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. 2022 Nov 3;20:84. doi: 10.18332/tid/153972

Table 3.

Factors associated with tobacco cessation programs effectiveness in the Middle East

Authors Country Year Type of study Aim of the study Outcome (s) reported (%) Factors associated with program’s effectiveness
Yilmaz et al.42 Turkey 2006 Randomized control trial To determine if mothers receiving a SC program that focuses on health risks of environmental tobacco smoking (ETS) for their kids have higher quit rate compared to mothers who received SC program that focuses on their own health, or control group mothers. Quit rate

  • Child intervention: 24.3%

  • Mother intervention: 13%

  • Control: 0.8%

  • Discussion about the health effects of smoking on children and/or parents

  • Maternal education
Ybarra et al.35 Turkey 2012 Randomized control trial To report cessation rates observed in a messaging-base SC program for adult smokers. Primary outcome
Sustained abstinence at 3 months

  • Intervention group: 11%

  • Control group: 5%

Secondary outcome
7- day point prevalence

  • Intervention group: 12%

  • Control group: 9%

  • Provide in person contact

  • Provide psychological support.

  • Talk about benefits of quitting smoking and its dangers

  • Intervention group females were 4.5 times more likely to quit than control group females (95% CI: 1.2–16.0)

  • Among light smokers, intervention group participants (17%, n=5) were significantly more likely to quit compared to control group participants
Heydari et al.44 Iran 2012 Randomized control trial To evaluate the effectiveness of varenicline for tobacco cessation. Quit rate
Inline graphic

  • Varenicline has high effectiveness but not highly significantly differs from NRT

  • Free of charge intervention

  • Average nicotine dependence score of 5.5 ± 2.8 (0–10)
Ward et al.57 Syria 2013 Randomized control trial To evaluate nicotine patches and whether they boost smoking cessation rates along with behavioral support in primary health care clinics. Cessation rates
Primary end-point (prolonged)

  • End of treatment: placebo (20.0%), nicotine

  • (21.6%)

  • 6 months: placebo (14.1%), nicotine (13.4%)

  • 12 months: placebo (11.9%), nicotine (12.7%)

Secondary end-point (7-day point)

  • End of treatment: placebo (25.9%), nicotine

  • (25.4%)

  • 6 months: placebo (19.3%), nicotine (14.2%)

  • 12 months: placebo (14.8%), nicotine (20.1%)

  • Patients who experience less withdrawal symptoms had higher likelihood to abstain for long period (p=0.005).
Koyun and Eroğlu60 Turkey 2016 Randomized control trial To determine the influence of transtheoretical model (TTM)-based counseling, training, and a 6-month follow-up on smoking cessation in adult females. Cessation rate
At 6 months follow-up

  • 2.6% in control group

  • 23.7% in intervention group

  • In the intervention group behavioral processes increased over time (p<0.05), pros of change increased (p<0.05), cons of change decreased (p<0.05), and self-efficacy increased over time

  • This increase in TTM component scores was due to the use of TTM-based counseling and training

  • Cognitive processes are the only component of TTM that was not statistically different in the two groups
Aryanpur et al.40 Iran 2016 Randomized control trial To evaluate the effectiveness of two smoking cessation methods among newly diagnosed pulmonary tuberculosis patients at the clinic. Quit rate
At 6 months

  • combined intervention group: 71.7%

  • brief advice group: 33.9%

  • control group: 9.8%

  • Medical treatment + behavioral therapy interventions (combined intervention) group and brief advice group had 35 times (p<0.001, OR=35.26, 95% CI: 13.77–90.32) and 7 times (p<0.001, OR=7.14; 95% CI: 2.72–18.72) more odds of not being an active smoker compared to the control group

  • Patient with health problems have higher odds of quitting smoking from brief advice
Orouji et al.58 Iran 2017 Randomized control trial To determine the strength of smoking cessation behavior based on a transtheoretical model. At 6 months follow-up
40% of intervention group reached maintenance stage of smoking cessation

  • Cognitive processes, behavioral processes, and smoking temptation showed significant change in the intervention group during 6 months follow-up (p<0.05)

