Research paper
CC-BY-NC 4.0

Effects of different types of smoking cessation behavioral therapy in disadvantaged areas in the Netherlands: an observational study.

Fiona E Benson 1  ,  
Vera Nierkens 2,  
Academic Medical Centre - University of Amsterdam, Netherlands
Leiden University Medical Center (LUMC), Netherlands
Maastricht University, Netherlands
Tob. Prev. Cessation 2016;2(February):12
Publish date: 2016-02-22
Smokers in disadvantaged areas smoke more and make less successful quit attempts than smokers in other areas. Smoking cessation behavioural therapy (SCBT) +/- pharmacotherapy, can increase quit success, however, several different types of counselling are available. Settings also differ. The type of counselling which best assists smokers in disadvantaged areas to quit is unknown. We investigated the effect of four different types of SCBT offered in disadvantaged areas of the Netherlands (individual face-to-face, telephone, rolling group and fixed group counselling), and explored differences of effect between intervention types.

Data from 415 participants were collected from Dutch SCBT programmes serving disadvantaged areas. Settings included hospital, community, and primary care. Data collection included repeated survey and medical record research. Participants’ self-reported and CO-validated continuous abstinence prevalence per intervention type initially, and at 6 and 12 months were calculated. Predictors of continuous cessation at 12 months were analysed using logistic regression analysis.

Overall, 19% of participants were of low educational level. There was a 30% overall self-reported continuous abstinence prevalence at 12 months, which was highest in rolling group counselling (41%) and individual face-to-face counselling (35%). Fixed group counselling in hospital setting was more effective than in other settings. Both group counselling types were equally effective in a hospital setting.

Group counselling in a hospital setting is the most successful type of intervention in supporting smokers in disadvantaged areas to quit. We recommend that services in disadvantaged areas concentrate on offering group counselling, given in a hospital setting, where possible.

