7.13 Cessation assistance: printed self-help materials

7.13.0 Introduction

Most smokers who quit do so without professional help, and strategies that can support otherwise unaided attempts may increase the number who quit successfully.¹ Evidence-based interventions such as behavioural counselling and pharmacotherapies, although effective, are limited in their reach and may only be accessible or desirable to a small proportion of smokers.² Self-help materials, such as brochures, books, videotapes, CDs, audiotapes, and websites, aim to provide advice and information about quitting and have the potential to reach a large proportion of the smoking population.¹ Self-help materials can increase abstinence rates relative to no intervention, but the effects are small.^{1, 3} Materials that are tailored to the individual appear to be more effective than generic materials.^{1, 3}

7.13.1 Printed materials

Providing smokers with printed information on the harmful effects of smoking and methods of quitting has been a longstanding strategy for encouraging cessation attempts. However, the relatively low efficacy of such materials for cessation has limited their impact on public health.¹ A 2014 Cochrane review of standard, print-based self-help materials concluded that they increase quit rates compared to no intervention, but the effect is likely to be small. They do not appear to have an additional benefit when used alongside other interventions such as advice from a healthcare professional, or nicotine replacement therapy. Materials that are tailored for an individual smoker are more effective than non-tailored materials, although the effect remains small.¹ Increasing the duration and intensity of the provision of self-help materials may also increase their effectiveness.⁴ Individual characteristics are an important consideration in selecting treatment; Dutch research found that among smoking parents, a self-help brochure was less effective among less motivated and lower educated parents, while Quitline counselling was effective regardless of intention to quit and educational level.⁵

While printed self-help materials appear to be only marginally effective at helping people quit, psycho-educational self-help interventions may be useful for preventing relapse. US research found that repeatedly mailing a series of evidence-based relapse-prevention booklets to ex-smokers over the course of a year significantly increased abstinence^{6, 7} and was highly cost-effective.⁸ An adapted version of the booklets for new mothers, mailed until 8 months postpartum, was also found the reduce smoking among low-income women.⁹ A randomised controlled trial published in 2015 found that although sending self-help relapse prevention materials to all quitline callers appeared to provide little benefit overall, it did increase the abstinence rate among those who were highly nicotine dependent.¹⁰ Building on these findings, there is an ongoing randomized controlled trial examining whether this self-help treatment modality may be an efficacious, cost-effective, and easily disseminable intervention for smoking cessation.²

In Australia currently the most widely distributed resource is the booklet Quit Because You Can (often called the ‘Quit Book’),¹¹ written by Quit Victoria with Commonwealth funding. It contains evidence-based information on all stages of quitting, from preparing to quit through to preventing relapse. 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.¹² This booklet has been regularly updated since 1997 and was last comprehensively updated in 2014.

An additional online resource, Choosing the Best Way to Quit,¹³ provides an overview of evidence-based information on quitting. It suggests that there are two types of support that increase the likelihood of success:

• guidance from a professional advisor or coach to help with managing habits and emotions linked to smoking, and
• nicotine replacement products or quitting medications.

Evidence suggests these two forms of help have additive benefits.^{3, 14}

The Quit Book forms 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 callers’ 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.¹⁵

A 2010 evaluation in the UK concluded that national distribution of a self-help cessation intervention (Quit Kit) may be successful in terms of uptake of the intervention, triggering quit attempts, and helping cessation.¹⁶ A refined version of the kit (Quit Kit-2) was evaluated in 2013, which contained practical behaviour change techniques and NRT, and was distributed via pharmacies. Results again showed that this intervention can promote quit attempts and short-term abstinence, with the addition of NRT being particularly appealing to smokers.¹⁷

Relevant news and research

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References

1. Hartmann-Boyce J, Lancaster T, and Stead LF. Print-based self-help interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2014; 6:CD001118. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24888233

2. Unrod M, Simmons VN, Sutton SK, Meltzer LR, Harrell PT, et al. A randomized clinical trial of self-help intervention for smoking cessation: Research design, interventions, and baseline data. Contemporary Clinical Trials, 2014; 38(2):284–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24865525

3. Fiore MC, Jaén M, Carlos Roberto, Baker TB, Bailey WC, Benowitz NL, et al. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: US Department of Health and Human Services, 2008. Available from: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html

4. Brandon TH, Simmons VN, Sutton SK, Unrod M, Harrell PT, et al. Extended self-help for smoking cessation: A randomized controlled trial. American Journal of Preventive Medicine, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26868284

5. Schuck K, Otten R, Kleinjan M, Bricker JB, and Engels RC. Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material. Preventive Medicine, 2014; 69C:126–31. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25278424

6. Brandon TH, Collins BN, Juliano LM, and Lazev AB. Preventing relapse among former smokers: A comparison of minimal interventions through telephone and mail. Journal of Consulting and Clinical Psychology, 2000; 68(1):103. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10710845

7. Brandon TH, Meade CD, Herzog TA, Chirikos TN, Webb MS, et al. Efficacy and cost-effectiveness of a minimal intervention to prevent smoking relapse: Dismantling the effects of amount of content versus contact. Journal of Consulting and Clinical Psychology, 2004; 72(5):797–808. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15482038

8. Chirikos TN, Herzog TA, Meade CD, Webb MS, and Brandon TH. Cost-effectiveness analysis of a complementary health intervention: The case of smoking relapse prevention. International Journal of Technology Assessment in Health Care, 2004; 20(04):475–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15609798

9. Brandon TH, Simmons VN, Meade CD, Quinn GP, Lopez Khoury EN, et al. Self-help booklets for preventing postpartum smoking relapse: A randomized trial. American Journal of Public Health, 2012; 102(11):10.2105/AJPH.012.300653. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477952/

10. Unrod M, Simmons VN, Sutton SK, Cummings KM, Celestino P, et al. Relapse-prevention booklets as an adjunct to a tobacco quitline: A randomized controlled effectiveness trial. Nicotine & Tobacco Research, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25847293

11. Quit Victoria. Quit because you can. 2016. Available from: http://www.quit.org.au/preparing-to-quit/choosing-best-way-to-quit/order-a-free-quit-pack

12. Wakefield M and Miller C. Evaluation of the quitline service, in Australia's national tobacco campaign. Evaluation report volume one. Hassard K, Editor Canberra: Commonwealth Department of Health and Aged Care; 1999. p 84–106 Available from: http://www.quitnow.info.au/internet/quitnow/publishing.nsf/Content/evaluation-reports

13. Quit Victoria. Choosing the best way to quit. 2016. Available from: http://www.quit.org.au/preparing-to-quit/choosing-best-way-to-quit

14. Zwar N, Richmond R, Borland R, Peters M, Stillman S, et al. Smoking cessation pharmacotherapy: An update for health professionals. Melbourne: Royal Australian College of General Practitioners, 2007. Available from: http://www.treatobacco.net/en/uploads/documents/Treatment%20Guidelines/Australia%20treatment%20guidelines%20-%20pharmacotherapy%20in%20English%202007.pdf

15. Baker J and Hayes L, 2010 quitline evaluation: Preliminary findings from the 1 month follow up. CBRC topline research report Melbourne, Australia: Centre for Behavioural Research in Cancer, Cancer Council Victoria; 2011.

16. 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; 20(5):380–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21415063

17. Murray RL, Szatkowski L, and Ussher M. Evaluation of a refined, nationally disseminated self-help intervention for smoking cessation (“quit kit-2”). Nicotine & Tobacco Research, 2013; 15(8):1365–71. Available from: http://ntr.oxfordjournals.org/content/15/8/1365.abstract