Print‐based self‐help interventions for smoking cessation
Background Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully. Objectives The aims of this review were to determine the effectiveness of different forms of print‐based self‐help materials th...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2019-01, Vol.2019 (1), p.CD001118 |
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| creator | Livingstone‐Banks, Jonathan Ordóñez‐Mena, José M Hartmann‐Boyce, Jamie Hartmann‐Boyce, Jamie |
| description | Background
Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully.
Objectives
The aims of this review were to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups.
Search methods
We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018.
Selection criteria
We included randomised trials of smoking cessation with follow‐up of at least six months, where at least one arm tested print‐based materials providing self‐help compared with minimal print‐based self‐help (such as a short leaflet) or a lower‐intensity control. 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 accordance with standard methodological procedures set out by Cochrane. 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 study and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a random‐effects model.
Main results
We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.
Thirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison c |
| doi_str_mv | 10.1002/14651858.CD001118.pub4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7112723</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2165659196</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5394-e6749845f67ad0ee868c6686841e890a9ba300f587baecdfbd25efabcbc3d5c73</originalsourceid><addsrcrecordid>eNqFUMtOwzAQtBCIlsIvVDlySbHj2E4OIEF5SpXgAGfLcTZtIImL3Rb1xifwjXwJjvpQ4cLF9u7MzqwHoT7BA4JxdEZizkjCksHwGmNCSDKYzrN4D3VbIGyR_Z13Bx0594ox5WkkDlGHYh7RVOAuOn-yZTP7_vzKlIM8cFAVvphANQ18H-wCmllpGhcUxgauNm9lMw40OKfa9jE6KFTl4GR999DL7c3z8D4cPd49DC9HoWY0jUPgIk6TmBVcqBwDJDzRnPszJpCkWKWZohgXLBGZAp0XWR4xKFSmM01zpgXtoYuVrv9kDbn2S1lVyakta2WX0qhS_kaaciLHZiEFIZGIqBc4XQtY8z4HN5N16TRUlWrAzJ2MCGecpSTlnspXVG2NcxaKrQ3Bss1ebrKXm-xb89gP9neX3I5twvaEqxXho6xgKbXRE-v9_9H94_IDiWyYcw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2165659196</pqid></control><display><type>article</type><title>Print‐based self‐help interventions for smoking cessation</title><source>MEDLINE</source><source>Cochrane Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Livingstone‐Banks, Jonathan ; Ordóñez‐Mena, José M ; Hartmann‐Boyce, Jamie ; Hartmann‐Boyce, Jamie</creator><creatorcontrib>Livingstone‐Banks, Jonathan ; Ordóñez‐Mena, José M ; Hartmann‐Boyce, Jamie ; Hartmann‐Boyce, Jamie</creatorcontrib><description>Background
Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully.
Objectives
The aims of this review were to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups.
Search methods
We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018.
Selection criteria
We included randomised trials of smoking cessation with follow‐up of at least six months, where at least one arm tested print‐based materials providing self‐help compared with minimal print‐based self‐help (such as a short leaflet) or a lower‐intensity control. 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 accordance with standard methodological procedures set out by Cochrane. 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 study and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a random‐effects model.
Main results
We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.
Thirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).
Thirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.
Five studies evaluated self‐help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes.
Authors' conclusions
Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded. Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.
Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD001118.pub4</identifier><identifier>PMID: 30623970</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Behavior Therapy ; Behavioural therapy ; By treatment type ; Chewing Gum ; Humans ; Interventions to help smokers and other tobacco users to quit ; Lungs & airways ; Medicine General & Introductory Medical Sciences ; Nicotine ; Nicotine - analogs & derivatives ; Nicotine - therapeutic use ; Patient Education as Topic ; Polymethacrylic Acids ; Polymethacrylic Acids - therapeutic use ; Polyvinyls ; Polyvinyls - therapeutic use ; Psychological approaches ; Randomized Controlled Trials as Topic ; Self Care ; Self Care - methods ; Smoking Cessation ; Smoking Cessation - methods ; Smoking Prevention ; Temperance ; Temperance - statistics & numerical data ; Tobacco ; Tobacco Use Cessation Devices ; Tobacco, drugs & alcohol</subject><ispartof>Cochrane database of systematic reviews, 2019-01, Vol.2019 (1), p.CD001118</ispartof><rights>Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5394-e6749845f67ad0ee868c6686841e890a9ba300f587baecdfbd25efabcbc3d5c73</citedby><cites>FETCH-LOGICAL-c5394-e6749845f67ad0ee868c6686841e890a9ba300f587baecdfbd25efabcbc3d5c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27928,27929</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30623970$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Livingstone‐Banks, Jonathan</creatorcontrib><creatorcontrib>Ordóñez‐Mena, José M</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><title>Print‐based self‐help interventions for smoking cessation</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully.