Fiona E Benson   
Academic Medical Centre - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
1. Tobacco Free Initiative (TFI): Tobacco Facts. Available at: http:// (accessed 16 July 2015).
2. Shohaimi S, Luben R, Wareham N, Day N, Bingham S, Welch A, Oakes S, Khaw KT: Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European Investigation into Cancer (EPIC-Norfolk). J Epidemiol Community Health 2003, 57(4):270-276. doi: 10.1136/jech.57.4.270.
3. Pearce J, Barnett R, Moon G: Sociospatial inequalities in health-related behaviours: Pathways linking place and smoking. Prog HumGeog 2012, 36(1):3-24. doi: 10.1177/0309132511402710
4. Pickett KE, Pearl M: Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. JEpidemiol Community Health 2001, 55(2):111-122. doi:10.1136/jech.55.2.111.
5. Giskes K, van Lenthe FJ, Turrell G, Brug J, Mackenbach JP:Smokers living in deprived areas are less likely to quit: a longitudinalfollow-up. Tob Control 2006, 15(6):485-488. doi: 10.1136/tc.2006.015750.
6. Businelle MS, Kendzor DE, Reitzel LR, Costello TJ, Cofta-WoerpelL, Li YS, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ et al:Mechanisms Linking Socioeconomic Status to Smoking Cessation:A Structural Equation Modeling Approach. Health Psychol 2010,29(3):262-273. doi: 10.1037/a0019285.
7. Stead LF, Lancaster T: Combined pharmacotherapy and behaviouralinterventions for smoking cessation. Cochrane Database Syst Rev2012, 10:CD008286. doi: 10.1002/14651858.CD008286.pub2.
8. Stead LF, Lancaster T: Group behaviour therapy programmesfor smoking cessation. Cochrane Database Syst Rev 2005(2):CD001007. doi: 10.1002/14651858.cd001007.
9. Stead LF, Hartmann-Boyce J, Perera R, Lancaster T: Telephonecounselling for smoking cessation. Cochrane Database Syst Rev2013, 8:CD002850. doi: 10.1002/14651858.CD002850.pub3.
10. Lancaster T, Stead LF: Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2005(2):CD001292.
11. Benson FE, Stronks K, Willemsen MC, Bogaerts NM, Nierkens V:Wanting to attend isn’t just wanting to quit: why some disadvantagedsmokers regularly attend smoking cessation behavioural therapywhile others do not: a qualitative study. BMC Public Health 2014,14:695. doi: 10.1186/1471-2458-14-695.
12. de Weert B: Pakje Kans. Samen stoppen met roken handbook. DenHaag: STIVORO voor een rookvrije toekomst.; 2009.
13. Bauld L, Ferguson J, McEwen A, Hiscock R: Evaluation of a drop-inrolling-group model of support to stop smoking. Addiction 2012,107(9):1687-1695. doi: 10.1111/j.1360-0443.2012.03861.x.
14. van Ernst A, M W: Telefonische Coaching bij Stoppen met Roken.Handleiding voor de coach. Utrecht: STIVORO; 2008.
15. World Health Organisation (WHO): Developing and improvingnational toll-free tobacco quit line services. A World HealthOrganizaton manual. In., November 2011 edn. France: WorldHealth Organisation (WHO); 2011.
16. Bauld L, Bell K, McCullough L, Richardson L, Greaves L: Theeffectiveness of NHS smoking cessation services: a systematicreview. J Public Health (Oxf) 2010, 32(1):71-82. doi: 10.1093/pubmed/fdp074.
17. Brose LS, West R, McDermott MS, Fidler JA, Croghan E, McEwenA: What makes for an effective stop-smoking service? Thorax 2011,66(10):924-926. doi: 10.1136/thoraxjnl-2011-200251.
18. Hiscock R, Murray S, Brose LS, McEwen A, Bee JL, Dobbie F, Bauld L: Behavioural therapy for smoking cessation: the effectiveness of different intervention types for disadvantaged and affluent smokers. Addict Behav 2013, 38(11):2787-2796. doi: 10.1016/j.addbeh.2013.07.010.
19. Hiscock R, Moon G, Pearce J, Barnett R, Daley V: Do general medicalpractice characteristics influence the effectiveness of smokingcessation programs? A multilevel analysis. Nicotine Tob Res 2012,14(6):703-710. doi: 10.1093/ntr/ntr271.
20. Judge K, Bauld L, Chesterman J, Ferguson J: The English smokingtreatment services: short-term outcomes. Addiction 2005, 100 Suppl2:46-58. doi: 10.1111/j.1360-0443.2005.01027.x.
21. Bauld L, Boyd KA, Briggs AH, Chesterman J, Ferguson J, JudgeK, Hiscock R: One-year outcomes and a cost-effectiveness analysisfor smokers accessing group-based and pharmacy-led cessationservices. Nicotine Tob Res 2011, 13(2):135-145. doi: 10.1093/ntr/ntq222.
22. Khara M, Okoli C, Nagarajan VD, Aziz F, Hanley C: Smokingcessation outcomes of referral to a specialist hospital outpatientclinic. Am J Addict 2015, 24(6):561-570. doi: 10.1111/ajad.12259.
23. Kwaliteitsregister Stoppen met Roken: Goedgekeurde(geaccrediteerde) interventies. Available at:
24. Wittebrood K, Permentier, M.,: Wonen, wijken & interventies.Krachtwijkenbeleid in perspectief. In. Edited by Planbureau SeC.Den Haag: Sociaal en Cultureel Planbureau; 2011.
25. Benson FE, Nierkens V, Willemsen MC, Stronks K. Smokingcessation behavioural therapy in disadvantaged neighbourhoods: anexplorative analysis of recruitment channels. Subst Abuse Treat PrevPolicy 2015, 10:28. doi: 10.1186/s13011-015-0024-3.
