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\slugcomment{To appear in The Astrophysical Journal (ApJ)}

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\shorttitle{EFFECTIVENESS OF INTERNET-BASED OR CELL PHONE-BASED INTERVENTIONS TO
ACHIEVE SMOKING CESSATION FOR ADOLESCENT AND ADULT SMOKERS: A
META-ANALYSIS}
\shortauthors{Arindam Basu}

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\title{EFFECTIVENESS OF INTERNET-BASED OR CELL PHONE-BASED INTERVENTIONS TO
ACHIEVE SMOKING CESSATION FOR ADOLESCENT AND ADULT SMOKERS: A
META-ANALYSIS}

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\author{Arindam Basu\affil{University of Canterbury} Sabine Leech\affil{Affiliation not available} Awaiting Activation\affil{Affiliation not available}}





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%\keywords{globular clusters: general --- globular clusters: individual(NGC 6397, NGC 6624, NGC 7078, Terzan 8}


\section*{Summary or Abstract of the
Thesis}\label{summary-or-abstract-of-the-thesis}

The summary or abstract of the thesis needs more work!

Smoking is a leading cause of preventable diseases and death world wide
and within New Zealand.To date, a lot of previous research has been
conducted and this suggests that Internet and Cell phone based
interventions are effective to achieve cessation of smoking however the
effects are short term.The purpose of this Meta Analysis was to
investigate the effectiveness of Internet and Cell phone based
interventions to achieve longer term cessation of smoking among
adolescent and adult smokers.The analysis was based on the assessment of
Randomied Controlled Trials whose interventions included Internet and
Cellphone components and reported outcomes at six months or longer.
Furthermore, this analysis was based on English Language articles
published in the previous 10 years and whose comparison group received
either any other intervention or an intervention inclusive of but not
limited to Internet and Cell phone based interventions delivered at a
lower frequency. Both a Fixed effects and a Random effects Meta Analysis
between all studies were conducted to assess the length of
abstinence.Morever the individual studies were grouped using an outcome
theme and five subgroup analyses were conducted. Findings from both, the
Fixed effects and Random effects analysis suggest great heterogeneity
among the studies.Additionally some heterogeneity was found among the
five subgroup but overall findings suggest that Internet and Cell phone
based interventions used in smoking cessation are effective in achieving
longer term cessation of smoking. Findings from the subgroup analyses
suggest that both Internet and Cell phone based interventions combined
with an additional intervention Nicotine Replacement Therapy are most
effective in achieving longer term cessation of smoking among adolescent
and adult smokers.

\section*{How to add citations?}\label{how-to-add-citations}

\begin{enumerate}
\def\labelenumi{\arabic{enumi}.}
\tightlist
\item
  Click on the ``cite'' link
\item
  As you use Endnote, you will need to export your citations from
  Endnote to the bibtex format. In the endnote, select all your
  citations (control A) and then export the citations in bibtex format
  (bibtex style)
\item
  Email me the bibtex file and I will add it to the folder here
\item
  Next type the name of the author whose citation you want to add to the
  text and then simply add the citation.
\item
  Please pleae please do not just copy paste endnote citations direclty
  into Authorea. It breaks everything!!
\end{enumerate}

\section*{Chapter 1: Introduction and Review of the
Literature}\label{chapter-1-introduction-and-review-of-the-literature}

\subsection*{Overview}\label{overview}

This chapter provides background information about previous research on
Internet and cellphone based interventions for smoking cessation. The
existing literature suggests that Internet-and Cell phone-based
interventions have the potential to achieve short--term cessation of
smoking. In this chapter, the key studies on the effectiveness of the
Internet based intervention for achieving smoking cessation is provided.

Furthermore it provides information about risk factors for smoking among
adolescents and adults, benefits of Smoking Cessation and Internet- and
Cell phone-based interventions, the search of the literature and
information about this Meta-Analysis.

\textbf{This above last paragraph was unnecessary}.

\subsection*{Smoking among adolescents and
adults}\label{smoking-among-adolescents-and-adults}

\subsubsection*{Risk factors for smoking among adolescents and
adults}\label{risk-factors-for-smoking-among-adolescents-and-adults}

Smoking often starts in adolescence. The USDHHS warns that ``In
abstinence of intervention, adolescent smokers will most likely become
adult smokers'' (USDHHS, 2014).

There are \emph{many} (you have provided two of them: starting to smoke
at adolescence and influence of being exposed to second hand smoke early
on in the household. You may want to list these right here upfront to
make things clear and bring a focus as to why Internet can be a useful
intervention medium) risk factors for cigarette smoking among
adolescents and adults. Joffer et al. (2014) ??on the basis of what?
indicated that smoking most often starts sometime during adolescence and
continues through to adulthood if no intervention was sought. Findings
from this research suggest (\textbf{when you write findings from
established research, use present tense as that is established
knowledge}), that peers, friends, siblings, tobacco advertisement and
especially interpersonal and psychological factors inclusive of stress
and low self-esteem are significant influences in smoking initiation
among adolescents.

Navas-Nacher (2015) suggest ??on the basis of what study?? that exposure
to cigarette smoking during childhood years is a significant risk factor
for the reason that it is a learned behaviour. Exposure to household
smoking behaviour also referred to as `living with a regular smoker who
smoked in the home' nearly doubles the risk of becoming a smoker
compared to those who had never been exposed to household smoking
(\textbf{give OR estimates here along with 95\% confidence interval}).
Forty percent (\textbf{when you start a sentence with number, always
spell out}) of participants (N = ??) who reported that they had been
exposed to smoking in the home they lived in during their childhood and
adolescence years and 20\% of them (?? 20 percent of them or the entire
population? What about the children who were exposed to second hand
smoking in the households? This is an important finding) were current
smokers.

Inter-personal and psychological factors inclusive of stress and low
self-esteem including already identified nicotine addiction are
significant factors among adult smokers (Joffer, 2014). This research
indicated that people smoke for a variety of reasons related to family
and social pressures, risk seeking, stress reductions and more. They may
pass through stages of smoking from trying a cigarette to addiction and
they suffer nicotine withdrawal with abrupt decrease from cigarettes
along the way (Joffer, 2014).

Need more substance here. Particularly focus on how Internet and social
media can influence, because your story down the line will include
Internet.

