Tobacco cessation programs and factors associated with their effectiveness in the Middle East: A systematic review.

Introduction: In Middle East countries, the average prevalence of tobacco use is relatively high. This systematic review aimed to explore different tobacco cessation programs provided in the Middle East, identify healthcare professionals providing these programs, and the factors associated with their effectiveness.

Methods: A systematic review was conducted using an electronic search of PubMed, EMBASE, Cochrane Library, ProQuest, and Web of Science, bibliographic databases between 24 January 2021 and 7 March 2021, to identify all relevant studies. The keywords used were 'tobacco cessation' and 'Middle East'. The review was undertaken applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). Based on the study types, several quality assessment tools including the Cochrane risk of bias tool for randomized controlled trials, MINORS for quasi-experimental studies, NIH for cross-sectional studies, NIH for pre-post studies, and CASP for cohort studies, were used.

Results: Among the 512 studies screened, only 30 were included in this review. Our systematic review identified different cessation methods, with some employing both behavioral change and pharmacological methods, and some utilizing only one method. Physicians are believed to be the most common providers of cessation programs, with only a few other healthcare professionals doing so. The results of this review revealed that several factors are associated with the effectiveness of tobacco cessation programs in the Middle East including individual, interpersonal, community, organizational, policy, and environmental.

Conclusions: Future research should focus on examining the sociocultural and economic factors that might influence tobacco cessation programs. The included studies were of average to poor quality, highlighting the need to conduct highquality studies. The findings provide evidence to encourage the development of multilevel programs to improve the efficacy of tobacco cessation initiatives in the Middle East.