Osong Public Health and Research Perspectives

Original Articles

Investigation of SARS-CoV-2 lineages and mutations circulating in a university-affiliated hospital in South Korea analyzed using Oxford Nanopore MinION sequencing: Hyaekang Kim, Sung Hee Chung, Hyun Soo Kim, Han-Sung Kim, Wonkeun Song, Ki Ho Hong, Jae-Seok Kim; Osong Public Health Res Perspect. 2022;13(5):360-369. Published online October 11, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0183; Funded: Kangdong Sacred Heart Hospital, Ministry of Health and Welfare

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Abstract PDF Supplementary Material: Objectives
Despite the introduction of vaccines, treatments, and massive diagnostic testing, the evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued to overcome barriers that had slowed its previous spread. As the virus evolves towards increasing fitness, it is critical to continue monitoring the occurrence of new mutations that could evade human efforts to control them. Methods: We performed whole-genome sequencing using Oxford Nanopore MinION sequencing on 58 SARS-CoV-2 isolates collected during the ongoing coronavirus disease 2019 pandemic at a tertiary hospital in South Korea and tracked the emergence of mutations responsible for massive spikes in South Korea. Results: The differences among lineages were more pronounced in the spike gene, especially in the receptor-binding domain (RBD), than in other genes. Those RBD mutations could compromise neutralization by antibodies elicited by vaccination or previous infections. We also reported multiple incidences of Omicron variants carrying mutations that could impair the diagnostic sensitivity of reverse transcription-polymerase chain reaction-based testing. Conclusion: These results provide an understanding of the temporal changes of variants and mutations that have been circulating in South Korea and their potential impacts on antigenicity, therapeutics, and diagnostic escape of the virus. We also showed that the utilization of the nanopore sequencing platform and the ARTIC workf low can provide convenient and accurate SARS-CoV-2 genomic surveillance even at a single hospital.

A case-control study of acute hepatitis A in South Korea, 2019: Jung Hee Hyun, Ju Young Yoon, Sang Hyuk Lee; Osong Public Health Res Perspect. 2022;13(5):352-359. Published online October 12, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0141; Funded: Ministry of Education, National Research Foundation of Korea

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Graphical Abstract Abstract PDF: Objectives
We aimed to reconfirm the source of hepatitis A virus (HAV) infection through epidemiological and genotype investigations of individual cases in a 2019 outbreak in South Korea. Methods: We investigated food intake histories, associations with hepatitis A, and genotypes of HAV in 31 patients with hepatitis aged 20 to 49 years registered in the integrated disease and health management system during December 1–7, 2019 (case group) and in 35 sex- and agematched people without a history of HAV vaccination or infection among patients’ families and colleagues (control group). Results: The consumption of salted clams was a significant factor (odds ratio, 4.33; 95% confidence interval, 1.32–14.18) in the risk factor analysis of food intake history. HAV genotypes were analyzed in 24 of 31 patients. Type IA and type IIIA were found in 23 and 1 cases, respectively. Conclusion: Salted clams are considered to have been the source of HAV infection at 49 weeks of the HAV outbreak in 2019; this result was consistent with that of a previous epidemiological investigation conducted by the Korea Disease Control and Prevention Agency in September 2019. Therefore, monitoring of the production and distribution of salted clams needs to be continued.

Review Article

Effects of medication adherence interventions for older adults with chronic illnesses: a systematic review and meta-analysis: Hae Ok Jeon, Myung-Ock Chae, Ahrin Kim; Osong Public Health Res Perspect. 2022;13(5):328-340. Published online October 12, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0168; Funded: National Research Foundation of Korea

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Abstract PDF: This systematic review and meta-analysis aimed to understand the characteristics of medication adherence interventions for older adults with chronic illnesses, and to investigate the average effect size by combining the individual effects of these interventions. Data from studies meeting the inclusion criteria were systematically collected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The results showed that the average effect size (Hedges’ g) of the finally selected medication adherence interventions for older adults with chronic illnesses calculated using a random-effects model was 0.500 (95% confidence interval [CI], 0.342−0.659). Of the medication adherence interventions, an implementation intention intervention (using face-to-face meetings and telephone monitoring with personalized behavioral strategies) and a health belief model–based educational program were found to be highly effective. Face-to-face counseling was a significantly effective method of implementing medication adherence interventions for older adults with chronic illnesses (Hedges’ g=0.531, 95% CI, 0.186−0.877), while medication adherence interventions through education and telehealth counseling were not effective. This study verified the effectiveness of personalized behavioral change strategies and cognitive behavioral therapy based on the health belief model, as well as face-to-face meetings, as medication adherence interventions for older adults with chronic illnesses.