\subsection*{Review of Quitting
Measures}\label{review-of-quitting-measures}

Velicer et al. (1997, cited in Velicer, 2004) classifies outcomes of
smoking cessation programmes into three measures as follows:

\begin{itemize}
\tightlist
\item
  point prevalence abstinence. -- refers to the proportion of people not
  smoking at any given point in time,
\item
  continuous abstinence. -- refers to the proportion of people not
  smoking at all since the onset of the intervention
\item
  prolonged abstinence. -- refers to the proportion of people abstinent
  for some interval.
\end{itemize}

The minimum time intervals for point prevalence abstinence are 24 hours,
7-days, and 30-days. The advantages of point prevalence abstinence is
that non-smoking may be biochemically validated. \textbf{Write here how
this can be done} It includes people who have progressed through the
stages of change (\textbf{explain the stages of change model briefly
here}) and it includes people who delay action and quit at a later time
after an intervention. However, point prevalence may overestimate the
number of quitters as people may start smoking again at a later time and
smokers who quit within the common point prevalence time frames of 24
hours, one week or one month may only experience the immediate health
benefits of cessation.

Continuous abstinence is more stable over time because for longer
periods of abstinence also the likelihood of relapse reduces and it
allows for the evaluation of longer-term health effects of smoking
cessation. However continuous abstinence includes only a small number of
smokers who quit without relapses also this only decreases as more
quitters relapse and it cannot be validated biochemically.

Prolonged abstinence refers to that smokers have been abstinent for a
long time period inclusive of 6-12 months. This is more stable than
point prevalence, it allows smokers who take delayed action to quit to
be counted and it can assess long-term health benefits, however this
requires a long follow up period and cannot be validated biochemically
(Velicer, 2004).

West (2009) proposes The Russell Standard, named after \textbf{??Russell
(give a short history of this)} which defines the smoking status in
clinical research for monitoring the throughout success rates of stop
smoking services, allowing meaningful direct comparisons between the
services. The Russell Standard outlines six criteria as follows:

\begin{itemize}
\item
  ``treated smoker''. -- A `treated smoker (TS)'is a smoker who
  undergoes at least one treatment session on or prior to the quit date.
  Smokers who attended an assessment session but fail to attend
  thereafter will not be counted. Neither are smokers who have already
  stopped smoking at the time they first came to the attention of the
  services;
\item
  `self-reported 4-week quitter (SR4WQ)'. -- A smoker is counted as a
  `self-reported 4-week quitter (SR4WQ)' if he/she is a `treated
  smoker', is assessed (face-to-face, by postal questionnaire or by
  telephone) 4 weeks after the designated quit date (minus 3 days or
  plus 14 days) and declares that he/she has not smoked even a single
  puff on a cigarette in the past 2 weeks,
\item
  ``Co-verified 4-week Quitter (4WQ). -- A smoker is described as a
  `Co-verified 4-week quitter (4WQ) if he/she is a `self-reported 4-week
  quitter' and his/her expired air CO is assessed 4 weeks after the
  designated quit date (minus 3 days or plus 14 days) and found to be
  less than 10ppm;
\item
  Lost to follow up at 4 weeks (LFU4W). -- A smoker is counted as `lost
  to follow up at 4 weeks (LFU4W)' if on attempting to determine the 4
  --week quitter status, he/she cannot be contacted;
\item
  52-week Quitter (52WQ). -- A smoker is counted as a '52-weeks quitter
  (52WQ)' if he/ she is a `treated smoker', is assessed (Face-to face,
  by postal questionnaire or telephone) 52 weeks after the designated
  quit date (plus or minus 30days) and declares that he/she has not
  smoked more than five cigarettes in the past 50 weeks.
\item
  ``Lost to Follow Up at 52 Weeks (LFU52W)''. -- A `treated smoker' is
  counted as a `lost to follow up at 52 weeks (LFU52W)' if on attempting
  to determine the 52-week quitter status, he/she cannot be contacted.
\item
\end{itemize}

\textbf{Theory of Addiction} We need a linking paragraph here as to why
all of a sudden you are talking about this

Robert West(2007) developed the Theory of Addiction , a theory which put
the previous used Trans-theoretical model, developed by Prochaska and
DiClemente (1983) at rest.The Theory of Addiction is based on a
synthetic theory of motivation that focuses on the moment-to moment
control of actions through casual pathsways through varying the lengths
ad levels of complexity from single reflexes, through impulses and
inhibitory forces, the desires,drives and emotional states to

Trans-theoretical Model of Behaviour Change which describes the
progression through which smokers go through before terminating their
addiction. You still have not brought in the issue of Internet here or
the role of interventions. This is the phase here where you shall bring
it in**.

This model of behaviour change divides itself into the stages of change,
processes of change and levels of change and it identifies five stages
of readiness for changing a health behaviour including smoking behaviour
among smokers: \textbf{Add a figure here} (see above in the preface as
to how to add figures)

\begin{enumerate}
\def\labelenumi{\arabic{enumi})}
\tightlist
\item
  pre-contemplation, 2) contemplation, 3) preparation, 4) action and 5)
  maintenance (Prochaska \& DiClemente, 1983).
\end{enumerate}

\subsubsection*{Description of the stages in the context of
smoking}\label{description-of-the-stages-in-the-context-of-smoking}

// Sabine, you do not need to worry too much about the stages of change
model, as Mark was commenting that this is now deprecated. Put more
emphasis on the classification of the smokers //

\textbf{Pre-contemplation} is described as the stage in which smokers
are not thinking about quitting or intending to quit in the next 6
months. The reason for this may be people may not be informed about the
consequences of smoking and demoralized in their ability to make the
behaviour change. They may be resistant or unmotivated for behavioural
change (Prochaska \& DiClemente, 1983). The next stage is the
contemplation stage, in which individuals are considering quitting
within the next 6 months and people in this stage are more aware of the
benefits of quitting. Furthermore, the preparation stage includes
smokers who are intending on quitting smoking within the next 30 days.
These smokers may have taken action in the past by reducing smoking or
making a quit attempt and they also have a plan for action (Prochaska \&
Velicer, 1997). The action stage is the stage in which smokers have quit
during the past 6 months and the maintenance stage consists of people
who have quit for more than 6 months. This model also recognizes that
people move through the stages in a spiral pattern in which some people
progress through and relapse while others progress and successfully
quit. (Velicer et al, 2004).

