Self-help movements
Although clinical and public health interventions have proliferated over the past few
decades, up to 90 per cent of ex-smokers report having stopped without any formal help
(Fiore et al. 1990). Lichtenstein and Glasgow (1992) reviewed the literature on self-help
quitting and reported that success rates tend to be about 10–20 per cent at one-year
follow-up and 3–5 per cent for continued cessation. The literature suggests that lighter
smokers are more likely to be successful at self-quitting than heavy smokers and that
minimal interventions, such as follow-up telephone calls, can improve this success.
Research also suggests that smokers are more likely to quit if they receive support from
their partners and if their partners also stop smoking (Cohen and Lichtenstein 1990)
and that partner support is particularly relevant for women trying to give up smoking
during pregnancy (e.g. Appleton and Pharoah 1998). However, although many ex-
smokers report that ‘I did it on my own’, it is important not to discount their exposure to
the multitude of health education messages received via television, radio or leaflets.Public health interventions: promoting cessation in populations
Public health interventions aim to promote behaviour change in populations and
have become increasingly popular over recent years. Such interventions are aimed at all
individuals, not just those who seek help. For smoking cessation, they take the form
of doctor’s advice, worksite interventions, community-wide approaches, government
interventions. For drinking behaviour, most public health interventions take the form of
government interventions.1 Doctor’s advice. Approximately 70 per cent of smokers will visit a doctor at some
time each year. Research suggests that the recommendation from a doctor, who is
considered a credible source of information, can be quite successful in promoting
smoking cessation. In a classic study carried out in five general practices in London
(Russell et al. 1979), smokers visiting their GP over a four-week period were allocated
to one of four groups: (1) follow-up only; (2) questionnaire about their smoking
behaviour and follow-up; (3) doctor’s advice to stop smoking, questionnaire about
their smoking behaviour and follow-up; and (4) doctor’s advice to stop smoking,
leaflet giving tips on how to stop and follow-up. All subjects were followed up at
one and twelve months. The results showed at one-year follow-up, 3.3 per cent of
those who had simply been told to stop smoking were still abstinent, and 5.1 per
cent of those who were told to stop and had received a leaflet showed successful
cessation. This was in comparison to 0.3 per cent in the group that had received
follow-up only and 1.6 per cent in the group that had received the questionnaire
and follow-up. Although these changes are quite small, if all GPs recommended
that their smokers stopped smoking, this would produce half a million ex-smokers
within a year in the UK. Research also suggests that the effectiveness of doctor’s
advice may be increased if they are trained in patient-centred counselling techniques
(Wilson et al. 1988). Minimum interventions for smoking cessation by health120 HEALTH PSYCHOLOGY