Original Articles

The effect of photodynamic therapy using Radachlorin on biofilm-forming multidrug-resistant bacteria: Choong-Won Seo, Young-Kwon Kim, Jeong-Lib An, Jong-Sook Kim, Pil-Seung Kwon, Young-Bin Yu; Osong Public Health Res Perspect. 2022;13(4):290-297. Published online August 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0150; Funded: Konyang University

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Abstract PDF: Objectives
This study aimed to test the effect of photodynamic therapy (PDT) on the inhibition and removal of biofilms containing multidrug-resistant Acinetobacter baumannii.
Methods
Using multidrug-resistant A. baumannii strains, an antibiotic susceptibility test was performed using the Gram-negative identification card of the Vitek 2 system (bioMérieux Inc., France), as well as an analysis of resistance genes, the effects of treatment with a light-emitting diode (LED) array using Radachlorin (RADA-PHARMA Co., Ltd., Russia), and transmission and scanning electron microscopy to confirm the biofilm-inhibitory effect of PDT.
Results
The antibiotic susceptibility test revealed multiple resistance to the antibiotics imipenem and meropenem in the carbapenem class. A class-D–type β-lactamase was found, and OXA-23 and OXA-51 were found in 100% of 15 A. baumannii strains. After PDT using Radachlorin, morphological observations revealed an abnormal structure due to the loss of the cell membrane and extensive morphological changes, including low intracellular visibility and small vacuoles attached to the cell membrane.
Conclusion
PDT involving a combination of LED and Radachlorin significantly eliminated the biofilm of multidrug-resistant A. baumannii. Observations made using electron microscopy showed that PDT combining LED and Radachlorin was effective. Additional studies on the effective elimination of biofilms containing multidrug-resistant bacteria are necessary, and we hope that a treatment method superior to sterilization with antibiotics will be developed in the future.

Insufficient weight management in pregnant women with gestational diabetes mellitus: Kyunghee Han, Dong Wook Kwak, Hyun Mee Ryu, Hyun-Young Park; Osong Public Health Res Perspect. 2022;13(4):242-251. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0182; Funded: Korea National Institute of Health

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Graphical Abstract Abstract PDF: Objectives
This study investigated whether weight was managed appropriately in pregnant women with gestational diabetes mellitus (GDM) and examined the association between insufficient gestational weight gain (GWG) and adverse pregnancy outcomes.
Methods
The study included 235 pregnant women with GDM from the Korean Pregnancy Outcome Study. GWG from the second to the third trimester (kg/wk) and total GWG (kg) were classified as insufficient, appropriate, or excessive according to the 2009 Institute of Medicine guidelines. Adverse pregnancy outcomes included maternal (hypertensive disorders of pregnancy, preterm birth, cesarean delivery, and delivery complications) and infant (low birth weight, high birth weight, neonatal intensive care unit admission, and congenital anomalies) outcomes.
Results
The proportion of pregnant women with GDM who had insufficient GWG from the second to the third trimester was 52.3%, and that of participants with total insufficient GWG was 48.1%. There were no significant associations between insufficient GWG from the second to the third trimester and adverse pregnancy outcomes. Participants with total insufficient GWG had a significantly lower risk of preterm birth (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.60) and high birth weight (OR, 0.23; 95% CI, 0.07–0.80).
Conclusion
Our findings suggest the importance of appropriate weight management and the need for GWG guidelines for pregnant women with GDM.