\subsection*{Discussion of how Internet- and Cell phone components
included in smoking cessation
programmes}\label{discussion-of-how-internet--and-cell-phone-components-included-in-smoking-cessation-programmes}

Start with a brief introduction to the concept of Internet and cell
phones and why or how unique are these two media or two approaches to
enable a smoker to quit. For example, start with a quick introduciton to
the concept of Internet as a system of networked computers that was
preceded by the DARPA experiments, and then following the experiments
and initially confined to the scientific community, how the World Wide
Web became a major channel of information dissemination. Here, mention
that all smoking cessation programmes are essentially based on reaching
messages and information to individuals in an effort to make the quit
smoking and stay as quitters. State that Internet as a channel for
connecting people who provide the message and who receive such messages
can be very useful. Then in the next paragraph write about the emergence
of mobile devices of communication. Start with a brief history of
tailored messaging for smoking cessation (discuss the work by Matthew
Kreuter and his tailored messaging through telephones) and then write
about how from desktop telephones, people graduated to cell phones as
ubiquitous devices. Also here discuss that cell phone usage among
adolescents is very popular. If this is the target population to be
aimed at for smoking cessation and control, then focus on using cell
phones and Internet and social media through the Internet and the world
wide web can be a very useful channel. Then start the next paragraph

More health care providers are now including Internet and Cell phone
components inclusive of text messaging, emails, accessing websites,
accessing video clips online, access to online discussion forums and
information within their smoking cessation programmes. The Internet and
Cell phone allows people to receive information and treatment at any
time, wherever they are and it provides anonymity.

\textbf{Internet- and Cell phone-based interventions in smoking
cessation}

The Internet and Cell phone have become increasingly useful in the
delivery of health care including smoking cessation programmes
world-wide and within New Zealand. Internet- and Cell phone-based
interventions are described as interventions in which the Internet and
Cell phone are a main part of the smoking cessation programme. These
mentioned interventions are inclusive of but not limited to access to
websites containing information about dangers of smoking, quitting,
prevention of relapse, questionnaires, online discussion forums, access
to private chat messages and online peer support, online smoking
cessation diary, , informative and motivational emails and text messages
including advice and suggestions about strategies how to cope with
craving situations, interactive voice response and video clips
containing information about smoking and presentations from medical
professionals.

Previous research suggests that Internet-based and Cell phone-based
interventions have the potential to achieve cessation of smoking among
adult smokers, however results are short-term and it is uncertain
whether these above mentioned interventions can help achieve longer-term
cessation of smoking. Internet- and Cell phone-based interventions are
inclusive of access to websites containing information about the dangers
of smoking, quitting, relapse prevention, questionnaires, online
discussion forums, access to private chat messages and online peer
support, online smoking cessation diary, informative and motivational
emails and text messages including advice and suggestions about
strategies how to cope with cravings situations and interactive voice
response.

\subsubsection*{Internet only}\label{internet-only}

Etter et al. (2005) assessed two computer-tailored interventions for
smoking cessation. `Stop-Tabac' is a French language website inclusive
of fact sheets, online booklets, answers to frequently asked questions,
access to personal stories written by current and former smokers, games,
forums and chat room; and 11969 participants aged 18 years plus took
part in this. Findings of this research suggest personalized messages
via emails can be effective short-term and 25.2\% versus 15.7\% had quit
smoking at the 2.5 months follow up.

Participants were asked to complete a 62-item questionnaire providing
the following information: their smoking history, their smoking status,
the stage of change they are in, if they had quit before, their level of
tobacco dependence, their attitudes towards smoking and their coping
methods. Participants received personalized counselling in form of a
letter, illustrated with cartoons and graphs specific to match their
match their answers from the questionnaire. The other programme used a
shorter 38-item questionnaire however their counselling letter was based
on information about Nicotine replacement (NRT) and with not much
information about health risks of smoking and how to deal with craving
situations.

\textbf{What were the results?}

Schwartz et al. (2006) assessed short-term efficacy (90 days) of an
automated behavioural intervention for smoking cessation which was
delivered via an Internet website. 351 participants were included and
the majority of them (86\%) were aged between 26 and 55 years. It was
expected that participants quit within the next 30 days. Results from
this research indicate that web-based interventions can have a positive
impact on changing health behaviours. 24.1\% presented abstinence at 90
days post quit date. The 1-2-3 Smoke free programme included a website
which was designed to be an automated approximation of the experience a
smoker would receive when working with a live smoking cessation
counsellor. This intervention was inclusive of five major content
modules: benefits of stopping smoking, overcoming common barriers to
cessation, strategies for avoiding situations that prompt cravings,
strategies for dealing with cravings and setting a quit date. The last
included creating a personalized quit plan calendar with individual
advice and a list of options for social support. The intervention
included video segments which included a physician presenting a message
about the health importance of stopping smoking. There was no personal
email or telephone component included therefore participants only
interacted with the website. The control group received nothing for 90
days.

Strecher et al. (2005) assessed the efficacy of a web-based
computer-tailored smoking cessation programme as a supplement to
nicotine patch therapy. Results demonstrate effectiveness of web-based
interventions in conjunction with Nicotine Replacement Therapy. 29\% of
the web \& Nicotine Group had quit compared to 23.9\% in the web-only
group at 6 weeks. At 12 weeks 28\% of the web and Nicotine Replacement
Group compared to 18\% in web-only group. This included 3971
participants aged 18 years plus and who used NiQuitin (CQ) 21mg patch.
The following interventions were compared: the active CQ plan and a
non-tailored web-based smoking cessation programme. Participants were
asked to complete a questionnaire and provide the following information:
demographics, their smoking history, their motives for quitting, their
expectations about more challenging situations during the quit process.
Based on information included in the questionnaires, participants
received three tailored newsletters delivered via email and behavioural
support messages also delivered via email over a period of 10 weeks.
Emails included a cessation guide inclusive of suggestions about how to
stay quit and overcoming craving situations and were also encouraging
compliance with Nicotine Replacement Therapy (NRT) since all
participants were using NiQuitin (CQ). Additionally participants were
allowed to identify a supportive person that would receive an email with
advice how to support the participant. The control group received the
newsletters and emails including advice and no Nicotine Replacement
Therapy (NRT).

\subsection*{Cell phone only}\label{cell-phone-only}

Bramley et al. (2005) assessed the effectiveness of using mobile phone
text messaging interventions among Maori and non-Maori to achieve
cessation of smoking. Findings suggest short-term effectiveness of Cell
phone-based intervention self-reported abstinence rates. 26\% of
intervention group compared with 11.2\% of the control group reported
abstinence at 6 weeks. 1705 participants (Maori and non-Maori) aged 16
years plus were included in this study. The STOMP- Stop Smoking by
Mobile Phone intervention included regular, personalized text --messages
providing smoking cessation advice, support and distraction.
Participants self-identifying as Maori received in addition to text
messages in English also text-messages in Maori. There were 140 texts
specifically developed. Five text messages daily for 4 weeks were sent
after participant's quit day. 6 weeks after quit date text-messages were
reduced from five text messages daily to three text messages per week
until follow up at 26 weeks. The control group received no
smoking-related information and only received one text message a
fortnight. There were no differences found between Maori and non-Maori.

