Tobacco cessation strategies in military personnel: A meta-analysis of randomized trials

Objective: To evaluate the effectiveness of behavioural and pharmacological tobacco cessation interventions among active-duty military personnel and veterans. Methods: We followed PRISMA guidelines to assess the efficacy of behavioural and pharmacological interventions on tobacco cessation in military populations. Randomized controlled trials were identified through PubMed (from 1966), Web of Science (from 1900), Scopus (from 1960), and the Cochrane Library/CENTRAL (from 1991) from database inception to July 2024. Random-effect models were used to estimate odds ratios and 95 % confidence intervals. Results: Five randomized controlled trials involving a total of 2619 participants were included. Seven-day point prevalence abstinence was significantly increased at short-term (≤ 3 months) (OR 2.03 [95 % CI: 1.49, 2.77], low certainty) and long-term (≥ 6 months) (OR 1.53 [95 % CI: 1.12, 2.09], low certainty) follow-ups among those receiving interventions compared with controls. Subgroup analyses were conducted by type of personnel, tobacco product, intervention type, and sex. Conclusions: These findings highlight the need for stronger, accessible, and military-tailored cessation programs, particularly for veterans who show lower quit rates. Expanding high-quality randomized trials that test modern cessation approaches in diverse military populations is essential to inform future policy and clinical practice.