7.13 Cessation assistance: self-help

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There are many types of self-help materials that deliver behavioural methods of quitting. These include brochures, books, videotapes, CDs, audiotapes, reactive telephone lines and internet-based information. Cessation interventions delivered by generic self-help materials (stand alone or in combination with other support) marginally increase abstinence rates relative to no intervention.¹ There is little evidence that using multiple types of self-help without any interactive support significantly enhances cessation outcomes.¹ Personalised materials may be more effective than standard materials.² Self-help materials do have the potential to reach more people than through more intensive approaches.

7.13.1 Printed materials

Providing smokers with information on the harmful effects of smoking and methods of quitting has been a basic approach for over 20 years. In Australia currently the most widely distributed resource is the booklet Quit Because You Can (often called the 'Quit Book'), written by Quit Victoria with Commonwealth funding. In 2010, 335 000 copies were printed for state and territory use.³ The content is evidence based and covers issues on preparing to quit through to coping with setbacks after quitting. The Quit Book was evaluated in 1997 as part of the National Tobacco Campaign. Of those who received it after calling the Quitline, 100% found it easy to understand (very or somewhat), 95% found it helpful, and 93% said they would recommend it to friends.⁴ This booklet has been regularly updated since 1997 and was redeveloped in 2007.

An additional resource, Choosing the Best Way to Quit, was also developed in 2007 and provides an overview of evidence-based information on quitting. The booklet is designed to help smokers choose the most effective approach to quitting, which suits their individual needs. It recommends that for most people the best way to quit is to:

• get some coaching (from the Quitline, Quit Pack, group courses, the Internet or individual counselling), and
• use quitting medications (NRT or prescribed medications).

Evidence suggests these two forms of help have additive benefits.^{1, 5}

These two resources form the central part of a pack of free print materials sent to Quitline callers on request. The Quit Book is also distributed through a range of health professional settings.

Supplementary print materials can also be included in the 'Quit Pack' to tailor information to Quitline caller needs. Examples include specific information for women, parents, adolescents, people living with illnesses such as diabetes, asthma, or mental illness, and people wanting to help a family member or friend who smokes. Information is available on nicotine replacement products or other quitting medications and on other aspects of quitting, smoking and health. Some print resources are available in a range of languages other than English. A Victorian survey in 2010 found that 44% of respondents who received a Quit Pack had read it all, 81% had read at least half, 82% found it somewhat or very easy to understand, relevant and helpful and 94% would recommend it to friends or family members.⁶

There is some evidence that distributing a self-help cessation intervention (Quit Kit) at a national level may be successful in terms of uptake, triggering quit attempts and helping cessation.⁷

Other self-help print materials are available, produced by a range of independent non-profit organisations and those with a commercial interest. The quality of the information these self-help materials contain varies from the excellent to the inadequate and misleading, and care needs to be taken in their selection and use. In most cases (but not all) the research base for the resource is limited, and so any claims (especially excessive claims) for success should be treated sceptically unless they are fully validated.

7.13.2 Internet-based resources: not tailored or interactive

Many internet sites have been established to help smokers quit. As with other areas, they vary in quality and credibility from those that are comprehensive and well researched to sites set up by tobacco manufacturers. There is a scarcity of good research and evaluation to establish their effectiveness. There is some evidence that people using the Internet for smoking cessation information often do not link to research-based sites, which may reduce the potential impact of the Internet as an effective cessation tool.⁸

A major advantage of the Internet over printed material is the potential for interactivity and tailoring information to individual needs.

Many state and territory based Quit organisations in Australia have their own websites, as does the Commonwealth Department of Health and Ageing (www.quitnow.info.au, which links to Quit organisations). Some non-government tobacco-control groups also have a strong internet presence including sections dedicated to cessation. Manufacturers of smoking cessation products often have internet sites to inform and support the users of their products; these sites may also provide general quitting information.

Another potential opportunity provided by the Internet is to target specific groups such as young people, who are mostly very familiar with information technology. OxyGen (www.OxyGen.org.au) is an Australian tobacco education website that aims to inform young people about smoking. It is a tri-state initiative of Quit Victoria, Quit South Australia and the Smarter than Smoking Program in Western Australia. The most recent redevelopment was funded by the Department of Health and Ageing.

Sites such as YouTube may provide opportunities for disseminating cessation information. Limited findings highlight the need for videos containing evidence-based practices and for further research to determine whether such videos influence knowledge, attitudes and behaviour regarding quitting smoking.^9,10

7.13.3 Other electronic resources

Some small projects have focused on the acceptability of using computerised smoking awareness education in health settings tailored to cultural backgrounds and literacy levels.¹¹

References

1. Fiore MC, Jaén M, Carlos Roberto, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence. Clinical Practice Guidelines. Rockville, Maryland: US Department of Health and Human Services, 2008. Available from: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf

2. Lancaster T and Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database of Systematic Reviews 2005. (2)DOI: 10.1002/14651858.CD001292.pub2 Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001292/frame.html

3. Quit Victoria, Calls to Australian Quitlines June 2009 to June 2011 (personal communication). 2012.

4. Wakefield M and Miller C. Evaluation of the Quitline service. In Hassard K, edn.Australia's National Tobacco Campaign. Evaluation report volume one. Canberra: Commonwealth Department of Health and Aged Care, 1999 84-106. Available from: http://www.quitnow.info.au/internet/quitnow/publishing.nsf/Content/evaluation-reports

5. Zwar N, Richmond R, Borland R, Peters M, Stillman S, Litt J, et al. Smoking cessation pharmacotherapy: an update for health professionals. Melbourne: Royal Australian College of General Practitioners, 2007.

6. Centre for Behavioural Research in Cancer. 2010 Quitline evaluation: preliminary findings from the 1 month follow up, unpublished data. Melbourne, Australia: Cancer Council Victoria. 2011.

7. Ussher M, Chambers M, Adams R, Croghan E and Murray R. Evaluation of a nationally disseminated self-help intervention for smoking cessation ('Quit Kit'). Tobacco Control 2011;[Epub ahead of print] Available from: http://tobaccocontrol.bmj.com/content/early/2011/03/16/tc.2010.040535.full.pdf

8. Cobb N. Online consumer search strategies for smoking-cessation information. American Journal of Preventive Medicine 2010;38(3 suppl.):S429–32. Available from: http://www.ajpm-online.net/article/PIIS0749379709008654/fulltext

9. Backinger C and Augustson E. Where there's an app, there's a way? American Journal of Preventive Medicine 2011;40(3):390–1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21335276

10. Richardson C, Vettese L, Sussman S, Small S and Selby P. An investigation of smoking cessation video content on YouTube. Substance Use & Misuse 2011;46(7):893–7. Available from: http://informahealthcare.com/doi/full/10.3109/10826084.2011.570628

11. Andersen S, Andersen P and Youngblood N. Multimedia computerized smoking awareness education for low-literacy Hispanics. Computers, Informatics, Nursing 2011;29(suppl. 2):TC35–42. Available from: http://journals.lww.com/cinjournal/pages/articleviewer.aspx?year=2011&issue=02001&article=00007&type=abstract