Research conducted by Obermeyer et al. (2004) assessed Cell phone
components in smoking cessation programmes among college students.
Findings from this study present 28\% had quit and 43\% had made at
least one 24 hour quit attempt. 46 college students aged between 18-25
years participated in this study. The interventions were inclusive of
text messages and access to a website. Firstly a questionnaire including
the following information: participant's smoking habit and smoking
pattern, basic history of their smoking, information about their
high-risk cravings situations, their motivation and self-efficacy to
quit was completed by participants. Participants had access to a website
using a log-in and were encouraged to visit the website daily. The
programme also offered text-messages inclusive of motivational messages
and several educational components on topics including information on
how to handle withdrawal symptoms of smoking, information how to handle
high-risk situations sent using a Cell phone. Participants were able to
alert everyone by sending a `SOS-messages' (in urge for help messages)
at the time they found themselves in a high-risk situation in which they
craved a cigarette. This intervention also offered peer-support, allowed
selected others inclusive of family and close friends of participants to
follow the smokers' progress on the website and send additional text
messages encouraging the smoker in their quitting.

Research done by Ybarra et al. (2012) assessed cessation rates in a
text-messaging based smoking cessation programme. 45\% of the
intervention group and 36\% of the control group reported abstinence at
12 weeks and this result was confirmed by carbon monoxide testing (CO).
151 Participants were included in this study and they were aged 18 years
plus. This programme was based on motivational and supportive
text-messages. Participants were asked to answer the following
questions: to describe their feelings about smoking how they would rate
their craving for a cigarette on a scale from 1-3, if they wanted to
quit, the reasons why they wanted to quit and what they would do if
someone offered them a cigarette. A informative brochure including
understanding quitting, strategies on how to cope with craving
situations and how to stay committed to quitting and information about
smoking behaviour and dangers, finding out their smoking patterns and
the reason why they smoke, learn how to start up a smoking diary, advice
on how to involve their family and friends in supporting them but also
learn to become a self-supporter was provided to all participants
including the ones in the control group. The intervention group received
text messages in addition to the informative brochure. Five text
messages inclusive motivational and supportive advice was sent out to
participants on a daily base. Abstinence was measured using
self-reported as well as carbon monoxide (CO) testing

\subsection*{Both Internet \& Cell phone}\label{both-internet-cell-phone}

Research done by Riley et al. (2008) assessed Internet- and cell
phone-based interventions among college students. At 6 weeks 45\%
achieved abstinence (self-reported) and 42\% were based on cotinine
verification. These results indicate that Internet- and Cell phone-based
interventions are potentially efficacious and an easily disseminated
method for providing cessation interventions to young adult smokers.
This study included 31 college students aged between 18 and 24 years.
The web-based component of this intervention provided the participants
with educational modules including information about smoking and smoking
dangers, progress-monitoring tools including quit calendar and email
alerts to user-selected significant others who would provide social
support at critical times during the programme. Text messages were
personalised and on the basis of participants individual quit date.
Participants received between one and three text messages daily. These
included personal advice about how to stay quit, strategies how to cope
with craving situations and how to stay abstinent. Most participants
received two text messages daily. Additionally participants could sent
an `emergency message' when the needed additional support.

\textbf{Add a supporting paragraph here to summarise what sense you make
of these various studies (this list is very short even at this stage.
Much of these could be just put into a table and important points
summarised that way. Use this paragraph to justify that while Internet
based interventions and cell phone based interventions are generally
shown to be effective, the apparent effectiveness of these programmes
are short lived. Then ask the question what would be the effectiveness
of Internet based and cellphone based programmes for longer term
cessation of smoking among the target audience? Then add a paragraph
where you add the questions specific to this research}.

\section*{Chapter 3: Methods}\label{chapter-3-methods}

A meta analysis was conducted to measure the effectiveness of Internet-
and Cell phone- based interventions for the quitting and prevention of
longer term relapse of smoking. The rationale and steps of the meta
analysis are presented below.

\subsection*{The Role of this
Meta-Analysis}\label{the-role-of-this-meta-analysis}

The purpose of this meta analysis was to investigate the role of
Internet-and Cell phone-based interventions `delivered via email,
accessing websites, text messages' to achieve longer-term cessation of
smoking among adult smokers. In meta analysis, results from two or more
primary studies are pooled to arrive at a summary estimate. Meta
analyses refer to a systematic process of framing a research question,
conducting a search of the available literature, assessment of the
similarities or homogeneity of the studies, and after establishment of
whether the studies are homogeneous or heterogeneous, the results from
these studies are pooled together in a number of different ways to
arrive at a set of summary results.

Meta analyses are useful for the following reasons: (1) using meta
analyses, it is useful to achieve an increase in power by pooling
together small studies; (2) improve accuracy known as the estimation of
intervention effect which can be improved if it is based on more
information, to assist in answering questions which are not presented by
individual primary studies due to them involving a specific type of
participants and specifically defined interventions, this way a
selection of studies in which these specific characteristics differ can
allow investigation of the consistency of effect and reasons for the
difference in effect estimates, to settle controversies arising from
apparently conflicting studies and to generate new hypotheses. For this
reason this statistical analysis of findings allows the degree of
conflict to be formally assessed and reasons for different results to be
explored and quantified.

\subsection*{Steps of the Meta
Analysis}\label{steps-of-the-meta-analysis}

Now write the steps of the meta analysis in clear simple English so that
anyone reading this can reproduce your steps. Write under the following
headings:

\subsection*{Study Question}\label{study-question}

Compared with traditional or all other approaches that do not use the
Internet or Cell phone-based messaging as their primary means, what is
the effectiveness of Internet based and Cell phone-based interventions
for longer term smoking cessation among smokers and for longer term
quitting?