26. Kwaliteitsregister Stoppen met Roken: Zoek een stoppen-met-rokenbegeleider Available at: (accessed 16 July 2015).
27. Dekker P, de Kanta W: Nederland Stopt! Met Roken. Nederland:Thoeris; 2008.
28. Dekker P, de Kanta W: Nederland stopt! Met roken. (Luisterboek).In. Nederland: Theoris; 2011.
29. Help-me-on-my-way! Available at: (accessed 16 July 2015).
30. Mackenbach JP: Socio-economic health differences in TheNetherlands: a review of recent empirical findings. Soc Sci Med1992, 34(3):213-226. doi: 10.1016/0277-9536(92)90264-q.
31. Kandel DB, Chen K. Extent of smoking and nicotine dependencein the United States: 1991-1993. Nicotine Tob Res 2000, 2(3):263-274. doi: 10.1080/14622200050147538.
32. West R, Hajek P, Stead L, Stapleton J: Outcome criteria in smokingcessation trials: proposal for a common standard. Addiction 2005,100(3):299-303. doi: 10.1111/j.1360-0443.2004.00995.x.
33. Partnership Stop met Roken: Richtlijn Behandeling vanTabaksverslaving Herziening 2009. In. Den Haag: Partnership Stopmet Roken; 2009.
34. Weinberger AH, Pittman B, Mazure CM, McKee SA: A behavioralsmoking treatment based on perceived risks of quitting: A preliminaryfeasibility and acceptability study with female smokers. Addictionresearch & theory 2015, 23(2):108-114. doi: 10.3109/16066359.2014.933813.
35. Vangeli E, Stapleton J, Smit ES, Borland R, West R: Predictors ofattempts to stop smoking and their success in adult general population samples: a systematic review. Addiction 2011, 106(12):2110-2121. doi: 10.1111/j.1360-0443.2011.03565.x.
36. Hiscock R, Judge K, Bauld L: Social inequalities in quitting smoking:what factors mediate the relationship between socioeconomic position and smoking cessation? J Public Health (Oxf) 2011, 33(1):39-47. doi: 10.1093/pubmed/fdq097. doi: 10.1093/pubmed/fdq097.
37. Rothwell PM: External validity of randomised controlled trials:“to whom do the results of this trial apply?”. Lancet 2005, 365(9453):82-93. doi:10.1016/S0140-6736(04)17670-8.
38. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO:The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991, 86(9):1119-1127. doi: 10.1111/j.1360-0443.1991.tb01879.x.
39. Hiscock R, Bauld L, Amos A, Fidler JA, Munafo M: Socioeconomicstatus and smoking: a review. Ann N Y Acad Sci 2012, 1248:107-123. doi: 10.1111/j.1749-6632.2011.06202.x.
40. Leeman RF, Quiles ZN, Molinelli LA, Terwal DM, Nordstrom BL,Garvey AJ, Kinnunen T: Attrition in a multi-component smoking cessation study for females. Tob Induc Dis 2005, 3(1):59-71. doi: 10.1186/1617-9625-3-2-59.
41. Rabius V, Pike KJ, Hunter J, Wiatrek D, McAlister AL: Effectsof frequency and duration in telephone counselling for smoking cessation. Tob Control 2007, 16 Suppl 1:i71-74. doi: 10.1136/tc.2007.019950.
42. Murray RP, Connett JE, Istvan JA, Nides MA, Rempel-Rossum S:Relations of cotinine and carbon monoxide to self-reported smoking in a cohort of smokers and ex-smokers followed over 5 years. Nicotine Tob Res 2002, 4(3):287-294. doi: 10.1080/14622200210141266.
43. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, KinneS: The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 1994, 84(7):1086-1093. doi: 10.2105/ajph.84.7.1086.
44. Zhu SH, Lee M, Zhuang YL, Gamst A, Wolfson T: Interventionsto increase smoking cessation at the population level: how much progress has been made in the last two decades? Tob Control 2012, 21(2):110-118. doi: 10.1136/tobaccocontrol-2011-050371.
45. Background smoking cessation rates in England. Available at:http://www. (accessed 16 July 2015).
46. West R, May S, West M, Croghan E, McEwen A: Performance ofEnglish stop smoking services in first 10 years: analysis of service monitoring data. BMJ 2013, 347:f4921. doi: 10.1136/bmj.f4921.
47. Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, ByrdM, Gutierrez-Terrell E: Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med 2002, 347(14):1087-1093. doi: 10.1056/NEJMsa020660.
48. Ferguson J, Bauld L, Chesterman J, Judge K: The English smokingtreatment services: one-year outcomes. Addiction 2005, 100 Suppl 2:59-69. doi: 10.1111/j.1360-0443.2005.01028.x.
49. Willemsen MC, van der Meer RM, Bot S: Description, effectiveness,and client satisfaction of 9 European Quitlines: Results of the European Smoking Cessation Helplines Evaluation Project (ESCHER). In. Den Haag: STIVORO for a smoke free future; 2008.
50. McBride CM, Emmons KM, Lipkus IM: Understanding the potentialof teachable moments: the case of smoking cessation. Health Educ Res 2003, 18(2):156-170.doi: 10.1093/her/18.2.156.
51. Becona E, Miguez M: Group Behaviour Therapy for SmokingCessation. Journal of Groups in Addiction & Recovery 2008, 3(1-2):63-78. doi: 10.1002/14651858.CD001007.pub2.
52. Croghan E: Local Stop Smoking Services: Service Delivery andMonitoring Guidance 2011/12. In. Edited by Health Do. United Kingdom: Department of Health; 2011.