Featured Review: Does behavioural support help people to stop smoking?

A woman sits on a couch across from a therapist

Behavioural interventions for smoking cessation: an overview and network meta‐analysis

Key messages

Behavioural support can help more people to stop smoking for six months or longer, without causing unwanted effects.

Some types of support appear to work better than others. More studies are needed to identify the best ways to support people who are trying to stop smoking, and to identify the best people to support them.

Stopping smoking

The best thing people who smoke can do for their health is to stop smoking. People breathe more easily and cough less when they stop smoking. Stopping also lowers their risk of getting lung cancer and other diseases.

How to help people stop smoking

Most people who smoke want to stop, but many find it difficult. People who smoke may use nicotine replacement therapy, such as nicotine patches or gum, or other medicines to help them stop. Behavioural support provides an alternative – or additional – way to help people stop smoking. Sometimes behavioural support can be combined with nicotine replacement or other medicines to help people stop smoking.

Types of behavioural support can include: advice and counselling on ways to make it easier to stop smoking; information about why or how to stop; or a combination. Behavioural support can be given in group sessions or one-to-one.

Why did the authors do this Cochrane Review?

The authors wanted to find out:

  • which types of behavioural support work best to help people stop smoking;
  • the best ways to give behavioural support (including the best people to give it); and
  • what aspects of behavioural support help someone to stop smoking.

They also wanted to know if behavioural support can cause any unwanted effects.

What did authors do?

They searched for Cochrane Reviews of behavioural support to stop smoking, to identify relevant studies of adults who smoked. They then compared the studies with each other, to find out how well the different types of behavioural support helped people to stop smoking.

Search date: the authors included evidence published up to July 2020.

What they found

The authors found 33 Cochrane Reviews, from which they identified 312 relevant studies in 250,503 adults (aged 18 to 63 years) who smoked cigarettes. The studies investigated 437 different combinations of ways to stop smoking.

The studies looked at the following types of behavioural support, among others:

  • giving someone information about their test results, or their risk of smoking-related disease;
  • counselling (face-to-face, by telephone or by video call);
  • self-help materials, resources, and reminders by mobile phone messages or apps;
  • rewards (money, or a chance to win money by entering competitions);
  • exercise-based support; and
  • hypnotherapy.

In the studies, a variety of people provided behavioural support, including: doctors, consultants, nurses, pharmacists, dentists, counsellors and lay health advisors.

Most studies were conducted in the USA or Western Europe; 115 studies took place in healthcare settings and 195 took place in the community. On average, people taking part in the studies were followed up for 10.5 months.

The studies compared the effects of behavioural support with:

  • no behavioural support;
  • usual or standard care;
  • less-intense forms of the behavioural support; or other approaches.

The authors compared all treatments with each other using a mathematical method called network meta-analysis.

What are the main results of this review?

Compared with no behavioural support it was clear that some types of behavioural support increased people's chances of quitting for six months or longer, including: counselling and giving them money for successfully stopping smoking. More people stopped smoking with these types of support whether or not they were also taking medicines to help them stop smoking.

Behavioural support by text messages probably helped more people to stop smoking than no support.

Compared with no support, tailoring behavioural support to the person, or group of people, trying to stop smoking probably slightly increased how many of them stopped smoking, as did support that focused on how to stop smoking.

Increasing the intensity of the support given, such as contacting people more often or having longer sessions, modestly increased how many people stopped smoking.

The authors are uncertain about:

  •  the effects of other types of behavioural support, including hypnotherapy, exercise-based support, and entering competitions; and
  • the effect of who gives the behavioural support.

Only some studies reported results for unwanted effects; in these, behavioural support did not increase the numbers of any unwanted effects.

How confident are the authors in these results?

The authors are confident that counselling and rewards of money help people to stop smoking; they do not expect that more evidence will change these results. They are less confident in the results for other types of behavioural support, and about who gives the support and how. They found limitations with some of the studies, including how they were designed, conducted, and reported. These results are likely to change when more evidence becomes available. More studies are needed.

Tuesday, January 5, 2021