 ◽

Vol 8 (7) ◽

pp. e18255

Author(s):

Alexandra Rhodes ◽

Andrea D Smith ◽

Paul Chadwick ◽

Helen Croker ◽

Clare H Llewellyn

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Weight Gain ◽

Meta Analysis ◽

Risk Of Bias ◽

Dietary Behaviors ◽

User Engagement ◽

Digital Interventions ◽

Effective Interventions ◽

Meta Analyses

Background Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.

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An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network Meta-Analysis (Preprint)

10.2196/preprints.11086 ◽

2018 ◽

Author(s):

Brian W Slattery ◽

Stephanie Haugh ◽

Laura O'Connor ◽

Kady Francis ◽

Christopher P Dwyer ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Mobile Apps ◽

Meta Analysis ◽

Pain Interference ◽

Management Interventions ◽

Effective Interventions ◽

Reduction Of Pain ◽

Electronic Health ◽

Meta Analyses

BACKGROUND Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. OBJECTIVE The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. METHODS Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. RESULTS The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43% chance that mobile apps delivered the most effective interventions, followed by a 34% chance that interventions delivered via virtual reality were the most effective. CONCLUSIONS This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge.

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Elimination and Reduction of Harmful Substances in Cigarette Smoke, Using Nanomaterials: Study Protocol for a Systematic Review

10.21203/rs.3.rs-1173417/v1 ◽

2021 ◽

Author(s):

Mohammad Hossein Chalak ◽

Soqrat Omari Shekaftik ◽

Hossein Jafari ◽

Hamid Reza Ghaffari ◽

Sakineh Dadipoor ◽

...

Keyword(s):

Systematic Review ◽

Cigarette Smoke ◽

Systematic Reviews ◽

Meta Analysis ◽

Evaluation Methodology ◽

Toxic Substances ◽

Assessment Development ◽

Effective Interventions ◽

Harmful Substances ◽

Meta Analyses

Abstract Background Cigarette smoke is an aerosol containing more than thousands of chemical compounds, several of which are carcinogens and toxic. Many efforts have been made to use nanomaterials (NMs) to remove and filter toxic substances in cigarette smoke. Due to the characteristics of MLs and their selectivity to different compounds, NMs have a high potential for practical application in reducing harmful compounds in cigarette smoke. The objective of this systematic review is to collect, combine, and analyze the basic intervention research on NMs for removal and reduction of harmful substances in cigarette smoke. This systematic review will determine the most important factors and expected characterizations for the development or commercialization of a new filters. Finally, we will review the challenges of using NMs-based interventions. Methods This protocol is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P protocol and Cochrane methodology. The inclusion/exclusion criteria are determined based on PICOTS (Population, Intervention, Comparator, Outcome, Time, Study Design) Framework. The Comprehensive literature searches will be conducted in international databases such as PubMed, Scopus, Science Direct and 3Iranian database, including SID, Iranmedex and Magiran. The quality of the papers and the risk of bias will be assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. The results will be presented in the text as well as in a table and figure based on the SWiM guidelines (Synthesis Without Meta-analysis). the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and guidelines will be tracked to certify a robustness and reproducibility of the process. Discussion A comprehensive analysis of the studies conducted in this field can identify research needs, examine the current and expected situation, provide the necessary parameters for research and development of new filters and ultimately determine the effective priorities for further effective interventions.

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The prevalence of substance use disorders and substance use in anorexia nervosa: a systematic review and meta-analysis

Journal of Eating Disorders ◽

10.1186/s40337-021-00516-3 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Daniel J. Devoe ◽

Gina Dimitropoulos ◽

Alida Anderson ◽

Anees Bahji ◽

Jordyn Flanagan ◽

...

