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, and websites, aim to provide advice and information about quitting and have the potential to reach a large proportion of the smoking population.1 The 2019 National Drug Strategy Household Survey found 10% of smokers who had made a quit attempt in the previous year had used cessation literature in a brochure or on the internet (see 7.14.4 for an overview of internet-based interventions).3 Self-help materials can increase abstinence rates relative to no intervention, but the effects are small.
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.A 2019 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, which typically involve repeated assessment and mailing, do not appear to provide additional benefit compared with untailored materials when delivered similarly 1, 5 Increasing the duration and intensity of the provision of self-help materials may increase their effectiveness.US research found that intensive repeated mailing of self-help cessation booklets and other materials over a year significantly increased short-term6 and long-term abstinence7 compared with booklets mailed at less intense frequencies, and was also highly cost-effective.6 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.8 Offering linguistically and culturally relevant self-help materials may help reach and improve cessation outcomes among culturally and linguistically diverse groups9 (see also Section 9A.2).
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 10, 11 and was highly cost-effective.12 An adapted version of the booklets for new mothers, mailed until eight months postpartum, was also found the reduce smoking among low-income women.13 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.14
In Australia currently the most widely distributed resource is the booklet Quit Because You Can (often called the ‘Quit Book’),15 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.16 This booklet has been regularly updated since 1997. A condensed version of this booklet is also available in the form of the a brochure called ‘What I can do to stop smoking’.18
The Quit Book forms the central part of a pack of free print materials on the Quit website that are available to download or to be sent on request. The Quit Book is also distributed through a range of health professional settings. Supplementary print materials can also be downloaded or sent on request from the Quit website to tailor information to a smokers’ 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.21
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.22 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.23
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References for Section 7.13
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. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2019. ADA Dataverse, 2021. Last update: Viewed Available from: http://dx.doi.org/10.26193/WRHDUL.
4. 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.
5. Livingstone-Banks J, Ordonez-Mena JM, and Hartmann-Boyce J. Print-based self-help interventions for smoking cessation. Cochrane Database Systematic Reviews, 2019; 1:CD001118. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30623970
6. 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
7. Simmons VN, Sutton SK, Meltzer LR, Unrod M, Meade CD, et al. Long-term outcomes from a self-help smoking cessation randomized controlled trial. Psychology of Addictive Behaviors, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30284878
8. 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
9. Simmons VN, Sutton SK, Medina-Ramirez P, Martinez U, Brandon KO, et al. Self-help smoking cessation intervention for Spanish-speaking Hispanics/Latinxs in the United States: A randomized controlled trial. Cancer, 2022; 128(5):984-94.
10. 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
11. 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
12. 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
13. 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/
14. 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
15. 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
16. Wakefield M and Miller C. Evaluation of the quitline service, in Australia's national tobacco campaign. Evaluation report volume one., Canberra: Commonwealth Department of Health and Aged Care, 1999. Available from: https://webarchive.nla.gov.au/awa/20140801095025/http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm.
17. 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: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-publicat-document-metadata-tobccamp.htm.
18. What I can do to stop smoking, Quit, Editor 2018. Available from: https://d1pz9rwztkrv8y.cloudfront.net/media/documents/AP1525_WhatICanDo_DL_2018_v3.pdf.
19. Quit Victoria. Choosing the best way to quit. 2016. Available from: http://www.quit.org.au/preparing-to-quit/choosing-best-way-to-quit
20. 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.
21. 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.
22. 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
23. 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