Smoking Prevention and Cessation Programs for Children and Adolescents Focusing on Parental Involvement: A Systematic Review and Meta-Analysis.

This study aims to determine the effect and equity outcomes of smoking prevention or smoking cessation interventions for children and adolescents involving parents. A systematic literature search was conducted between 24 November 2022 and 27 November 2023 in PubMed, Medline, Web of Science, Embase, PsycINFO, Google Scholar, ClinicalTrials.gov, EU Clinical Trials Register, and the WHO international clinical trials registry. Experimental or quasi-experimental studies reporting smoking initiation among never smokers, smoking cessation among smokers, and differential effects in socio-economic subgroups with a follow-up of at least 6 months were selected. Information was extracted concerning setting, study design, sample size, type of parental intervention, follow-up time, and relative risk estimates of intervention effects (risk ratios, odds ratios, and hazard ratios). Random effect model was used for meta-analysis of 24 studies, with the remaining studies included in a narrative synthesis. After screening 6,748 records, 36 studies, based on 29 unique interventions (27 smoking prevention and 2 smoking cessation), were included. The summary estimate of relative risk of smoking initiation among children and adolescents participating in smoking prevention interventions involving parents compared to control conditions was 0.84 (95% CI: 0.76, 0.94). Results concerning smoking cessation and equity aspects were inconclusive due to the paucity of studies. Smoking prevention interventions for children and adolescents where parents are actively involved appear to be effective, but the overall quality of evidence was moderate. No conclusion was possible to be drawn on the effects of interventions involving parents on offspring's smoking cessation. Equity aspects of these interventions remain to be studied.