Keyword(s):

Systematic Review ◽

Substance Use ◽

Anorexia Nervosa ◽

Drug Abuse ◽

Binge Eating ◽

Substance Use Disorders ◽

Meta Analysis ◽

English Summary ◽

High Prevalence ◽

Meta Analyses

Abstract Aim Individuals with anorexia nervosa (AN) often present with substance use and substance use disorders (SUDs). However, the prevalence of substance use and SUDs in AN has not been studied in-depth, especially the differences in the prevalence of SUDs between AN types [e.g., AN-R (restrictive type) and AN-BP (binge-eating/purge type]. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of SUDs and substance use in AN samples. Method Systematic database searches of the peer-reviewed literature were conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from inception to January 2021. We restricted review eligibility to peer-reviewed research studies reporting the prevalence for either SUDs or substance use in individuals with AN. Random-effects meta-analyses using Freeman–Tukey double arcsine transformations were performed on eligible studies to estimate pooled proportions and 95% confidence intervals (CIs). Results Fifty-two studies met the inclusion criteria, including 14,695 individuals identified as having AN (mean age: 22.82 years). Random pooled estimates showed that substance use disorders had a 16% prevalence in those with AN (AN-BP = 18% vs. AN-R = 7%). Drug abuse/dependence disorders had a prevalence of 7% in AN (AN-BP = 9% vs. AN-R = 5%). In studies that looked at specific abuse/dependence disorders, there was a 10% prevalence of alcohol abuse/dependence in AN (AN-BP = 15% vs. AN-R = 3%) and a 6% prevalence of cannabis abuse/dependence (AN-BP = 4% vs. AN-R = 0%). In addition, in terms of substance use, there was a 37% prevalence for caffeine use, 29% prevalence for alcohol use, 25% for tobacco use, and 14% for cannabis use in individuals with AN. Conclusion This is the most comprehensive meta-analysis on the comorbid prevalence of SUDs and substance use in persons with AN, with an overall pooled prevalence of 16%. Comorbid SUDs, including drugs, alcohol, and cannabis, were all more common in AN-BP compared to AN-R throughout. Therefore, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN. Finally, clinicians should consider screening for SUDs and integrating treatments that target SUDs in individuals with AN. Plain English Summary Individuals with anorexia nervosa (AN) may also present with substance use or have a substance use disorder (SUDs). Thus, we conducted a systematic review and meta-analysis to determine the prevalence of substance use and substance use disorders in individuals with AN. We examined published studies that reported the prevalence of either substance use or SUDs in individuals with AN. We found that substance use disorders had a 16% prevalence and that drug abuse/dependence disorders had a prevalence of 7% in those with AN. These rates were much higher in individuals with binge-eating/purging type compared to the restrictive AN. However, many specific substance use disorders and substance use types were low in individuals with AN. Nonetheless, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN.

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Abstract 14945: Electronic Cigarettes Are Effective for Smoking Cessation: Evidence From a Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.130.suppl_2.14945 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Muhammad A Rahman ◽

Nicholas R Hann ◽

Andrew M Wilson ◽

George Mnatzaganian ◽

Linda Worrall-Carter

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Electronic Cigarettes ◽

Meta Analysis ◽

Publication Date ◽

Cross Sectional ◽

Random Effects Models ◽

Effective Interventions ◽

Randomised Controlled ◽

Meta Analyses

Introduction: Smoking is the leading cause of preventable death worldwide. Finding effective interventions for smoking cessation has proven difficult and existing interventions have limited consumer appeal. Electronic cigarettes (e-cigarettes) are becoming increasingly popular and a possible role for them in smoking cessation is being debated. Our objective was therefore to analyse existing research to investigate whether use of e-cigarettes is an effective smoking cessation method. Hypothesis: We assessed the hypothesis that use of e-cigarettes is an effective smoking cessation method. Methods: A systematic review of articles in English of any publication date was conducted by searching PubMed, Web of Knowledge and Scopus databases. Published studies investigating the effectiveness of e-cigarettes for smoking cessation among current smokers were included. Studies were systematically reviewed, and meta-analyses were conducted using the Mantel-Haenszel fixed-effect and random-effects models. Heterogeneity and quality of the selected studies were also evaluated. Results: Six studies were selected, including two randomised controlled trials, two cohort studies and two cross-sectional studies, and included 7,551 participants. Meta-analyses included 1,242 participants on whom complete smoking cessation data was available. Of these, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled Effect Size of 0.20 (95%CI 0.11-0.28). Nicotine filled e-cigarettes were more effective in achieving cessation compared to those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Use of e-cigarettes was also effective in reducing smokers’ daily cigarette consumption. The studies included were heterogeneous, (I 2 =93%, p<0.001). A meta-regression model showed that 98% of this heterogeneity was caused by study design and gender variation. Conclusions: In conclusion, available literature suggests that the use of e-cigarettes may be an effective alternate smoking cessation method. Further research is required to investigate this among both genders.

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