Self-help interventions for smoking cessation.
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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Tobacco Addiction Group trials register using the terms 'self-help', 'manual*' or 'booklet*'. Date of the most recent search March 2002.


METHODS
We included randomised 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.


METHODS
We extracted data in duplicate on the type of subjects, the nature of the self-help materials, the amount of face to face contact given to subjects and to controls, outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients 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 effects model.


RESULTS
We identified fifty-one trials. Thirty two compared self-help materials to no intervention or tested materials used in addition to advice. In eleven trials in which self-help was compared to no intervention there was a pooled effect that just reached statistical significance (odds ratio 1.24, 95% confidence interval 1.07 to 1.45) This analysis excluded one trial with a strongly positive outcome that introduced significant heterogeneity. Four 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 was evidence from fourteen trials using materials tailored for the characteristics of individual smokers that such personalised materials were more effective than standard manuals (ten trials, odds ratio 1.36, 95% confidence interval 1.13 to 1.64) or no materials (three trials, odds ratio 1.80, 95% confidence interval 1.46 to 2.23). A small numbers of trials failed to detect benefit from using additional materials or targetted materials.


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 health care professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are more effective.
ICRF General Practice Research Group, Division of Public Health and Primary Health Care, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF. tim.lancaster@dphpc.ox.ac.uk
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D001521:Behavior Therapy; D002638:Chewing Gum; D006801:Humans; D009538:Nicotine / Q000031:analogs & derivatives / Q000627:therapeutic use; D010353:Patient Education as Topic; D011109:Polymethacrylic Acids / Q000627:therapeutic use; D011145:Polyvinyls / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention
D002638:Chewing Gum; D011109:Polymethacrylic Acids; D011145:Polyvinyls; D009538:Nicotine