Abstract

Does behavioural support help people to stop smoking?

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.

Most people who smoke want to stop, but many find it difficult. People who smoke may use 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 we did this Cochrane Review

We 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.

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

What did we do?

We searched for Cochrane Reviews of behavioural support to stop smoking, to identify relevant studies of adults who smoked. We 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: we included evidence published up to July 2020.

What we found

We found 33 Cochrane Reviews, from which we 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.

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.

We compared all treatments with each other using a mathematical method called network meta‐analysis.

What are the main results of our 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.

We 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 we in our results?

We are confident that counselling and rewards of money help people to stop smoking; we do not expect that more evidence will change these results.

We are less confident in our results for other types of behavioural support, and about who gives the support and how. We 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.