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The Evidence Base Is Too Limited to Draw Any Strong Conclusions

• Only a small number of randomized controlled trials (RCTs) of mindfulness meditation interventions for treatment of tobacco use have been published, and the interventions, comparators, and outcomes vary considerably. Important aspects of methodology were often unreported in the journal articles describing these RCTs.
• Effects on smoking cessation (abstinence) favored meditation but were not statistically different from comparator interventions, and the mean number of cigarettes per day was not statistically different between meditation and comparator interventions at follow-up. Analysis suggested that effects vary by type of intervention.
• Only three RCTs addressed adverse events, and all reported no events.
• No included studies reported the number of quit attempts or quality of life measures, and no studies obtained a "good" quality rating. Only one study reported on adverse events related to the mindfulness intervention.

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of mindfulness meditation interventions — used adjunctively or as monotherapy — to provide estimates of their efficacy and safety for treating tobacco use.

The primary outcome of interest was smoking/tobacco cessation. Other outcomes of interest included reduction in use, decrease in cravings, health-related quality of life, and adverse events. Meta-analyses for efficacy outcomes were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.

Nine studies met inclusion criteria. Studies compared mindfulness training for smokers, mindfulness training, and a mindfulness-based smoking cessation program with American Lung Association's Freedom from Smoking program, quitline counseling, interactive learning, or treatment as usual. Intervention duration and intensity varied considerably. Meta-analyses for smoking cessation and cigarettes smoked per day indicated no statistically significant differences between mindfulness interventions and comparator interventions. Analysis suggested effects vary by type of intervention. Only three studies reported on adverse events; they stated that there were no reportable medication reactions associated with the adjunctive nicotine replacement treatment or that no serious adverse events occurred.

We conclude that the body of evidence for mindfulness meditation for the treatment of tobacco use is very limited. Additional high-quality studies with samples large enough to detect effects and confirming smoking cessation through biochemical means are suggested.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Appendix A

  Search Strategy

• Appendix B

  Excluded Full-Text Articles

• Appendix C

  Evidence Table of Included Studies