Tobacco cessation interventions with culturally and linguistically diverse people: are they effective in reducing use?

September 2022

Immigrants from culturally and linguistically diverse (CALD) countries comprise approximately one third of Australia’s population [1]. Compared to the general population, CALD groups typically have higher rates of tobacco use [2-4] and poorer health outcomes [5-7]. Lower smoking cessation rates are a result of differing cultural norms [4, 5], attitudes and beliefs [4, 7], and language barriers [4, 5, 7]. Interventions can help address these potential barriers and increase tobacco cessation rates among CALD groups [4, 8].

Cancer Council NSW (CCNSW) commissioned the National Centre for Education and Training on Addiction (brokered through the Sax Institute) to undertake a review of the evidence on “What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities” As Chinese, Vietnamese and Arabic-speaking people comprise Australia’s largest CALD groups [9]and have high tobacco use in NSW, they were the CALD groups of focus in the review.

The Evidence Check identified literature published between January 2013-March 2022 from searching five electronic databases, undertaking a desktop search, and directly contacting key Australian organisations (for grey literature). Studies were included that were undertaken in countries similar to Australia (US, UK, New Zealand and Canada). The search process identified 571 documents, and 19 met the studies inclusion criteria. The National Health and Medical Research Council Levels of Evidence and Joanna Briggs Institute’s Critical Appraisal Tools were used to assess the robustness and critically appraise the included studies.

Tobacco cessation interventions captured were often multi-component. Findings were reported by individual component for all targeted CALD groups and then for each group. By addressing the effectiveness of individual components, key building blocks of an effective intervention was demonstrated.

The evidence check found 15 tobacco cessation intervention components. Interventions captured ranged from 2-6 components, with most involving at least three components. The most common intervention components were written information (14 studies) and education sessions (10 studies). The evidence check found promising evidence regarding 8/15 intervention components to target tobacco cessation among Chinese-speaking participants. These were: written information, education sessions, visual information, counselling, involving a family member or friend, nicotine replacement therapy, branded merchandise, and mobile messaging. The components - media campaign and telephone follow-up, showed aggregated evidence (i.e., results for Chinese-speaking and other CALD group(s) were combined). Promising evidence regarding the intervention component of counselling was found to target tobacco cessation with Arabic-speaking participants, with the component written information having mixed evidence. No component had promising evidence for targeting tobacco cessation with Vietnamese-speaking participants whilst written information, education sessions, counselling and nicotine replacement therapy had aggregated evidence.

Due to much of the evidence base for Vietnamese and Arabic-speaking participants being limited by aggregating results for multiple CALD groups, further research with individual CALD groups is warranted to determine the interventions’ effectiveness. Another evidence gap was that most studies were of low evidence level and quality. For instance, the review included only two randomised controlled trials and no systematic review. Thus, the evidence base has a risk of bias. Furthermore, studies generally lacked adequate detail of their intervention design which affected the quality appraisal. More research is also needed to raise the evidence base as the effectiveness of certain intervention components was either unknown (no studies) or insufficient (only one study) across CALD groups. This was particularly the case for Arabic-speaking for Vietnamese-speaking participants.

In summary, the evidence for use of a range of intervention components to address tobacco cessation among Chinese-speaking populations was sound whilst evidence was lacking regarding interventions with Vietnamese and Arabic-speaking participants. More research is required to determine whether components considered effective for use in one CALD group are applicable to other CALD populations.

The outcome of the Evidence Check will be used by CCNSW to inform the development of targeted and tailored smoking cessation interventions for CALD population groups in NSW and to identify opportunities to reach populations of highest need.

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  8. NSW Health, Multicultural Programs and Services Program (MPSP): 2019–2020 NSW Health report for the period 1 July 2018 to 30 June 2020. 2020, Prepared for NSW Health by Multicultural NSW.
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