Meta-Analysis the Effect of Nicotine Replacement Therapy on the Successful Smoking Cessation

Lina Eta Safitri, Agus Kristiyanto, Bhisma Murti


Background: About 23% of the world's population smokes, which includes 32% of men with the highest prevalence coming from Indonesia and 7% are women. East Asia and Southeast Asia have the highest smoking prevalence in the world at around 45%, while in Indonesia, the problem of smoking is a serious threat due to the increasing preva­lence of smoking at 18 years of age from 7.2% to 9.1%. This study aims to analyze the magnitude of the effect of using NRT on the success of smoking cessation based on a number of previous similar studies.

Subjects and Method: This research is a systematic review and meta-analysis carried out by following the PRISMA flow diagram. The process of searching for articles through a journal database which includes: Google Scholar, PubMed, and Science Direct by selecting articles published in 2011-2020. Keywords used include: "nicotine replace­ment therapy" AND "smoker" OR "smoking" AND "smoking cessation". The inclusion criteria were a full paper article with an observational study design, English and Indonesian, and analyzed using multivariate analysis with adjusted odds ratio. Articles that meet the requirements were analyzed using the Revman 5.3 application.

Results: Nine articles were reviewed in this study with a cohort study design. A meta-analysis of nine cohort studies showed that use of nicotine replacement therapy was 1.42 fold increased smoking cessation success compared to placebo (aOR 1.42; 95% CI 1.14 to 1.76; p <0.002).

Conclusion: Nicotine replacement therapy improves smoking cessation success.

Keywords: nicotine replacement therapy, smoking cessation

Correspondence: Lina Eta Safitri. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email:

Journal of Epidemiology and Public Health (2021), 06(01): 21-32

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Adam NT, Marris J (2020). Smoking. Stat-Pearls. in Februari 2021.

Arifianti T, Soemanto, Prasetya H (2019). The contextual effect of school on smoking behavior among male high school students. J Health Promot Behav. 4(1): 76-84. 2019.04.01.08.

Arifin J, Mccracken LC, Nesbitt A, Warner A, Dinniwell RE, Palma DA, Louie AV (2020). Does free nicotine replacement improve smoking cessation rates in cancer patients. Curr Oncol. 27(1): 14–18. DOI:10.3747/co.27.5-267.

Benowitz NL (2010). Nicotine Addiction. N Engl J Med. 362(24): 2295-303.

Brainly (2018). Batas-Batas Letak Geografis Australia. Accessed from in May 2021

Cather C, Pachas GN, Cieslak KM, Evins AE, (2017). Achieving smoking cessation in individuals with schizophrenia: Special considerations. CNS Drug. 31(6). 471-481.

Cochrane (2014). RevMan 5.3 User Guide.


Edgwick P (2013). Meta-analyses: How to read a funnel plot. In BMJ. 346 (7898).

Edunitas (2019). North America. Accessed from Utara_12180_ensiklopedia-bebas-q-sttbandung.html in May 2021.

Flowers L (2017). Nicotine Replacement Therapy. Am J Psychiatry Resid J. 11(6): 4-7.

Graham AL, Papandonatos GD, Cha S, Erar B, Amato MS (2018). Improving adherence to smoking cessation treatment: Smoking outcomes in a web-based randomized trial. Ann Behav Med. 52(4): 331341.

Haaker H, Lonsdorf TB, Schumann D, Bunzeck N, Peters J, Sommer T, Kalisch R (2017). Where there is smoke there is fearimpaired contextual inhibition of conditioned fear in smokers. Int J Neuropsychopharma-cology. 42(8): 1640–1646.

Haddad I, Samman A, Person T, Karakattu S, Mehta J (2020). Combined nicotine replacement therapy (Nicotine patch and short acting nicotine) VS nicotine patch for smoking cessation: A systematic review and meta-analisis. J. Chest. 158(4): 18-21.

Islami SU, Prasetya H, Murti B (2019). Schools have contextual influence on smoking behavior among high school students in Dumai, Riau. J Health Promot Behav. 4(3): 212-223.

Kementerian Kesehatan Republik Indonesia. (2017). Hidup sehat tanpa rokok (Healthy living without smoking). Kementerian Kesehatan Indonesia.

Kementerian Kesehatan Republik Indonesia (2019). HTTS 2019: Jangan biarkan rokok merenggut napas kita (HTTS 2019: don't let cigarettes take our breath). Accessed from /htts2019janganbiarkanrokok-merenggutnapas-kita.html in February 2021.

Krus GR, Park E, Haberer L, Abroms, Shadid NN, Howard, Chang Y (2019). Proactive text messaging (GetReady2Quit) and nicotine replacement therapy to promote smoking cessation among smokers in primary care: A pilot randomized trial protocol. Contemp Clin Trials. 80: 48-54.

