Smoking Cessation Interventions

Smoking Cessation Interventions; Behavioural interventions

1. Self help interventions for smoking cessation Self-help cessation materials are a common component of most smoking cessation interventions, ranging from brief clinical interventions to community campaigns, but their effectiveness is not often evaluated due to practical difficulties in 'real world settings'. In particular, there are difficulties with follow-up of recipients and in disentangling the effects of a self-help resource from the effects of other cessation intervention components ^(9,17). There are also difficulties in generalizing about the efficacy of a particular method due to the lack of standardization of content (e.g. self-help manuals⁽¹⁸⁾ ). Most commonly, self-help materials are printed leaflets or manuals, although use of audiotapes and videotapes is also well established. The new generation of self-help materials is computer-based on CDs or internet websites or linked to television programs. Other forms of behavioural interventions that are predominantly self-help are client-initiated telephone quit lines and Quit-and-Win competitions. Quit-line services provide a contact point for provision of written self-help materials and may also employ counsellors to assist and support people during cessation attempts. The quit-line number is promoted extensively. The key elements for an effective quit-line are public access, quit smoking resources and information, counselling, training of counsellors and referral services^(19,20). Quit-lines are difficult to evaluate using randomized, controlled methods because self-selection by users is part of the method and identification and enrolment of suitable controls is difficult. Well-promoted quit-lines should be developed to support self-help cessation attempts.		Evidence proved that generic self-help materials alone are of small benefit compared to no intervention as provision of self-help materials of any type compared to no intervention, produced a small but significant increase in the odds of quitting at six months or more (OR= 1.23, 95% CI 1.01, 1.51)⁽¹⁷⁾. There is not enough evidence from comparative studies to recommend one or more types of self-help intervention over others ⁽¹⁷⁾. Materials tailored to the characteristics of individual smokers (especially stage of change) were more effective than standard materials in achieving sustained cessation at six months (OR 1.51, 95% CI 1.13, 2.02) ^(17,20,21). A brief leaflet is sufficient to support pharmacotherapy or smoking cessation advice from a health professional. Therefore, self-help materials should be tailored to the needs and cessation stages of individual smokers and selected population groups (pregnant women, asthmatics and adolescents). 2. Minimal clinical intervention Minimal clinical intervention, or brief advice by health professionals could have a great influence on Saudi smoking cessation levels, but has been underused. Australian doctors identify two thirds of their patients who smoke but advise only half of these (34%) to quit ^(22,23). Dentists also have high potential to provide advice on smoking cessation. Nurses usually have frequent, more extended contact with clients/patients, therefore are well placed to provide cessation advice. The US⁽¹²⁾ , and UK ⁽²⁴⁾ smoking cessation guidelines for health professionals recommend that all clinicians strongly advise their patients to quit smoking.