Various behavioural strategies may help healthy people quit smoking

Xu M, Guo K, Shang X, et al. Network meta-analysis of behavioral programs for smoking quit in healthy people J Am J Prev Med. 2023;65:327-336.

Review question

What are the effects of different behavioural strategies on quitting smoking in physically and mentally healthy people?

Background

Smoking is a risk factor for the development of chronic diseases. Globally, over one billion people smoke. Medications are available that can help people quit, but they often come with side effects like insomnia and nausea. Behavioural strategies can be used instead of or with medication.

How the review was done

This is a network meta-analysis of 119 randomized controlled trials. The studies were published between 1991 and 2022 and included 118,935 total participants.

Key features of the studies were:

• Participants were physically and mentally healthy people who smoke and had smoked a minimum of 1 cigarette/day over the past six months. They ranged in age from 16-71.
• Participants received one of the following behavioural strategies: e-mail, exercise training, face-to-face cognitive education, financial incentives, health education, mindfulness-based treatment, motivational interviews, no contact (e.g., not receiving any strategy), quit-smoking app, quit smoking website alone or with telephone counselling or text messages, self-help material alone or with telephone counselling, telephone counselling, text messages, and video counselling.
• Researchers measured smoking abstinence (i.e., quitting) at different durations (continuous abstinence, 30-day abstinence, and 7-day abstinence).
• Results were compared with people in control groups receiving brief advice on quitting smoking.

What the researchers found

The review found that eight of the 17 behavioural strategies studied may help healthy people quit smoking compared to brief advice on quitting. In order from most to least effective, the following strategies may be beneficial for the following quitting durations:

• continuous abstinence: motivational interviews and financial incentives
• 30-day abstinence: face-to-face cognitive education and financial incentives
• 7-day abstinence: video counselling, financial incentives, self-help materials combined with telephone counselling, motivational interviews, health education, telephone counselling alone, and text messages

Certainty in the evidence ranges from very low to moderate depending on the strategy. More high-quality research is needed to confirm some of these results and increase confidence in the findings. 

Conclusion

In healthy people, a range of behavioural strategies may lead to smoking cessation for different durations compared to brief advice on quitting.