  • Individual counseling, providing the proper amount of nicotine based on dependence level, and helping patients who are willing to quit is important for SC program success
El Hajj et al.43 Qatar 2017 Randomized
control trial		 To test the impact of a structured smoking cessation program delivered by trained ambulatory pharmacists in pharmacies. Quit rate
At 12 months

  • Intervention group: 14.3%

  • Control group: 2.7%

 Motivation to quit

  • Free SC services

  • Live healthier 88/152 (57.9%)

  • Religious reasons 55/129 (42.6%)

Success to quit

  • Anti-smoking awareness publicly and applying legislative tobacco smoking measures

  • Pharmacists smoking cessation training at HMC

  • The model (HMC) helps to prepare the participant to enter action stage

  • Seeking family support

  • Follow-up sessions even after quitting to help/support

Failure to quit

  • High nicotine dependence
Durmaz et al.37 Turkey 2019 Randomized control trial To evaluate the impact of support messages through WhatsApp application added to the usual care of a university hospital cessation unit, compared to usual care alone, on abstinence rates at first 4 weeks. Quit rate
At 1 month

  • 65.9% for the intervention group, and 40.9% for the control group

  • At 3 months

  • 50.0% for the intervention group, and 30.7% for the control group

  • At 6 months

  • 40.9% for the intervention group, and 22.7% for the control group

  • Follow-up after abstinence and face-to-face follow-up resulted in a significant success to quit smoking

  • Smoking cessation success increased after using the WhatsApp by 1.67%

  • For each increase in the number of quit attempts, the abstinence rate increased by 1.39 times
Heydari et al.44 Iran 2010 Quasi-experimental study To compare the effect of the four types of NRT on the quit rate. Quite rate
At 6 months

  • 38% both genders p=0.08

At 12 months

  • 40% both genders p=0.02

  • Providing NRTs is positively related with quit rate p=0.000

  • Nicotine patches found to be about 3 times more effective than other forms of NRT p=0.039
Heydari53 Iran 2017 Quasi-experimental study To evaluate the duration of using Champix (Varenicline) based on its cost. Quit rate
At 1 month 51.1%
At 3 months 43.6%
At 6 months 20.6%

  • The use of varenicline for 6 weeks or more, increases the quitting success rate compared with using it for a shorter time significantly p<0.000

  • The reason of not continuing taking varenicline and the difference in durations was the cost
Shahrokhi et al.25 Iran 2008 Quasi-experimental study To evaluate the effect of a nursing smoking cessation intervention based on the transtheoretical model of change on a sample of military students. Quit rate
At 6 months follow-up 8.3%

  • The participants’ stages of change before and after the program were significant (p<0.05)

  • The amount smoked per day comparing the time 1, 2, 3, 4 and 5 (t = 5.73, 4.87, 4.27, 4.16, p<0.01)

  • The average cigarettes smoked per day by students showed a statistically significant decrease after the smoking cessation program (Wilks’ lambda = 0.47, p<0.05)
Heydari et al.36 Tehran 2012 Cohort study To assess the efficacy of this Quit and Win contests campaign in the short-term and long-term quitting rates, and also assess some of the factors associated with quitting. Quit rate
At 1 month (self-reported)

  • In 1998 (41.8%), and in 2004 (92.8%)

  • At 1 year (follow-up)

  • In 1998 (22.5%), and in 2004 (91.2%)

  • Participation in an international competition affected the decision to quit or reduce cigarettes consumption (more than 60% of the participants)

  • In all 4 campaigns, 1 month quit rate and taking the decision to quit at the time of the contest were important indicators for long-term quitting success

  • In 2002 and 2004 campaigns, participants who received advice from health professionals had higher odds to quit by 2.60 (95% CI: 1.30–3.20) and 3.10 (95% CI: 2.50–3.80) than those who did not receive advice

  • The most reported reasons for relapse were withdrawal symptoms (around 59% of who relapsed) and the poor knowledge about how to quit (around 16.4% of those that relapsed)
Hawari et al.47 Jordan 2012 Cohort study To compare quit rates of different formulations of nicotine replacement among clients. Quit rate
After 4 weeks: 88.2% At 6 months: 54.9%
At 12 months: 36.2%

  • Combining nicotine patches and gum had the higher quit rate

After 4 weeks: 95.2%
At 12 months: 62.5%
Hawari et al.48 Jordan 2013 Cohort study To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center. Quit rate
At 12 months was 21.2%
Type of treatment and quit rate