The role of risk perception, risk communication, and demographic factors in COVID-19 preventive behaviors: an online survey in Iran: Mansour Rezaei, Nader Rajabi Gilan, Ali Almasi, Mehdi Khezeli, Fatemeh Jamshidi Nazar, Zahra Jorjoran Shushtari, Yahya Salimi, Farid Najafi, Neda Sarabi, Shahram Saeidi, Saeid Saeidi; Osong Public Health Res Perspect. 2022;13(4):282-289. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0345; Funded: Kermanshah University of Medical Sciences Research

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Abstract PDF: Objectives
This study investigated preventive behaviors toward coronavirus disease 2019 (COVID-19) and related factors in a Kurdish Iranian sample.
Methods
This online survey was conducted among the population aged 18 and above in Kermanshah Province, in western Iran, in April 2020. Samples were invited and recruited through social media. Data were collected using a questionnaire consisting of 4 sections (questions on demographic variables, risk perception, risk communication, and COVID-19 preventive behaviors) and analyzed using Stata ver. 8.
Results
The Pearson correlation test showed that risk communication was significantly correlated with COVID-19 preventive behaviors (r=0.320, p<0.01). In the final model, where the explanatory power increased with the entry of the risk communication variable, the variables explained a total of 14% of variance in COVID-19 preventive behaviors. Sex (β=−0.482), risk perception (β=0.047), and risk communication (β=0.662) were significant determinants.
Conclusion
Risk communication and risk perception related to COVID-19, as well as being a woman, were determinants of COVID-19 preventive behaviors.

Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study: Suneela Garg, Nidhi Bhatnagar, Mongjam Meghachandra Singh, Saurav Basu, Amod Borle, Yamini Marimuthu, Falak Azmi, Yomri Dabi, Indu Bala; Osong Public Health Res Perspect. 2022;13(4):273-281. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0127; Funded: Delhi State Health Mission

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Abstract PDF

Objectives
Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India.
Methods
A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face.
Results
In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM.
Conclusion
More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

Citations

Citations to this article as recorded by

Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study
Aditya Singh, Mahashweta Chakrabarty, Shivani Singh, Rakesh Chandra, Sourav Chowdhury, Anshika Singh
BMC Public Health.2022;[Epub] CrossRef

Brief Report

Isolation and identification of monkeypox virus MPXV-ROK-P1-2022 from the first case in the Republic of Korea: Jin-Won Kim, Minji Lee, Hwachul Shin, Chi-Hwan Choi, Myung-Min Choi, Jee Woong Kim, Hwajung Yi, Cheon-Kwon Yoo, Gi-Eun Rhie; Osong Public Health Res Perspect. 2022;13(4):308-311. Published online August 31, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0232; Funded: Korea Diseases Control and Prevention Agency

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Graphical Abstract Abstract PDF

Objectives
Monkeypox outbreaks in nonendemic countries have been reported since early May 2022. The first case of monkeypox in the Republic of Korea was confirmed in a patient who traveled to Europe in June 2022, and an attempt was made to isolate and identify the monkeypox virus (MPXV) from the patient’s specimens.
Methods
Clinical specimens from the patient were inoculated in Vero E6 cells. The isolated virus was identified as MPXV by the observation of cytopathic effects on Vero E6 cells, transmission electron microscopy, conventional polymerase chain reaction (PCR), and sequencing of PCR products.
Results
Cytopathic effects were observed in Vero E6 cells that were inoculated with skin lesion swab eluates. After multiple passages from the primary culture, orthopoxvirus morphology was observed using transmission electron microscopy. In addition, both MPXV-specific (F3L and ATI) and orthopoxvirus-specific genes (A39R, B2R, and HA) were confirmed by conventional PCR and Sanger sequencing.
Conclusion
These results indicate the successful isolation and identification of MPXV from the first patient in the Republic of Korea. The isolated virus was named MPXV-ROK-P1-2022.

Citations

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Isolation and Characterization of Monkeypox Virus from the First Case of Monkeypox — Chongqing Municipality, China, 2022
Baoying Huang, Hua Zhao, Jingdong Song, Li Zhao, Yao Deng, Wen Wang, Roujian Lu, Wenling Wang, Jiao Ren, Fei Ye, Houwen Tian, Guizhen Wu, Hua Ling, Wenjie Tan
China CDC Weekly.2022; 4(46): 1019. CrossRef

Original Articles

Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis: Pragya Sharma, Saurav Basu, Suruchi Mishra, Mongjam Meghachandra Singh; Osong Public Health Res Perspect. 2022;13(3):184-190. Published online June 10, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0014; Funded: ATE Chandra Foundation and ACT grants

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Graphical Abstract Abstract PDF: Objectives
The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021. Methods: This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity). Results: The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%−54.3%) in January 2021 to 81.8% (95% CI, 80.9%−82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%−91.7%). Seropositivity positively correlated with participants’ age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants. Conclusion: The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.

