Self-help interventions for smoking cessation

 

Abstract

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.

 

Plain language summary

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.

 

摘要

背景

戒菸的自助方案

許多吸菸者在獨自戒菸時容易放棄，但如果給予指導手冊或訊息也許可以幫助他們增加成功戒菸率

目標

在這次回顧的目的在於確定不同形式的自助手冊的有效性，並且跟沒有治療，以及其他最低限度的接觸策略進行比較；其他與自助附屬物品的有效性，如：電腦回饋，電話熱線和藥物;以及比較為個人量身訂製的手冊與否的效果

搜尋策略

我們以‘selfhelp’(自我幫助)或‘manual’(手冊) ‘booklet’ (小冊子)搜尋登錄在Cochrane Tobacco Addiction Group的試驗研究，搜尋到2005年4月的之前的文章

選擇標準

我們將戒菸與後續至少六個月內追蹤的隨機試驗研究納入，這些研究至少有一個目標是檢驗自助方案的處遇措施。我們定義自助需有結構化的課程，以幫助戒菸者在沒有治療者密集接觸的情況下嘗試戒菸

資料收集與分析

我們取得參與者的資料副本，自助手冊的真實內容，介入組跟對照組面對面接觸的量，結果測量，隨機抽樣的方法，追蹤完成率。主要的結果測量在於接受追蹤六個月後的戒除率。在每一個研究中，我們採用最嚴格的抽菸戒除的定義，並且取得有效的生理指數。在適當地情況底下，我們以固定效果模式進行後設分析

主要結論

我們找出60個研究。有33是比較自助手冊與沒有處遇或除了建議之外的測試的素材。在11個比較自助與無處遇的研究中，其總括效果有達到統計的顯著性(N = 13733;odds ratio [OR] 1.24, 95% confidence interval [CI] 1.07 to 1.45)。這個分析排除了兩個極為正向的結果，因為有顯著的異質性。另有四個研究，其中控制組接受替代性素材，這些研究沒有足夠的證據顯示其戒菸的自助方案是有效的。沒有足夠的證據顯示，面對面的指導或尼古丁替代療法加上自助手冊後是有幫助的。有17個研究採用為癮君子量身訂製的手冊，後設分析發現此方法是有效的(N = 20,414; OR 1.42, 95% CI 1.26 to 1.61)。與不介入相較之下，特製化的手冊明顯有效，同時，特製化的手冊比標準手冊更有幫助。有部份的影響是來自於其他額外的接觸或必須取得個人的資料。有少數的研究並不認為使用額外的素材或標把素材是有效的在不同的自助方案當中有差異性

作者結論

標準的自助手冊可能比沒有處遇更能夠增加戒菸率，但效果可能很小。我們沒有發現足夠的證據顯示同時使用其他的療法如專業人員的指導，或尼古丁替代療法，能夠獲得額外的效益。雖然絕對效果量還是很小，但證據顯示為癮君子特製化的手冊是有效的，而且比非特製化有效

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

提供癮君子手冊以幫助他們戒菸，其效果是有限的，除非手冊能夠考量到癮君子個人的特性。指導與行為輔導可以幫助癮君子戒菸。同樣形式的書面資料雖然對一些沒有其他協助的人有一些幫忙，但研究並沒有發現標準手冊或其他大眾傳播工具很有用。特製化的手冊能夠提供個別化的協助，這比較有效。比較不同形式的標準化手冊之間的效果並沒有顯著的差異