Objectives
The aims of this review were to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups.
Search methods
We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018.
Selection criteria
We included randomised trials of smoking cessation with follow‐up of at least six months, where at least one arm tested print‐based materials providing self‐help compared with minimal print‐based self‐help (such as a short leaflet) or a lower‐intensity control. 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 accordance with standard methodological procedures set out by Cochrane. 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 study and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a random‐effects model.
Main results
We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.
Thirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).
Thirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.
Five studies evaluated self‐help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes.
Authors' conclusions
Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded. Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.
Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available.</description><subject>Behavior Therapy</subject><subject>Behavioural therapy</subject><subject>By treatment type</subject><subject>Chewing Gum</subject><subject>Humans</subject><subject>Interventions to help smokers and other tobacco users to quit</subject><subject>Lungs & airways</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Nicotine</subject><subject>Nicotine - analogs & derivatives</subject><subject>Nicotine - therapeutic use</subject><subject>Patient Education as Topic</subject><subject>Polymethacrylic Acids</subject><subject>Polymethacrylic Acids - therapeutic use</subject><subject>Polyvinyls</subject><subject>Polyvinyls - therapeutic use</subject><subject>Psychological approaches</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Self Care</subject><subject>Self Care - methods</subject><subject>Smoking Cessation</subject><subject>Smoking Cessation - methods</subject><subject>Smoking Prevention</subject><subject>Temperance</subject><subject>Temperance - statistics & numerical data</subject><subject>Tobacco</subject><subject>Tobacco Use Cessation Devices</subject><subject>Tobacco, drugs & alcohol</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUMtOwzAQtBCIlsIvVDlySbHj2E4OIEF5SpXgAGfLcTZtIImL3Rb1xifwjXwJjvpQ4cLF9u7MzqwHoT7BA4JxdEZizkjCksHwGmNCSDKYzrN4D3VbIGyR_Z13Bx0594ox5WkkDlGHYh7RVOAuOn-yZTP7_vzKlIM8cFAVvphANQ18H-wCmllpGhcUxgauNm9lMw40OKfa9jE6KFTl4GR999DL7c3z8D4cPd49DC9HoWY0jUPgIk6TmBVcqBwDJDzRnPszJpCkWKWZohgXLBGZAp0XWR4xKFSmM01zpgXtoYuVrv9kDbn2S1lVyakta2WX0qhS_kaaciLHZiEFIZGIqBc4XQtY8z4HN5N16TRUlWrAzJ2MCGecpSTlnspXVG2NcxaKrQ3Bss1ebrKXm-xb89gP9neX3I5twvaEqxXho6xgKbXRE-v9_9H94_IDiWyYcw</recordid><startdate>20190109</startdate><enddate>20190109</enddate><creator>Livingstone‐Banks, Jonathan</creator><creator>Ordóñez‐Mena, José M</creator><creator>Hartmann‐Boyce, Jamie</creator><creator>Hartmann‐Boyce, Jamie</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZTPLO</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190109</creationdate><title>Print‐based self‐help interventions for smoking cessation</title><author>Livingstone‐Banks, Jonathan ; Ordóñez‐Mena, José M ; Hartmann‐Boyce, Jamie ; Hartmann‐Boyce, Jamie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5394-e6749845f67ad0ee868c6686841e890a9ba300f587baecdfbd25efabcbc3d5c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Behavior Therapy</topic><topic>Behavioural therapy</topic><topic>By treatment type</topic><topic>Chewing Gum</topic><topic>Humans</topic><topic>Interventions to help smokers and other tobacco users to quit</topic><topic>Lungs & airways</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Nicotine</topic><topic>Nicotine - analogs & derivatives</topic><topic>Nicotine - therapeutic use</topic><topic>Patient Education as Topic</topic><topic>Polymethacrylic Acids</topic><topic>Polymethacrylic Acids - therapeutic use</topic><topic>Polyvinyls</topic><topic>Polyvinyls - therapeutic use</topic><topic>Psychological approaches</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Self Care</topic><topic>Self Care - methods</topic><topic>Smoking Cessation</topic><topic>Smoking Cessation - methods</topic><topic>Smoking Prevention</topic><topic>Temperance</topic><topic>Temperance - statistics & numerical data</topic><topic>Tobacco</topic><topic>Tobacco Use Cessation Devices</topic><topic>Tobacco, drugs & alcohol</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Livingstone‐Banks, Jonathan</creatorcontrib><creatorcontrib>Ordóñez‐Mena, José M</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><creatorcontrib>Hartmann‐Boyce, Jamie</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Coronavirus (COVID-19): effective options for quitting smoking during the pandemic (Open Access)</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Livingstone‐Banks, Jonathan</au><au>Ordóñez‐Mena, José M</au><au>Hartmann‐Boyce, Jamie</au><au>Hartmann‐Boyce, Jamie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Print‐based self‐help interventions for smoking cessation</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2019-01-09</date><risdate>2019</risdate><volume>2019</volume><issue>1</issue><spage>CD001118</spage><pages>CD001118-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully.