Transmission parameters of coronavirus disease 2019 in South Asian countries: Mridul Sannyal, Abul Mukid Mohammad Mukaddes; Osong Public Health Res Perspect. 2022;13(3):191-202. Published online June 23, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0234; Funded: Shahjalal University of Science and Technology, Sylhet

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Graphical Abstract Abstract PDF: Objectives
This study aimed to estimate the transmission parameters, effective reproduction number, epidemic peak, and future exposure of coronavirus disease 2019 (COVID-19) in South Asian countries. Methods: A susceptible-exposed-infected-recovered-death (SEIRD) model programmed with MATLAB was developed for this purpose. Data were collected (till June 28, 2021) from the official webpage of World Health Organization, along with the Center for Systems Science and Engineering at Johns Hopkins University. The model was simulated to measure the primary transmission parameters. The reproduction number was measured using the next-generating matrix method. Results: The primary transmission rate followed an exponential Gaussian process regression. India showed the highest transmission rate (0.037) and Bhutan the lowest (0.023). The simulated epidemic peaks matched the reported peaks, thereby validating the SEIRD model. The simulation was carried out up to December 31, 2020 using the reported data till June 9, 2020. Conclusion: The information gathered in this research will be helpful for authorities to prevent the transmission of COVID-19 in the subsequent wave or in the future.

Sex differences in factors associated with prediabetes in Korean adults: Jin Suk Ra; Osong Public Health Res Perspect. 2022;13(2):142-152. Published online April 22, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0053; Funded: National Research Foundation of Korea

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Abstract PDF: Objectives
Identifying the factors associated with prediabetes is necessary for the early detection and management of high-risk individuals with prediabetes. The purpose of this study was to identify the factors associated with prediabetes according to sex in Korean adults. Methods: Using the Korean National Health and Nutrition Examination Survey from 2015 to 2019, a total of 13,595 adults (5,565 males and 8,030 females) aged ≥20 years were included in the data analysis. Logistic regression analysis was performed to identify the factors associated with prediabetes according to sex in Korean adults. Results: In both males and females, age and a family history of type 2 diabetes were associated with prediabetes. In males, current and past smoking habits were associated with increased prediabetes. In addition, low-intensity physical activity and prolonged sedentary behavior were associated with a higher prevalence of prediabetes. Females with a lower education level (less than middle school graduation) showed a higher risk of prediabetes. Conclusion: Sex-specific prevention strategies for prediabetes should be developed. In addition, older individuals and those with a family history of type 2 diabetes should be screened for prediabetes.

Prevalence of plasmid-mediated AmpC β-lactamases among uropathogenic Escherichia coli isolates in southwestern Iran: Nabi Jomehzadeh, Khadijeh Ahmadi, Zahra Rahmani; Osong Public Health Res Perspect. 2021;12(6):390-395. Published online December 1, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0272; Funded: Research of Abadan University of Medical Sciences

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Abstract PDF

Objectives
This study was undertaken to evaluate AmpC β-lactamase-producing Escherichia coli urine isolates and to characterize the frequency of plasmid-mediated AmpC (pAmpC)-encoding genes.
Methods
Antimicrobial susceptibility tests were performed using the disk diffusion technique. AmpC β-lactamase production was assessed with a phenotypic inhibitor-based method. The presence of 6 pAmpC-encoding cluster genes was detected by multiplex polymerase chain reaction (PCR).
Results
The proportion of antibiotic resistance of E. coli isolates ranged from 7.4% to 90.5%, and more than half (51.6%) of the total isolates were multidrug-resistant (MDR). Among the 95 E. coli isolates, 60 (63.2%) were found to be cefoxitin-resistant, but only 14 (14.7%) isolates were confirmed as AmpC β-lactamase-producers. In the PCR assay, pAmpC-encoding genes were found in 15 (15.8%) isolates, and blaDHA was the most prevalent type. However, blaFOX, blaMOX, and blaACC genes were not detected in the isolates.
Conclusion
Our findings contributed valuable information concerning antibiotic resistance, confirmatory phenotypic testing for AmpC production, and pAmpC β-lactamase gene content in E. coli isolates in southwestern Iran. The level of MDR recorded in AmpC-producing strains of this study was worrying; therefore, implementing strong infection control approaches to reduce the MDR burden is recommended.

