Quitting smoking: which types of behavioural support work best to help people stop?

In this blog for health practitioners and people wanting to quit smoking, Cochrane authors Annika Theodoulou and Dr Jamie Hartmann Boyce look at the latest Cochrane evidence on what types of behavioural support can best help people quit tobacco smoking.

Quitting smoking is one of the best things someone who smokes can do to improve their health There are many types of behavioural support available and studies suggest that:  Behavioural interventions for smoking cessation can help people quit smoking for 6 months or longer Receiving counselling or guaranteed monetary rewards for quitting are most likely to help Behavioural interventions are not likely to be harmful  

Smoking is a leading cause of death and illness but fortunately much of the damage can be reversed by quitting. Most people who smoke want to quit, but quitting smoking is very hard to achieve without support.1

Support to quit smoking can be provided through medication, behavioural therapies or a combination of the two. The highest chance of success comes from combining a stop smoking medication, like nicotine replacement therapy or varenicline,2, 3 with behavioural support.

What are behavioural interventions for quitting smoking?

Behavioural interventions to help people quit smoking can work by prompting an attempt to quit and/or by helping people to maintain abstinence from smoking once the attempt has been made. These interventions can vary greatly in their content, delivery, intensity, and availability, and can be offered in various combinations or as stand-alone treatments.

For example, interventions can vary based on:

  • Their focus – for example some interventions focus on why people should quit smoking, others focus on giving advice on how to quit smoking
  • The behaviours they involve – for example, counselling, hypnotherapy, or exercise
  • How they are delivered – for example, in person, over the phone, online, or in print materials
  • Who provides the intervention – for example a nurse, physician, or counsellor
  • The intensity of the intervention – how often, and for how long, a person receives the support

Given the number of different types of behavioural support available, you, like us, may now also be wondering which types of behavioural therapy work best.

What we did

We searched Cochrane Reviews of behavioural support to stop smoking and found 312 relevant studies including 250,503 adults who smoked cigarettes. The studies reported on 437 different combinations of ways to stop smoking!

So, which types are most effective to help people quit smoking?

Our analysis showed that behavioural interventions for smoking cessation can increase quit rates compared to no behavioural support, but effectiveness varied on the type of support provided.

We found high-certainty evidence that providing counselling or guaranteed monetary rewards for quitting smoking increased people’s chances of quitting for 6 months or longer compared with minimal intervention.

We found moderate-certainty evidence that the following intervention characteristics were probably beneficial compared to no support:

  • Interventions delivered by text message
  • Individual tailoring of interventions
  • Motivational components included in intervention content
  • A focus on how to quit
  • Delivery in a group setting

Evidence on other intervention characteristics such as on who delivers the intervention was low- to very low-certainty, so we are still uncertain about the effects of some intervention characteristics.

Are behavioural interventions for quitting smoking harmful?

There was no evidence to suggest an increase in harms in people who received behavioural support to help quit smoking.

Our overview was published in January 2021 in the Cochrane Database of Systematic Reviews.4

References (pdf)

Join in the conversation on Twitter with @CochraneUK, @CochraneTAG, @AnnikaTheod and @jhb19 or leave a comment on the blog.

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right to not publish any we consider offensive. Cochrane UK does not fact check – or endorse – readers’ comments, including any treatments mentioned.

Annika Theodoulou reports grants from National Institute for Health Research. Jamie Hartmann-Boyce reports grants from National Institute for Health Research and grants from Cancer Research UK and British Heart Foundation.

Annika’s profile appears below. View Jamie’s profile.



Quitting smoking: which types of behavioural support work best to help people stop? by Annika Theodoulou

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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