Self-Help Interventions by the Smoker
and,morerarely,isalsoactedupon.Greaterseriousnessisattachedtodecisionsthatare promptedbypersonalillnessorbytheillnessordeathofafamilymemberorclosefriend.
Fromourownexperienceofcounsellingsmokers,weknowthatevenheavysmokers 40–60cigarettesdaycancarrythroughsuchdecisionswithoutmajoreffort.The6stud-
iespublishedtodateinwhichself-helpinterventionsledtosuccessfulsmokingcessation for6–9monthsOR=1.08;CI:0.81–1.44or12monthsOR=1.0;CI:0.75–1.34are
of limited value because biochemical variables were measured in only isolated cases [12]
.Thesupportofapartnerwasdescribedasanincreasingsuccessfulaspectforquit- ting in only 2 of the 6 studies
[12] . Smokers whose partners are non-smokers or ex-
smokersaremorelikelytobesuccessfulatquitting [13,14]
.Currentlymarriedsmokers haveahigherchanceofsuccessthandivorced,widowedornevermarriedsmokers
[15] .
Thesupportofthespousemaybebeneicialforsuccess [16,17]
.Ifsmokersarecon- stantly nagged, face complaints about their behaviour or are repeatedly criticised for
failedattemptsto quitsmoking,then their positionbecomesentrenched [18]
.Studies indicatingthepositiveinluenceofthespousepartnerinthiscontextarecounteredby
otherswhicharecriticaloftheirrole [19,20]
.Twosystematicstudiesreportthesupport- iveeffectofapartnerinachievingsmokingcessation
[21,22] ,inonecaseincludingthe
recommendationsoftheAHQR [21]
. However, numerous organisations also provide self-help manuals designed to assist
smokerswhowishtoquit [23,24]
.Consultingatherapist,inaddition,mayenhancethe effectivenessofthemethod
[23] .Standardinstructionshavebeenfoundtobelesseffective
thanpersonalisedinstructionstailoredforagroupofsmokersOR=1.41;CI:1.14–1.75 [25]
.Overall,instructionsonsmokingcessationareassessedasusefulandmoreeffective thanattemptingsmokingcessationwithoutinstructions.
Sporting activities are a key aspect of self-help to achieve smoking cessation [26]
. Physicalexercisehasabeneicialeffectoncravings
[27] ,depressedmood
[28] ,sleepdis-
turbances [29]
,feelingsoftension [30]
,stresssituations [31]
andonweightgainfollowing smokingcessation,anaspectthatisespeciallyimportantforwomen
[32–34] .Sportalso
hasapositiveeffectonrelapses [35]
,copingwiththesmokingproblem [36]
andself- esteem
[37] .Overall,ofcourse,physicalactivityconfershealthbeneitsontheex-smoker
[38] ;heavysmokersoftenalreadynoticethisjust2or3weeksafterstoppingsmokingand
theyvolunteerthisinformationspontaneouslyduringcounsellingsessions.Outofatotal of8studiesofthisaspectpublishedtodate,6couldnotbeassessedbecausepatientnum-
bersweretoosmall.Intheinalanalysis,therefore,only1studyprovidedpositiveevi- denceoftheeffectofvigorousexerciseintermsofsmokingcessationOR=2.36;CI:
0.97–5.70 [39]
,withadeiniteincreaseincontinuousabstinencecomparedwithcontrols 11.9vs.5.4;p=0.05
[39] .
Todeterminewhetherexercise-basedinterventionsaloneorcombinedwithasmoking cessationprogrammearemoreeffectivethanasmokingcessationinterventionalone,
UsshersearchedtheCochraneTobaccoAddictionGroupspecializedregisterforstudies including the terms “exercise” or “physical activity” and MEDLINE, EMBASE,
PsycINFO, CINAHL, Dissertation Abstracts and SPORTDiscus. Randomized trials whichcomparedanexerciseprogrammealoneoranexerciseprogrammeasanadjunct
toacessationprogrammewithacessationprogrammerecruitingsmokersorrecentquit- ters,andwithafollow-upof6monthsormorewereincludedinthe
[40] .Eleventrials
wereidentiied,sixofwhichhadfewerthan25peopleineachtreatmentarm.Theyvar- iedinthetimingandintensityofthesmokingcessationandexerciseprogrammes.Three
studiesshowedsigniicantlyhigherabstinenceratesinaphysicallyactivegroupvs.a controlgroupattheendoftreatment.Oneofthesestudiesalsoshowedabeneitfor
exercisevs.controlonabstinenceatboththe3monthand12monthfollow-uppoints. Onestudyshowedsigniicantlyhigherabstinenceratesfortheexercisegroupvs.acon-
trolgroupatthe3monthfollow–up,butnotattheendoftreatmentorat12monthfol- low-up.Theotherstudiesshowednosigniicanteffectforexerciseonabstinence.The
studyconcludedthatonlyoneofthe11trialsofferedevidenceforexerciseaidingsmok- ingcessation.Allbutoneoftheothertrialsweretoosmalltoconcludethattheinterven-
tionwasineffective,orincludedanexerciseinterventionwhichwasinsuficientlyintense toachievethedesiredlevelofexercise.Trialsareneededwithlargersamplesizes,suf-
icientlyintenseexerciseinterventions,equalcontactcontrolconditionsandmeasuresof exerciseadherence
[40] .
The effectiveness of telephone counselling has been investigated in 23 studies, the resultsofwhichareextremelyheterogeneous.In4studies,telephonecounsellingwasfol-
lowedbyface-to-facecounselling.However,telephonecounsellingcanhelptoprevent furtherrelapsesorstabilisesmokingcessation
[41] .Sincetelephonecounsellingisusually
performedonanindividualbasis,itispreferabletogroupcounselling,amodalitythatis oftenrejectedbysmokers
[42] .Counsellingthenbecomesahotlinetorequestawiderange
of information. Counselling services have been set up speciically for smokers e.g. QuitlineAustralia, QuitEngland, Heidelberger TelefonGermany or they may operate
withinthebroaderframeworkofanintegratedsmokingcessationsupportservice [43]
. Similarly,theErfurtSmokerCounsellingCentreprovidesfreeinformationandadvice,but
alsooffersindividualtreatmentfree-of-chargeoveraperiodofweeksormonthswiththe goalofachievingsmokingcessationseeAppendix.