\subsection*{Inclusion and Exclusion criteria for
Studies}\label{inclusion-and-exclusion-criteria-for-studies}

Studies were included in this research if they met the following
criteria:

1.The research studied adolescents and adult population aged between 15
and 64 years residing anywhere in the world 2.The research assessed
Internet and Cell phone-based interventions inclusive of but not limited
to access to websites containing information about the dangers of
smoking, quitting, relapse prevention, questionnaires,discussion forums,
access to private chat messages, quitting diary, informative and
motivational emails and text messages including advice and suggestions
about strategies on how to cope with craving situations and interactive
voice response. Studies were included if they offered Nicotine
Replacement Therapy or Telephone Calls in addition to the Internet and
Cell phone. 3.The research compared Internet-and Cell phone-based
interventions with a)interventions which did not include any Internet-or
Cell phone components and included but were not limited of
self-treatment, phone or face to face counseling, herbal remedies,
e-cigarette, hypnosis and those which included b)Internet or Cell phone
components but at a lower frequency 4.The research assessed studies
whose primary outcome was abstinence of smoking for at least 6 months
after the start of the intervention or 12 months wherever data was
available. 5.The research measured self-reported abstinence and included
the ones that included biochemical validation. 6.The research was an
Randomized Controlled Trail(RCT) because they use high quality. 7.The
research was conducted in English Language or a written translation was
available. 8.The research was published between the 1st January 2004 to
1st April 2014.

\textbf{Finish the list}.

A study was excluded from this research if:

\begin{itemize}
\tightlist
\item
  The study did not have adults as the participants
\item
  If the study was not reported in English language or a translated
  version was not available
\item
  \ldots{}
\end{itemize}

\textbf{Finish this list}

\subsection*{Search Terms and Databases
Searched}\label{search-terms-and-databases-searched}

\textbf{We want a detailed breakdown of the search strategy}

The following search terms for the database search included: ``smok'' OR
``smoking'' OR ``tobacco'' OR ``cigarette'' OR ``nicotine'' OR ``tobacco
smoking'' OR ``cigarette smoking'' AND ``smoking cessation'' OR
``nicotine withdrawal'' OR ``tobacco cessation'' OR ``online therapy''
OR ``quit'' OR ``quitting'' OR ``e-therapy'' OR ``electronic therapy''
AND ``Internet'' OR ``online'' OR ``net'' OR ``world-wide web'' OR
``web'' OR ``www'' OR ``computer-mediated communication'' OR
``facebook'' OR ``twitter'' OR ``blog'' OR ``cellular phone'' OR
``cellphone'' OR ``mobile phone'' OR ``text-messaging'' OR ``text'' OR
``txt'' OR ``sms'' OR ``mms'' AND ``young adult (19-24 years)'' OR
``adult (19-44 years)'' OR ``young adult \& adult (19-24 years \& 45-64
years)'' OR ``middle age (45 plus years) AND ``English Language'' AND
``2004-2014''.

The following databases of the literature were searched: A search
through Pubmed, Medline, Google Scholar, Psyc Literature, CINAHL
(Cumulative Index of Nursing \& Allied Health Literature Database, Web
of Science, Collected Health Literature Related Databases which are
maintained at UC and the Cochrane Database of Systematic Reviews or CDSR
was conducted.

Write here in details what search terms were employed and what databases
were searched. How did you know that the search terms you used were good
enough?

List all the databases you searched in the following list.

\subsection*{Appraisal of the Studies Based on their Titles and
Abstracts}\label{appraisal-of-the-studies-based-on-their-titles-and-abstracts}

This is the first pass of the meta analysis. Write here what did you do
to filter studies based on their titles and abstracts. If the title and
or the abstract did not match your expectations or did not meet the
inclusion criteria for this study then they were removed from further
consideration. Write those here.

\subsection*{Search for fugitive literature and grey
literature}\label{search-for-fugitive-literature-and-grey-literature}

Fugitive literature refers to those studies where the author may have
conducted a study but he did not publish it anywhere. Alternatively, the
author may have sent for publication but that did not get published. It
is possible to find out about gray literature from trials databases, and
occasionally asking experts, etc. Describe what did you do about finding
out grey literature in this research.

\subsection*{Hand searches from the lists of references from the
literature
reviewed}\label{hand-searches-from-the-lists-of-references-from-the-literature-reviewed}

You need to convince your readers that you did as comprehensive a search
as possible. Write here that you rand hand searches following reading
the full texts of all studies included in the full text appraisal to
look for more studies. So, you searched the University of Canterbury
library archives, etc. Write that in details here.

\subsection*{Critical Appraisal of the studies included in the full
text}\label{critical-appraisal-of-the-studies-included-in-the-full-text}

Assessment of Risk of Bias in included studies Bias was assessed using
the Cochrane Collaboration's tool for assessment of Risk of Bias
(Higgins 2011a, Higgins 2011b). The following criteria was assessed
using the ``Cochrane Collaboration Risk of Bias Tool'' which is a
domain- based evaluation and includes the following parts: Random
sequence generation (selection bias), Allocation concealment (selection
bias), Blinding (performance bias and detection bias, blinding of
participants), incomplete outcome data (attrition bias), selective
reporting (reporting bias) and other bias (publication bias). The Risk
of Bias criteria was judged as ``low risk'', ``high risk'' or ``unclear
risk'' (lack of information or uncertainty over the potential bias). The
following table is the guide with the specific questions of the ``Risk
of Bias Tool

Table. ``Cochrane Collaboration Risk of Bias Tool'' Bias Question Random
Sequence generation Was the allocation sequence adequately generated?
Allocation Concealment Was the allocation adequately concealed? Blinding
Was knowledge of the allocated interventions adequately prevented during
the study? Incomplete Outcome Data Were incomplete outcome data
adequately addressed? Selective Outcome Reporting Are reports of the
study free of suggestion of selective outcome reporting? Other Sources
of Bias Was the study apparently free of other problems that could put
it at a high risk of bias?

Write here how were the full texts of the studies retrieved and what did
you do to appraise them critically. There are critical appraisal
checklists available. Write how you noted their biases and how you
conducted their risk of bias tables. This table will be needed in the
results section

\subsection*{Summarising the Results of the Study: Random effects versus
fixed effects meta
analysis}\label{summarising-the-results-of-the-study-random-effects-versus-fixed-effects-meta-analysis}

First of all, discuss here what is meant by fixed effects versus random
effects meta analysis. Then write, what did you do for this particular
thesis. Give the equations and steps. State that you used R and Stata
for this purpose. Summarising the results of the studies is done by
creating Forestlots

A Meta-Analysis uses two models, one is the Fixed-Effects Method and the
other one is the Random-Effects Method.