Krus G, Park ER, Shahid NN, Abroms L, Haberer JE, Rigotti NA (2019). Combining realtime ratings with qualitative interviews to develop a smoking cessation text messaging program for primary care patients. JMIR Mhealth Uhealth. 7(3): e114-98.

Kumparan (2021). Karakteristik benua Eropa yang membedakannya dari wilayah lainnya (The characteristics of the European continent that set it apart from other regions). Accessed from -1u4TFseLDxk/full in May 2021.

Lappin JM, Thomas D, Curtis J, Blowfield S, Gasti M, Marr G, Courtney R (2020). Targeted intervention to reduce smoking among people with severe mental illness: Implementation of a smoking cessation intervention in an inpatient mental health setting. Medicina (Kaunas). 56(4): 204.

Limsuwat C, Saito S, Halvorso K (2018). Review: Pharmacotherapy for smoking cessation. The Southwest Respiratory and Critical Care Chronicles. 6(24). 31-37.

Linda R, Gowing, Robert L, Ali1, Allsop S, Marsden J, Turf E (2015). Global statistics on addictive behaviours: 2014 status report. Addiction. 110 (6):904-19.

Martin LM, Sayette MA (2018). A review of the effects of nicotine on social functioning. Exp Clin Psyhopharmacol. 26(5): 425–439.

Metse AP, Wiggers J, Wye P, Bowman JA, (2018). Patient receipt of smoking cessation care in four Australian Acute psychiatric facilities. J Ment Health Nurs. 27(5). 1556-1563. doi: 10.1111/inm.12459.

Mikolajewicz N, Komarova SV (2019). Meta-analytic methodology for basic research: A practical guide. Front Physiol. 10: 203.

Nikolakopoulou A, Chaimani A, Veroniki AA, Vasiliadis HS, Schmid CH, Salanti G (2014). Characteristics of networks of interventions: A description of a database of 186 pub-lished networks. PLoS ONE, 9(1): e86754.

Nightingale CL, Sterba KR, Tooze JA, King JL, Weaver KE (2019). Cessation attitudes and preferences in head and neck cancer patients and implycations for cessation program design: A brief report. Glob Adv Health Med. 8: 2164956119847117.

Rajani NB, Weth, Mastellos N, filippidis FT (2019). Adherence of popular smoking cessation mobile applications to evidencebased guidelines. BMC Public Health. 19(1): 743.

Ramdhani N (2011). Penyusunan alat pengukuran berbasis Theory of Planned Behavior (Development of measurement tools based on Theory of Planned Behavior). Buletin Psikologi. 19 (2): 55-69.

Schuit E, Panagiotou OA, Munafo MR, Bennett DA, Bergen AW, David SP (2017). Pharmacotherapy for smoking cessation: Effects by subgroup defined by genetically informed biomarkers. Cochrane Library. 9(9): CD011823.

Setyawati A (2013). Suatu kajian molekuler ketergantungan nikotin (A molecular study of nicotine dependence). J Pharm Sci community. 10(2):118-127.

Sukmana T (2011). Mengenal rokok dan bahayanya (Knowing about smoking and its dangers). Jakarta: Be Champion.

Supit (2016). Ketergantungan Nikotin: asap molekuler dan implikasi terapi berbasis bukti (Nicotine dependence: molecular smoke and implications of evidencebased therapy). Cermin Dunia Kedokteran. 43(4).

Torres S, Samino S, Ràfols P, Green MM, Correig X, Ramírez N (2020). Unravelling the metabolic alterations of liver damage induced by thirdhand smoke. Environ Int. 146: 106242.

Tulloch HE, Pipe A, Els C, Clyde MJ, Reid RD (2016). Flexible, dualform nicotine replacement therapy or varenicline in comparison with nicotine patch for smoking cessation randomized controlled trial. BMC Med. 14(80): 2-10.

Oakes JM, Fuchs RM, Gardner JD, Lazartigues E, Yue X (2018). Nicotine and the reninangiotensin system. Am J Physiol Regul Integr Comp physiol. 315 (5). 895–906.

Putri AK, Zuhroh LZ, Ashari A, Sakinah A, Permatasari DA, Kodisu AE, Putri DA, et al. (2017) Perilaku merokok dan pengtahuan tentang nicotine replacement Therapy pada remaja (Smoking behavior and knowledge about Nico-tine Replacement Therapy in Adolescents).Jurnal Farmasi Komunitas. 4(1): 127-132.

Wadgave U, Nagesh L (2020). Nicotine replacement therapy: An overview. Int J Med sci Public Health. 10(3): 425–435.

World Health Organization (2020). Pernyataan WHO: Penggunaan Tembakau dan COVID-19 (WHO statement: Tobacco Use and COVID-19). Accessed from in Februari 2021.

Woolf JK, Zabad MN, Post JM, McNitt S, Williams GC, Bisognano JD (2012). Effect of nicotine replacement therapy on cardiovascular outcomes after acute coronary syndromes. Am J cardiol. 110 (7). 168-170.


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