  • Bupropion ± NRT: 6%

  • Varenicline ± NRT: 22%

  • NRT: 3%

  • Counseling: 2%

 Reasons for success

  • Varenicline ± NRT (22%)

  • 45% patient had smoking-related cancer

  • Reasons for failing to quit

  • Not being able to handle withdrawal symptoms followed by seeing no value in quitting (late stage of cancer); at six months and one year, failure to abstain was most commonly due to facing a stressful personal or professional situation
Pekel et al.59 Turkey 2015 Cohort study To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center. Quit rate
At 3 months: 24.4%

  • Older patients more likely to quit than younger patients (p=0.016)

  • Married patients more likely to quit than single patients (p=0.05)

  • Patients with lower CO levels more likely to quit than those with higher levels (p=0.01)
Salepci et al.56 Turkey 2016 Cohort study To establish the rate of smoking cessation and restarting in one year at the Balçova smoking cessation center. Cessation rate
At 1 year: 30.1%
Relapse rate: 51.3%

  • Patients with high dependence levels were more likely to restart smoking (p<0.001)

  • Relapse was lower in those who had pharmacotherapy than those who had behavioral therapy (p<0.05)

  • The rate of relapse was low in patients who took varenicline (p<0.001)
Turan and Turan62 Turkey 2016 Cohort study To compare smoking cessation rates between patients who had free medications during the period of the project, and those who had to pay for their medication. Cessation rates
At 1 month: Paid:75%, Free:43.5% (p=0.001)
At 3 months: Paid:42.2%, Free:25.4% (p=0.002)
At 6 months: Paid: 27.3%, Free:14.8% (p=0.008)
At 1 year: Paid:18.2%, Free:12.2% (p=0.059)

  • When quitters at 6 months and 1 year and non-quitters characteristics were compared, age was greater for those who quit (p=0.003)

  • Patients who quit at 6 months have significantly higher Fagerström score, more smoked cigarettes (as pack-years), pathological chest X-rays findings, and paid for their medication (p=0.021, 0.018, 0.013, 0.012)
White et al.49 Iran 2016 Cohort study To assess the smoking-related behaviors and the effectiveness of tobacco cessation therapy in prison. Fail to quit smoking

  • Prisoners who have high level of nicotine dependence smoked more cigarettes in prison (p<0.001)

  • High price of tobacco cessation medications (40%), and the environment of prison (35%), were the most common reasons for participants failure to quit
Marakoğlu et al.50 Turkey 2017 Cohort study To explore the introduction of a smoking cessation track within Congress 60 (a prominent recovery community within Iran). Quit rate
During the months of NRT use: 85%

  • Cessation rates improve with prolonged NRT

  • Peer support groups help in SC
Cetinkaya et al.41 Turkey 2018 Cohort study To compare the smoking cessation rate in the 1st month, 3rd month, 6th month, 1st year, and 2nd year among those who quit smoking after taking different pharmacological and behavioral therapies. Quit rate
At 1 month: varenicline + BT users (63.5%), bupropion + BT users (49.9%), NRT + BT (53.2%), BT (17.1%)

At 3 months: varenicline + BT (46.8%), bupropion + BT (35.6%), NRT + BT (24.3%), BT (7.1%)

At 6 months: varenicline + BT (34.4%), bupropion + BT (28.4%), NRT (27.3.%) , BT (6.7%)

At 2 years: varenicline + BT (19.9%), bupropion + BT (16.0%)

  • Varenicline + BT success rate in the 12th week was 1.27 times (95% CI: 1.16–1.39, p<0.001) higher than bupropion + BT success rate, and 1.92 times greater (95% CI: 1.08–3.41, p=0.07) than NRT + BT success rate, and 6.55 times (95% CI: 2.81–15.29, p<0.001) greater than behavioral therapy success rate
Shoorijeh et al.38 Iran 2019 Cohort study To know the smoking cessation rate in terms of method used to quit among patients presenting to a smoking cessation clinic in Turkey. Cessation rate At 1 year: 34.3%

  • The participant who received a combination of treatments (behavior motivation + counseling + bupropion) recorded the highest success rate among participants