Fixed-Effects Method: In a Fixed-Effects Analysis is assumed that all
the included studies share a common true effect size \selectlanguage{greek}µ. \selectlanguage{english}The observed
effects are distributed about \selectlanguage{greek}µ \selectlanguage{english}with a variance \selectlanguage{greek}σ\selectlanguage{english}2 that depends
primarily on the sample size of each study. There is only one level of
sampling since all studies are sampled from a population with effect
size \selectlanguage{greek}µ \selectlanguage{english}and therefore only one source of sampling error exists within the
studies. Since the goal of this approach is to assign more weight to the
studies that carry more information, researchers may propose to weight
each study by its sample size. So that for instance a study with one
thousand subjects would get 10 times the weight of a study with one
hundred subjects. Assignments of the weights are based on the inverse of
the variance rather than the sample size. The inverse variance is
roughly proportional to the sample size but is a more nuanced measure
and serves to minimize the variance of combined effect.

Random-Effects Method: The Fixed-Effects Method discussed above starts
with the assumption that the true effect is the same in all included
studies however the assumption may be implausible in some reviews. When
a decision is made to incorporate a group of studies in a Meta-Analysis
it is assumed that the studies have enough in common that it makes sense
to synthesize the information rather than assume that there is one true
effect. Rather than the assumption that there is one true effect, a
distribution of true effect sizes is tolerated. The combined effect
therefore cannot represent the common effect but instead represents the
effect sizes and the mean of the population true effects. The Random-
Effects Method consists of two level sampling and two sources of error.
Firstly the true effect sizes 0 are distributed about \selectlanguage{greek}µ \selectlanguage{english}with variance r\selectlanguage{ngerman}²
which reflects the actual distribution of the true effects about their
mean; second the observed effect T for any given 0 is distributed about
0 with variance \selectlanguage{greek}σ\selectlanguage{english}2 that depends primarily on the sample size for each
study. When assigning weights to estimate \selectlanguage{greek}µ \selectlanguage{english}there are two sources of
sampling error, one within the studies and one between the studies to
deal with. In the Fixed-Effects Analysis as comparison each study is
weight by the inverse of its variance. In the Random-Effects Analysis
too, each study is weight by the inverse of its variance. However the
difference is that the variance now includes the original
(within-studies) variance plus the between-studies variance.

\subsection*{Assessment of the heterogeneity of
studies}\label{assessment-of-the-heterogeneity-of-studies}

An assessment of heterogeneity using I-squared statistics was conducted.
I- squared statistics describes the percentage of variation across the
different studies and it expresses the inconsistency of the results of
the studies.This formula was used to calculate I-square ``I''
\^{}2=((``Q'' -``df'' ))/``Q'' ``*" 100 If the studies were found to be
statistically homogeneous based on the I-statistic cut off value (p=
0.1) then the results from these studies were combined. If on the other
hand, the studies demonstrated a lack of homogeneity on the basis of
statistical tests then the studies were further investigated to identify
the causes of their heterogeneity. A significance level of 0.1 was used
as an indication and the following interpretation guide was used: 0-40\%
indicates might not be important; 30-60\% indicates ``may represent
moderate heterogeneity''; 50-70\% ``may represent substantial
heterogeneity'' and 75\% or more indicates a ``considerable level of
inconsistency'' (Higgins 2011a).

\subsection*{Summarising the Studies: Odds Ratio and Forest
PLot}\label{summarising-the-studies-odds-ratio-and-forest-plot}

The results of the studies were combined and the following formula was
used to calculate the Odds Ratio:

The findings are presented in a Forest Plot created using the Review
Manager Software (RevMan). The Forest Plot illustrates the effect size
and precision for each study (95\% CI) and for the combined effect. It
shows whether the combined effect is based on a few studies or many and
whether the effect size is consistent or if it varies (OR 95\% CI). Data
entry is presented in two columns. The left- hand column includes the
list the names of the studies (Randomized Controlled Trials). The
right-hand column presents the plot of the measure of the effect (OR)
for each of the studies which is illustrated as a square. The overall
meta-analyzed measure of the effect is presented on the plot as a dashed
vertical line. The meta-analyzed measure of effect is plotted as a
diamond. Other points are used to indicate the confidence interval (CI)
for the estimate. Then a vertical line which represents no effect was
plotted. If the confidence intervals of the individual studies
overlapped with the line it demonstrates that at given level of
confidence their effect sizes do not differ from no effect for each
individual study. If the points of the diamond overlapped the line of
the no effect the overall meta-analyzed result meant it did not differ
from no effect at the given level of confidence.

Give the formula for the Odds Ratio, the 95\% Confidence Interval and
write how you constructed the Forest Plot

\subsection*{Testing for Publication Bias: visual
inspection}\label{testing-for-publication-bias-visual-inspection}

Publication Bias was tested by setting up a Funnel Plot. The Funnel Plot
is graphically presented and was created using the Review Manager
Software (RevMan).This shows the assumptions that the largest studies
are near the average and the small studies are spread on both sides of
the average. If there are any variations shown from this assumption
there is a likelihood that publication bias exists. A symmetric inverted
funnel shape indicates well-presented data in which publication bias is
very unlikely. And an asymmetric funnel shape indicates the relationship
between the treatment effect and the study size.

\subsection*{Subgroup Analysis}\label{subgroup-analysis}

Write here that you conducted subgroup analyses following analysis of
the entire data set. What were the criteria on the basis of which you
selected the sub groups? Write that here.

\subsection*{How to Enter Graphs in this
document}\label{how-to-enter-graphs-in-this-document}

Follow these steps:

\begin{enumerate}
\def\labelenumi{\arabic{enumi}.}
\tightlist
\item
  Export your graphs as png or jpg files
\item
  Click on +figure in this document
\item
  This will open up a file selection dialog
\item
  Select the jpg/png file. The file will automatically link here.
\item
  Add an appropriate caption
\end{enumerate}

You can add tables also like this. Except convert the tables to figures
by doing screen capture.\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Screenshot-2015-07-18-22.21.37/Screenshot-2015-07-18-22.21.37}
\caption{{Quorom Chart of the studies%
}}
\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Screenshot-2015-07-18-22.22.57/Screenshot-2015-07-18-22.22.57}
\caption{{Replace this text with your caption%
}}
\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Screenshot-2015-07-18-22.24.32/Screenshot-2015-07-18-22.24.32}
\caption{{Replace this text with your caption%
}}
\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Screenshot-2015-07-18-22.25.20/Screenshot-2015-07-18-22.25.20}
\caption{{Replace this text with your caption%
}}
\end{center}
\end{figure}

\section*{Chapter 5: Results of the Meta
Analysis}\label{chapter-5-results-of-the-meta-analysis}

Search Results of Literature

The search results must be accompanied by graphs, tables, and figures
Less writing. Start with your quorom chart.

