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Self‐help interventions for smoking cessation

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Abstract

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Background

Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully.

Objectives

The aims of this review were to determine the effectiveness of different forms of self‐help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to self help, such as computer‐generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non‐tailored materials.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register using the terms 'self‐help', 'manual*' or 'booklet*'. Date of the most recent search November 2008.

Selection criteria

We included randomized trials of smoking cessation with follow up of at least six months, where at least one arm tested a self‐help intervention. We defined self help as structured programming for smokers trying to quit without intensive contact with a therapist.

Data collection and analysis

We extracted data in duplicate on the participants, the nature of the self‐help materials, the amount of face‐to‐face contact given to intervention and to control conditions, outcome measures, method of randomization, and completeness of follow up.

The main outcome measure was abstinence from smoking after at least six months follow up in people smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a fixed‐effect model.

Main results

We identified 68 trials. Thirty‐four compared self‐help materials to no intervention or tested materials used in addition to advice. In 12 trials in which self help was compared to no intervention there was a pooled effect that just reached statistical significance (N = 15,711; risk ratio [RR] 1.21; 95% confidence interval [CI] 1.05 to 1.39). This analysis excluded two trials with strongly positive outcomes that introduced significant heterogeneity. Five further trials in which the control group received alternative written materials did not show evidence for an effect of the smoking self‐help materials. We failed to find evidence of benefit from adding self‐help materials to face‐to‐face advice, or to nicotine replacement therapy. There were 25 trials using materials tailored for the characteristics of individual smokers, where meta‐analysis supported a small benefit of tailored materials (N = 28,189; RR 1.31; 95% CI 1.20 to 1.42, I² = 19%). The evidence is strongest for tailored materials compared to no intervention, but also supports tailored materials as more helpful than standard materials. Part of this effect could be due to the additional contact or assessment required to obtain individual data. A small number of other trials failed to detect benefits from using additional materials or targeted materials, or to find differences between different self‐help programmes.

Authors' conclusions

Standard self‐help materials may increase quit rates compared to no intervention, but the effect is likely to be small. We failed to find evidence that they have an additional benefit when used alongside other interventions such as advice from a healthcare professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are more effective than untailored materials, although the absolute size of effect is still small.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

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Do self‐help materials containing information about how to give up smoking help people to quit

Advice and behavioural counselling can help smokers to quit. Giving the same type of support via written materials or other media has not been found to be very helpful, although there is likely to be a small benefit for people given no other support. Tailoring materials to provide individualized support is more effective. Comparisons between different types of standard materials have generally failed to show differences between them.