Helping teens quit: A systematic review and network meta-analysis of smoking cessation interventions

Objective: Adolescent smoking remains a significant public health concern. Effective smoking cessation interventions tailored for adolescents are essential, yet evidence comparing different strategies remains limited. We aimed to compare the effectiveness of various smoking cessation interventions for adolescents using a network meta-analysis (NMA) approach. Study design: Systematic review and network meta-analysis. Methods: We searched PubMed, EMBASE, CENTRAL, CINAHL, and PsycINFO from their inception to February 28, 2024. Randomized controlled trials comparing smoking cessation interventions for adolescents were included if they reported biochemical verification of smoking abstinence. Two pairs of researchers independently conducted the study selection. NMA was performed using a random-effects model in a frequentist framework. The quality of the included studies was assessed using Cochrane's Risk of Bias 2.0 tool. (PROSPERO CRD420251001010). Results: Twelve studies were included. No intervention demonstrated clear superiority over usual care or other comparators. Cognitive behavioral therapy (CBT)-based, CBT combined with nicotine replacement therapy (NRT), and Non-NRT interventions showed higher short-term abstinence (≤6 months) compared with usual care (UC), with relative risks (RRs) and 95% confidence intervals (CIs) of 2.31 (95%CI: 1.59-3.35), 2.44 (95%CI: 1.16-5.16), and 1.57 (95%CI: 1.09-2.28), respectively. However, these findings were based on very low-certainty evidence and were not sustained at longer follow-up. Conclusions: The evidence base for adolescent smoking cessation is limited and heterogeneous. While some interventions may offer short-term benefits, there is no robust evidence of sustained effectiveness beyond six months. High-quality trials are needed to establish effective long-term strategies.