Commentary

The health benefits of smoking cessation are well documented although quitting smoking can be very difficult. Interventions to aid smoking cessation include pharmacological agents such as nicotine replacement therapy¹ and behavioural approaches, mostly stage based interventions informed by the TTM.

The systematic review by Riemsma et al used rigorous methodology to assess the effectiveness of stage based behavioural interventions. Comprehensive, extensive searches were undertaken, and the methodological quality of included studies was independently assessed and reported fully. Details on volume of abstracts obtained and rationale for exclusion of studies, some of which were included in a previous narrative review of TTM, were not provided.² Heterogeneity of interventions prevented meta-analysis.

Although the outcomes of the review were behaviour change and movement across stages, less than half of the included studies evaluated stage change. Furthermore, problems existed with validity of assessment of stage change. The review has been criticised for lack of clarity regarding whether interventions were stage matched, the descriptive rather than quantitative summary, and the lack of weighting by study quality.³ However, most of these issues were discussed in the review by the authors themselves. There is a clear need for high quality trials of stage based behavioural interventions before the TTM approach to smoking cessation is abandoned. In the meantime, health professionals should not be discouraged from promoting smoking cessation at every opportunity.