Citations

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Prevalence of Extended-Spectrum β-Lactamase-Resistant Genes in Escherichia coli Isolates from Central China during 2016–2019
Zui Wang, Qin Lu, Xiaohui Mao, Li Li, Junfeng Dou, Qigai He, Huabin Shao, Qingping Luo
Animals.2022; 12(22): 3191. CrossRef

Yes-associated protein 1 as a prognostic biomarker and its correlation with telomerase in various cancers: Hye-Ran Kim, Choong-Won Seo, Keunje Yoo, Sang Jun Han, Jongwan Kim; Osong Public Health Res Perspect. 2021;12(5):324-332. Published online September 17, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0207; Funded: National Research Foundation of Korea

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Abstract PDF Supplementary Material: Objectives
The aims of this study were to investigate the expression of Yes-associated protein 1 (YAP1), its prognostic significance, and the correlation between YAP1 and telomerase in various cancers.
Methods
The Gene Expression Profiling Interactive Analysis database was used to analyze RNA sequencing data and the survival rate of patients with various cancers in The Cancer Genome Atlas (TCGA) database. PrognoScan was used to analyze the prognostic value of YAP1 expression in various cancers. Tumor Immune Estimation Resource was used to determine the correlation between YAP1 expression and telomerase in various cancer types based on TCGA data.
Results
The analysis suggested that YAP1 was differentially expressed between tissues of various cancers and non-tumor tissues. High YAP1 expression was also related to a poor prognosis in adrenocortical carcinoma, bladder urothelial carcinoma, and pancreatic adenocarcinoma. Moreover, YAP1 expression was correlated with the expression of telomerase reverse transcriptase and telomerase RNA component in various cancer types.
Conclusion
These results suggest that YAP1 is a potential biomarker with prognostic significance and relevance for oncogene research in various cancer types. The correlation between the expression of YAP1 and telomere-associated genes will help to understand their cancer-promoting mechanisms and interactions.

Review Article

Severe acute respiratory syndrome coronavirus 2 and respiratory syncytial virus coinfection in children: Milad Zandi, Saber Soltani, Mona Fani, Samaneh Abbasi, Saeedeh Ebrahimi, Ali Ramezani; Osong Public Health Res Perspect. 2021;12(5):286-292. Published online October 1, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0140; Funded: Abadan University of Medical Sciences

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Abstract PDF

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has infected many people around the world. Children are considered an important target group for SARS-CoV-2, as well as other viral infections such as respiratory syncytial virus infection. Both SARS-CoV-2 and respiratory syncytial virus can affect the respiratory tract. Coinfection of SARS-CoV-2 and respiratory syncytial virus can pose significant challenges in terms of diagnosis and treatment in children. This review compares the symptoms, diagnostic methods, and treatment of COVID-19 and respiratory syncytial virus infection in children.

Citations

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Respiratory syncytial virus, recurrent wheeze and asthma: A narrative review of pathophysiology, prevention and future directions
Elly Binns, Jane Tuckerman, Paul V Licciardi, Danielle Wurzel
Journal of Paediatrics and Child Health.2022; 58(10): 1741. CrossRef
Impact of genetic polymorphisms related to innate immune response on respiratory syncytial virus infection in children
Laura Elena Córdova-Dávalos, Alicia Hernández-Mercado, Claudia Berenice Barrón-García, Augusto Rojas-Martínez, Mariela Jiménez, Eva Salinas, Daniel Cervantes-García
Virus Genes.2022; 58(6): 501. CrossRef

Original Article

Behavioral therapy and pharmacotherapy for relapse prevention in abstinent smokers: a rapid review and meta-analysis for the Korea Preventive Service Task Force: Naae Lee, Eon Sook Lee, Jae Moon Yun, Cheol Min Lee, Seung-Won Oh, Younglee Choi, Belong Cho; Osong Public Health Res Perspect. 2021;12(4):244-253. Published online July 6, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0017; Funded: Korea Disease Control and Prevention Agency

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Abstract PDF Supplementary Material: Objectives
This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers.
Methods
This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity.
Results
Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I²=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.

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