Objectives
The aims of this review were to determine the effectiveness of different forms of print‐based self‐help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print‐based self‐help, such as computer‐generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups.
Search methods
We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018.
Selection criteria
We included randomised trials of smoking cessation with follow‐up of at least six months, where at least one arm tested print‐based materials providing self‐help compared with minimal print‐based self‐help (such as a short leaflet) or a lower‐intensity control. 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 accordance with standard methodological procedures set out by Cochrane. 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 study and biochemically validated rates when available. Where appropriate, we performed meta‐analysis using a random‐effects model.
Main results
We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.
Thirty‐five studies evaluated the effects of standard, non‐tailored self‐help materials. Eleven studies compared self‐help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low‐ and middle‐income countries because evidence for this comparison came from studies conducted solely in high‐income countries and there is reason to believe the intervention might work differently in low‐ and middle‐income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self‐help compared with brief leaflets did not show evidence of an effect of self‐help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self‐help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self‐help was provided as an adjunct to face‐to‐face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).
Thirty‐two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage‐matched or non‐tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self‐help with no self‐help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self‐help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self‐help with non‐tailored self‐help, results favoured tailored interventions when the tailored interventions involved more mailings than the non‐tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact‐matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.
Five studies evaluated self‐help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self‐help programmes.
Authors' conclusions
Moderate‐certainty evidence shows that when no other support is available, written self‐help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self‐help materials add to their effect. However, small benefits cannot be excluded. Moderate‐certainty evidence shows that self‐help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self‐help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.
Available evidence tested self‐help interventions in high‐income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low‐ and middle‐income countries, where more intensive support may not be available.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30623970</pmid><doi>10.1002/14651858.CD001118.pub4</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2019-01, Vol.2019 (1), p.CD001118 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7112723 |
| source | MEDLINE; Cochrane Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Behavior Therapy Behavioural therapy By treatment type Chewing Gum Humans Interventions to help smokers and other tobacco users to quit Lungs & airways Medicine General & Introductory Medical Sciences Nicotine Nicotine - analogs & derivatives Nicotine - therapeutic use Patient Education as Topic Polymethacrylic Acids Polymethacrylic Acids - therapeutic use Polyvinyls Polyvinyls - therapeutic use Psychological approaches Randomized Controlled Trials as Topic Self Care Self Care - methods Smoking Cessation Smoking Cessation - methods Smoking Prevention Temperance Temperance - statistics & numerical data Tobacco Tobacco Use Cessation Devices Tobacco, drugs & alcohol |
| title | Print‐based self‐help interventions for smoking cessation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-16T13%3A44%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Print%E2%80%90based%20self%E2%80%90help%20interventions%20for%20smoking%20cessation&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Livingstone%E2%80%90Banks,%20Jonathan&rft.date=2019-01-09&rft.volume=2019&rft.issue=1&rft.spage=CD001118&rft.pages=CD001118-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD001118.pub4&rft_dat=%3Cproquest_pubme%3E2165659196%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2165659196&rft_id=info:pmid/30623970&rfr_iscdi=true |