Tailored materials appear to be effective in helping people quit. Clinicians are encouraged to provide tailored self-help materials, either web based or printed, to their patients who want to quit.1
Self -help has been defined as the action or process of bettering oneself or overcoming one's problems without the aid of others.10 In reference to quitting smoking ,self-help refers to taking the initiative to quit and taking action toward cessation without anyone else’s involvement. Self-help is an attractive alternative for individuals who do not feel comfortable receiving face-to face counseling or have trouble traveling for treatment.
What are Self-Help Interventions?
When individuals are motivated to quit smoking, they often do it on their own. However, there are several self-help smoking cessation support programs available for individuals who want to quit smoking.
Lancaster (2009) defines self-help interventions as any manual or program used by the smoker to assist quit attempts without the help of any health professional, counselor or group support.
Some of the most common aids used by smokers are:
- Written materials: Pamphlets, booklets, mailings, manuals.
- Internet-based services: Computer programs, forums, chat rooms.
- Telephone-based services: Quitlines, texts messages, call backs.
According to Prevost (2008), self-help interventions are generally low-cost and wide reaching. Self-help interventions produce lower rates of abstinence than clinical interventions, but reach a larger population compared to clinical interventions 3. Although, clinical interventions for smoking cessation are known to yield the highest abstinent rates, they also yield the lowest participation rates. 4
Tailored materials have been shown to increase abstinence rates. The transtheoretical model (TTM) is a commonly used model to develop tailored materials. The TTM emphasizes the individual’s readiness to quit smoking. Tailored manuals created based on the TTM often yield higher abstinent rates when compared to standard manuals. 5
Web-internet based services have also been widely utilized and individuals seem to benefit from computerized tailored-feedback. 6 Several computer programs have been created to allow the smoker to keep track of their quitting success, which have been widely used by smokers, especially by those who do not have time to go to a clinic or attend a smoking cessation group.
Utilizing telephone services can increase abstinent rates in smokers. A telephone intervention call right before the quit date promotes the effectiveness of self-help abstinent rates.3 Quitlines; For instance, offer calls from experts whom asses the smoker readiness to quit and could even provide NRT as needed.
Self-help as an adjunct to other interventions:
Pairing self-help with other cessation programs has been proven to be more effective than self-help alone; some of the most common interventions paired with self-help are:
Telephone support (Quitlines):
- Compared to no intervention and/or self-help, “when smokers receive proactive telephone counseling, they are more than one and one-half times more likely to remain abstinent than if they had received minimal or no counseling or self-help” (DHHS, 2008, p. 28).
- A study conducted to see how effective telephone support was as an adjunct to self-help demonstrated that a single phone call helps the smoker remain abstinent for a longer period of time than if they hadn’t received any support.3
- One study found that when smokers receive advice from a physician they are more likely to quit smoking. In addition, cessation rates are much higher and more prevalent than if smokers quit on their own.7 Even though many smokers are very successful quitting on their own without any health care provider intervention, research shows that if there is physician intervention abstinent rates are much higher.
- Another study found that physician advice can be more effective when delivered in a motivational fashion, than in an informative way.8
Nicotine replacement Therapy (NRT):
- Studies comparing the effectiveness of self-help materials to nicotine replacement therapy (NRT) found that NRT yields higher quitting rates than self-help materials alone. NRT showed higher quitting rates even when using tailored materials.1 However, when used in conjunction abstienet rates were much higher.
Research suggests that self-help intervention in addition to other smoking cessation interventions produces higher and more sustained abstinent rates. It is important to note however that many individuals manage to quit on their own without any interventions.
The clinical practice guideline conducted a meta-analysis to compare the abstinent rates of self-help to other interventions. Brochures were used for the self-help intervention alone; the other analysis used brochures + counseling, and brochures + individual counseling. They found that abstinent rates for self-help were 12.3 %, for group counseling 13.9 % and for individual counseling 16.8 %. As we can appreciate, many individuals can quit without anybody’s intervention; however, individuals are most likely to remain quit when they pair self-help with other interventions (DHHS, 2008, p. 90).
American Cancer Society's Guide to Quitting Smoking
AHRQ's Help for Smokers and Other Tobacco Users online printable booklet.
Nicotine Anonymous offers help to those who wish to stop using nicotine using a twelve-step approach.
QuitNet is dedicated to providing comprehensive resources and support for people trying to give up smoking, yet does not claim to replace the advice of a physician. This site allows smokers to enter the number of cigarettes they smoke per day and provides them with estimates of how much money and lifetime have been lost due to cigarette use.
Smokefree.gov provides a comprehensive online quit guide and other resources. Smokefreefamilies.org: Advice to help pregnant smokers quit.
Mobile Health Technology: To view a presentation by Dr. Lorien Abroms, associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services, on the evidence base for using mobile phones as an aid in quitting smoking and an in-depth look at Text2Quit (a text messaging program for smoking cessation that has been integrated into quitline services in selected states) please click here (Part 1 and Part 2).
1. Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews 2005, Issue 3.
2. Naughton, F., Prevost, A., & Sutton, S. (2008). Self-help smoking cessation interventions in pregnancy: A systematic review and meta-analysis. Addiction, 103(4), 566-579. doi:10.1111/j.1360-0443.2008.02140.x
3. Míguez, M., & Becoña, E. (2008). Evaluating the effectiveness of a single telephone contact as an adjunct to a self-help intervention for smoking cessation in a randomized controlled trial. Nicotine & Tobacco Research, 10(1), 129-135. doi:10.1080/14622200701767746
4. Lando, H. A. (2006). Reflections on 30+ years of smoking cessation research: From the individual to the world. Drug and Alcohol Review, 25, 5–14.
5 .Webb, M. S., Hendricks, P. S., & brandon, T. H. (2007). Expectancy priming of smoking cessation messages enhances the placebo effect of tailored interventions. Health Psychology, 26(5), 598-609. doi:10.1037/0278-618.104.22.1688
6. Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2010). A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: Is human contact necessary for therapeutic efficacy?. Clinical Psychology Review, doi:10.1016/j.cpr.2010.10.002
7. Unrod, M., Smith, M., Spring, B., DePue, J., Redd, W., & Winkel, G. (2007). Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. Journal Of General Internal Medicine, 22(4), 478-484. doi:10.1007/s11606-006-0069-0
8. Gemmell, L., & DiClemente, C. C. (2009). Styles of physician advice about smoking cessation in college students. Journal Of American College Health, 58(2), 113-119. doi:10.1080/07448480903221251
9. Solberg LI, Maciosek MV, Edwards NM, et al. Repeated tobacco-use screening and intervention in clinical practice: health impact and cost effectiveness. Am J Prev Med 2006;31:62-71