More intensive behavioural support means more smokers successfully quit, finds new Cochrane review

Talk to anyone who’s ever given up smoking, or tried to, and they’ll tell you that it’s hard. Very hard. Here in the UK, you’ll probably be offered support in the form of individual or group sessions as well as nicotine replacement products and you can read more about that, including where to find your free local NHS Stop Smoking Service, on the NHS Smokefree website. So how welll does this work?

A new Cochrane review has been published today, looking at the effectiveness of providing behavioural support to smokers who are also using pharmacotherapy, such as nicotine replacement therapy (NRT), to help them give up smoking. The reviewers looked for controlled trials, with or without randomisation, where people in control groups received a level of support that was less intensive than that received by people in the intervention groups. This could range from basic written information to multi-session counselling.

The reviewers found 38 trials suitable for inclusion, with over 15,000 particpants, who were followed up for at least six months. All but two of the studies provided four or more support sessions, with the intensity of behavioural support varying for both intervention and control groups. Most studies used NRT. The participants were typically moderate to heavy smokers who were motivated to quit and most studies recruited people who had made previous quit attempts. Results of the studies were combined. Here’s what they found:

  • There was a small but statistically significant benefit of more intensive support
  • Increasing the amount of behavioural support is likely to increase the chance of success by about 16%
  • There was too little evidence relating to the use of nortriptyline or varenicline pharmacotherapy for conclusions to be drawn
  • The reviewers judged the evidence to be robust and none of the studies was judged to be at high risk of bias on any domain. However, not all the studies used biochemical validation of smoking abstinence and analysis of only the studies which did validate abstinence in this way increased the possibility that the intervention had no effect

The authors concluded:

Providing behavioural support in person or via the telephone for people using pharmacotherapies to stop smoking has a small but important effect.

The review did not explore the impact of different elements of behavioural support intervention, nor the quality of the delivery. But this strengthens other research suggesting that behavioural support in addition to pharmacotherapy will help more people stop smoking, with more intensive support bringing more benefit.

So how do you get smokers to join quit programmes in the first place? Another new Cochrane review has looked at this and it’s disappointing that the included studies varied too much for firm conclusions to be drawn. What’s more, few considered the impact of the recruitment strategies on both recruitment rates and smoking cessation, and few considered whether quits attempts succeeded in the long-term. These are surely priorities for future research.

Meanwhile, if you’re a smoker wanting to quit, or wanting to help someone who does, check out the NHS Smokefree website, which has lots of good information and  tools designed to help you, such as the free Quit Smoking app.


Stead LF, Lancaster T. Behavioural interventions as adjuncts to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009670. DOI: 10.1002/14651858.CD009670.pub2.

Marcano Belisario JS, Bruggeling MN, Gunn LH, Brusamento S, Car J. Interventions for recruiting smokers into cessation programmes. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009187. DOI: 10.1002/14651858.CD009187.pub2.

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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