  • Smoking cessation rate is highly correlated with having a chronic condition

  • NRT has higher rate in smoking cessation (47.9%)

  • More men (37.7%) quit smoking than women (30.9%)
Esen et al.61 Turkey 2020 Cohort study To investigate the effects of smoking cessation program on inpatients and factors that may affect success. Cessation survival rates (CSR)
At 1 month: 76%
At 2 months: 63%
At 3 months: 61%
At 4 months onward: 60%

  • CSR for inpatients who did not smoke at least 30 days before entering cessation program were greater than those of inpatients whose last smoking event was <30 days previously (p=0.05)

  • CSR for inpatients who use more than one item to smoke were higher than those using only cigarettes or hubblebubble (p=0.001)

  • Inpatients who have mild nicotine dependence had greater CSR than

  • Those with sever nicotine dependence (p=0.002)

  • Patients who were interested to stop smoking were more likely to quit (p=0.037)
Heydari et al.52 Iran 2007 Cohort study To investigate smoking cessation rates, the effects of follow-up visits and pharmacological therapies on smoking cessation in smoking cessation clinic in Turkey. Cessation rate
At 1 year: 45.3%
Relapse rate: 26.8%

  • The smoking cessation rate of the users who used varenicline was significantly higher than those who used bupropion (p=0.033)

  • Smoking cessation rate with a Fagerström score <6 was significantly higher than that with a Fagerström score ≥6

  • (p=0.008)

  • The smoking cessation rate of males (57.9%) was significantly lower than that of females (68.4%) (p=0.019)
Hamadeh et al.54 Bahrain 2017 Cross-sectional study Study the correlation between nicotine dependence rate and outcome of smoking cessation among the entrants of smoking cessation clinic. Quit rate
65.1%

  • Rate of success was high among smokers with low nicotine dependence after excluding those who failed to complete the course (n=79; 94%) (p=0.02)

  • Nicotine dependence rate increases by higher number of packs/year consumption (p=0.00)
Bacha et al.63 Lebanon 2018 Cross-sectional study To determine the quit rates among male attendees of quit tobacco clinics (QTC) in Bahrain and describe related factors. Quit rate

  • 56.5% during study period

  • 37.6% at 6 months or longer after QTC services

  • More than 3 visits to the clinics along with previous quit attempts of 21 months duration or more were related to success of quitting all types of tobacco (p<0.05)
Karadoğan et al.51 Turkey 2019 Cross-sectional study To assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center. Success rate
58.9%
Failure rate
41%

  • The number of packs smoked per year decreased the odds of smoking cessation success (OR=0.982: 95% CI: 0.97–0.994 , p =0.004)

  • Moderately and highly motivated smokers had more success in quitting smoking (p=0.027)

  • Patients who were compliant with treatment succeeded quitting smoking (p=0.001)
Sharifi et al.55 Iran 2012 Pre-post study To evaluate the demographic characteristics and other factors that influence the success of smoking cessation among program participants who completed a 5-year follow up. Cessation rate
After 5 years: 34.6%

  • Participants who used NRT abstained from smoking 1.9 times longer (95% CI: 1.2–2.9) than those not receiving NRT

  • Participants who did not suffer from withdrawal symptoms remained abstinent 2.3 times longer (95% CI: 1.5–3.4) than those with withdrawal symptoms
Öztuna et al.39 Turkey 2007 Pre-post study To evaluate the influence of harm reduction approach in the patterns of smoking of subjects who attended smoking cessation clinic. Quit rate
At 6 months: 12.9%

  • Number of smoked cigarettes and nicotine gums were 22.9 and 0.03 at the beginning of the study, and after 6 months follow-up the number of smoked cigarettes decreased to 11.3 and the use of nicotine gum increased to 5.63 (p<0.001), which means that harm reduction approach worked and decreased the number of daily cigarettes by approximately 50%.

The table shows type of studies included in the SR, their aims, outcomes in percentage (%), and the factors associated with TC programs effectiveness. TC: tobacco cessation. HMC: Hamad Medical Corporation. NRT: nicotine replacement therapy. CO: carbon monoxide. TTM: trans-theoretical model. BT: behavioral therapy. QTC: Quit Tobacco Clinic. CSR: cessation survival rate. OR: odds ratio. CI: confidence interval