112 articles were retrieved from the main database search and seven
additional articles were identified through other sources. After
duplicates were removed, the title and abstract of 96 articles was
studied and four articles were gained and discovered using the reference
research method. Full text was obtained of 25 articles and seven
articles were obtained from a previous search of the literature. The
seven articles which were obtained from a previous search of the
literature were used to demonstrate evidence of previous research
conducted in smoking cessation. After all fourteen studies met the
inclusion criteria after their full texts have been assessed and were
further investigated in this Meta-Analysis.

\subsection*{2.6.2 Randomized controlled trials included in this
Meta-Analysis}\label{randomized-controlled-trials-included-in-this-meta-analysis}

Fourteen studies met the inclusion criteria after their full texts have
been assessed. Three of them inclusive of Borland (2013), Brendryen
(2008) and Brendryen (2008) assessed both Internet- and Cell phone-based
interventions. Six of them inclusive of Elfeddali (2012), Haug (2011),
McKay (2008), Seidman (2010), Wangberg (2011) and Zbikowski (2011)
evaluated Internet-based interventions. Additionally five studies
inclusive of Free (2009), Free (2011), Haug (2013), Rodgers (2005) and
Skov-Ettrup (2014) investigated Cell phone-based interventions.
Furthermore (Brendryen 2008) included Nicotine Replacement Therapy and
Zbikowski (2011) included additional telephone calls.

\subsection*{Description of included
studies}\label{description-of-included-studies}

Borland et al. (2013) assessed Internet- and Cell phone-based
interventions in smoking cessation programmes. The main outcome of this
research was self-reported abstinence at 6 months. Participants included
in this study were 3530 adults (2195 in the intervention group and 1335
in the control group) aged 18 years plus, owned a Cell phone and had
access to the Internet. Quit Coach is a personalized smoking cessation
programme delivered over the Internet and Cell phone. These
interventions included letters of advice, suggestions about strategies
on how to cope with cravings and motivational messages. The control
group received brief information on web-and phone-based interventions.
Research conducted by Brendryen (2008) assessed Internet-and Cell phone
interventions. The outcome studied was self-reported abstinence at 6 and
12 months. Participants were 396 adults (197 in the intervention group
and 199 in the control group) 18 years plus, who had daily access to the
Internet and owned a Cell phone. Happy Ending is a one year smoking
cessation programme delivered via the Internet and Cell phone. It
consists of emails, access to webpages, interactive voice response, text
messages, access to a craving helpline, strategies on how to cope with
cravings situations. All participants were given free Nicotine
Replacement Therapy (NRT). The control group received self-help booklets
including 44 pages containing general information, a quit diary and
telephone numbers from the National Quitline. Brendryen (2008) assessed
Internet and Cell phone interventions and the outcome studied was
self-reported abstinence at 6 and 12 months. 290 adults (144 in the
intervention group and 146 in the control group) 18 years plus, who
owned a Cell phone and had access to the Internet were included.
Participants did not receive any Nicotine Replacement Therapy. The
intervention included emails, access to webpages and text messages
including strategies on how to stay abstinent. The Control group had
access to general resources including books and magazines about
self-treatment. Elfeddali (2012) assessed Internet-based interventions
in smoking cessation programmes. The outcomes studied were self-reported
and biochemically verified abstinence at 12 months. Participants were
2031 adults (1395 in the intervention group and 636 in the control
group) aged 18 years plus. Stay quit for you study (SQ4U) includes
online assignments and questionnaires, including information about
dangers of smoking, the benefits of not smoking and motivational
messages. The Control group only filled out questionnaires and did not
receive emails and interventions. Free (2009) assessed Cell phone-based
interventions and the outcome studied was self-reported and
biochemically verified abstinence at 6 months. Participants were 200
adolescents and adults (102 in the intervention group and 98 in the
control group) aged 16 years plus, who owned a Cell phone. STOMP- Stop
Smoking with Mobile Phone is a six months cessation programme delivered
via Cell phone. Participants received regular personal text messaging
with advice and support to help distract from cravings and withdrawal
symptoms. Five to six messages per day were sent for 4 weeks and the
maintenance stage included one message every fortnight. Quit Buddy and
messages on demand were available. The Control group received one text
per fortnight. Free (2011) assessed Cell phone-based interventions and
the outcome was 6 months self-reported and biochemically verified
abstinence at 6 months. This research included 5800 adolescents and
adults (2915 in the intervention group and 2885 in the control group)
aged 16 years plus and who owned a Cell phone. This six months smoking
cessation programme was delivered via Cell phone. Participants received
five text messages for the first 3 weeks, then three per week for 26
weeks. A total of 156 messages were sent and messages included
motivational and support messages to help participants stay abstinent.
They could text 'lapse' to receive urgent advice and to receive peer
support. The control group received simple short text messages on a
fortnightly basis. Self-reported and biochemically verified abstinence
was assessed using postal salivary cotinine testing and carbon monoxide
testing in person. Haug (2011) assessed Internet-based interventions and
the outcome was self-reported abstinence at 6 months. Participants
included in this research were 477 adults (242 in the intervention group
and 235 in the control group) aged 18 years plus, who had access to
emails and the Internet. Haug (2013) assessed Cell phone-based
interventions and the outcome was self-reported abstinence at 6 months.
Participants included were 755 adults (372 in the intervention group and
383 in the control group) aged 18 years plus and who owned a Cell phone.
SMS Quit Coach is a smoking cessation programme that includes text
messages at least three times per week, motivational messages, two text
messages per week for 3 months and messages including information on
strategies how to cope with withdrawal symptoms. The control group
received no text messages. McKay (2008) assessed Internet-based
interventions and the outcome was self-reported abstinence at 6 months.
Participants included were 2318 adults (1159 in the intervention group
and 1159 in the control group) aged 18 years plus and who had access to
the Internet. QSN (Quit Smoking Network) users were directed through
websites and the programme provided strategies on how to stay
non-smoking, how to overcome cravings and a web-forum was provided. The
control group received online resources (factsheets) articles. Rodgers
(2005) assessed Cell phone-based interventions and 1705 adolescents and
adults (852 in the intervention group and 853 in the control group) aged
18 years plus took part in this. This six months smoking cessation
programme delivered via Cell phone included regular personalized text
messages with information and advice to help distract participants from
cravings for a cigarette. Messages on demand were available. The control
group received one text message per fortnight. Seidman (2010) assessed
the effectiveness of internet interventions and the outcome was
self-reported abstinence at 6 months and 13 months. 2153 Adults (1106 in
the intervention group and 1047 in the control group) aged 18 years plus
and who had access to the Internet. Participants were provided with a
link to access an interactive website for information and to complete a
series of exercises to help reinforce the motivation to quit and stay
abstinent. Emails included advice and strategies how to cope with
triggers for a cigarette. The control group had access to a non-
interactive website containing downloadable self-help booklets (designed
by American Cancer Society). Skov-Ettrup (2014) assessed Cell phone
interventions and the outcome was self-reported abstinence at 12 months.
2030 adolescents and adults (1055 in the intervention group and 975 in
the control group) aged 15 years plus who owned a cell phone were
included. Xhalke.dk is a smoking cessation program which includes
Internet- and Cell phone components. Two personalized daily text
messages including advice on how to cope with specific situations were
delivered to participants. The control group received weekly text
messages. Wangberg (2011) assessed Internet based interventions and the
outcome studied was self-reported abstinence at 12 months. Included were
2298 adolescents and adults (1171 in the intervention group and 1127 in
the control group) aged 16 years plus. This smoking cessation programme
based on general advice included dangers of smoking, motivational
messages, discussion forum and a personalized online cessation diary was
delivered for 12 months. Buddy support and private chat messages were
available. The control group received also an Internet-based
intervention but had no email contact. Zbikowski (2011) assessed the
Internet and included additional telephone calls. The outcome studied
was self-reported abstinence at 6 months. 1198 adults (797 in the
intervention group and 401 in the control group) aged 18 years plus were
included. The website included interactive tools, a discussion forum,
personalized emails, five one-on one telephone calls for 7 days and 21
days while the control group only received telephone calls but no access
to the website.

Participants Nine studies Borland (2013), Brendryen (2008), Brendryen
(2008*), Elfeddali (2012), Haug (2011), Haug (2013), McKay (2008),
Seidman (2010) and Zbikowski (2011) included participants aged 18 years
plus, three studies Free (2009), Free (2011) and Wangberg (2011)
included adolescents aged 16 years plus and two studies Rodgers (2005)
and Skov-Ettrup (2014) included participants aged 15 years plus. Sample
sizes among the studies ranged from 200 participants (Free 2009) to 5800
participants (Free 2011).

Interventions Borland (2013), Brendryen (2008) and Brendryen (2008)
assessed both Internet- and Cell phone-based interventions whereas Free
(2009), Free (2011), Haug (2013), Rodgers (2005) and Skov-Ettrup (2014)
included Cell phone-based interventions. Elfeddali (2012), Haug (2011),
McKay (2008), Seidman (2010), Wangberg (2011) and Zbikowski (2011)
assessed Internet-based interventions. Brendryen (2008) used Nicotine
Replacement Therapy additionally and Zbikowski (2011) additional
telephone calls.

Outcomes All fourteen studies inclusive of Borland (2013), Brendryen
(2008), Brendryen (2008*), Elfeddali (2012), Free (2011), Free (2009),
Haug (2013), Haug (2011), McKay (2008), Rodgers (2005), Seidman (2010),
Skov-Ettrup (2014), Wangberg (2011) and Zbikowski (2011) reported
abstinence of smoking for at least six months or more after the start of
the intervention. For all these studies a seven-day point prevalence
self-reported abstinence of smoking was the main outcome. Two of these
studies reported a 30-day point prevalence additionally. Elfeddali
(2012), Free (2011) and Free (2009) assessed self-reported abstinence
and used biochemical verification testing to measure abstinence.

Recruitment Recruitment was very similar among the studies. Borland
(2013), Brendryen (2008), Brendryen (2008), Skov-Ettrup (2014) and
Zbikowski (2011) recruited their participants through quit websites and
advertisements in online newspapers. Rodgers (2005), Skov-Ettrup (2014)
and Zbikowski (2011) got their participants from quitline and cancer
societies. Free (2011), Free (2009) used the radio, leaflets and posters
for their recruitment. Rogers (2005) put posters up at tertiary
institutions within the region. Haug (2013) and Haug (2011) recruited
their participants from a rehabilitation centre and Zbikowki (2011)
found their participants through referrals from General Practitioners.

An overall Analysis inclusive of a Fixed-effect and a Random-effect
Analysis of all fourteen studies was conducted. Previously was decided
that if heterogeneity was found among studies, individual subgroup
analyses would be conducted to further investigate these results. The
details of this are described in the Methods section.

\subsection*{Figure 1: Quorom Chart (insert the figure
below)}\label{figure-1-quorom-chart-insert-the-figure-below}

\subsection*{Table 1: All studies included for this
review}\label{table-1-all-studies-included-for-this-review}

\subsection*{Table 2: Summary of Findings Table of all
studies}\label{table-2-summary-of-findings-table-of-all-studies}

\subsection*{Figure 2: Forest Plot of All Included
Studies}\label{figure-2-forest-plot-of-all-included-studies}

\subsection*{Figure 3: Funnel Plot to examine Publication
Biases}\label{figure-3-funnel-plot-to-examine-publication-biases}

\subsection*{Figure 4: Forest Plot of the Subgroup
Analyses}\label{figure-4-forest-plot-of-the-subgroup-analyses}

\subsection*{Description of the
Results}\label{description-of-the-results}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{./static.png}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{./static.png}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[h!]
\begin{center}
\includegraphics[width=0.70\columnwidth]{./static.png}

\end{center}
\end{figure}

\section*{Chapter 6: Discussion and
Conclusion}\label{chapter-6-discussion-and-conclusion}

\subsection*{What are the key findings from this
study?}\label{what-are-the-key-findings-from-this-study}

\subsection*{What findings tally with what others have
found?}\label{what-findings-tally-with-what-others-have-found}

\subsection*{What findings do not match with what others have
found?}\label{what-findings-do-not-match-with-what-others-have-found}

\subsection*{What are the surprising
findings?}\label{what-are-the-surprising-findings}

\subsection*{How do you explain the
findings?}\label{how-do-you-explain-the-findings}

\subsection*{What are the strengths of this study
design?}\label{what-are-the-strengths-of-this-study-design}

\subsection*{What are the weaknesses of this
study?}\label{what-are-the-weaknesses-of-this-study}

\subsection*{What do you suggest next?}\label{what-do-you-suggest-next}

\selectlanguage{english}
\FloatBarrier
\nocite{*}

\bibliographystyle{plain}
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}

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