What Are the Effective Components of Group-Based Treatment Programs For Smoking Cessation? A Systematic Review and Meta-Analysis

Commercial tobacco smoking remains a leading cause of premature death globally, with over 8 million deaths annually and more than 1.1 billion smokers worldwide. In response, the WHO Framework Convention on Tobacco Control calls for effective cessation programs. Behavioral counseling, delivered individually or in groups, is a core component of cessation support; group-based programs may provide added benefits through social support and shared learning. However, substantial variation exists in how such programs are structured and delivered, making it important to identify which components drive effectiveness. The Behavior Change Technique (BCT) Taxonomy offers a standardized framework to describe and analyze intervention components. This systematic review and meta-analysis aimed to map BCTs used in group-based smoking cessation interventions, estimate their overall effectiveness at 6 months, and identify specific BCTs and domains associated with improved cessation outcomes.

Prior evidence indicates group-based counseling can outperform self-help and some forms of individual support. A 2017 Cochrane review found group-based interventions improved cessation versus usual care (RR 2.60), self-help (RR 1.88), and brief individual support (RR 1.22). The BCT Taxonomy (v1) provides a consensus framework of 93 techniques to describe intervention components and has been applied in analyses of internet-based and digital smoking cessation interventions, which found more BCTs per intervention can yield greater effects. However, no previous systematic review had used the BCT taxonomy specifically to identify the active components of group-based smoking cessation programs.

Protocol and reporting: The review was registered on PROSPERO (CRD42022318308) and conducted in accordance with PRISMA 2020. Search strategy: Databases searched included MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science, covering publications from January 2000 to March 2022. Eligibility criteria: English-language randomized controlled trials (including cluster RCTs) of group-based smoking cessation interventions for current smokers were included. Group-based programs were defined as interventions involving scheduled group meetings delivering information, motivation, or behavioral therapy; studies could include adjunct treatments (eg, self-help, individual counseling, pharmacotherapy). No restrictions were placed on population (general or subgroups) or cessation outcome measures; comparators included no intervention, usual care, placebo, or active treatments. Screening and selection: Records were managed in Covidence. Two reviewers independently screened titles/abstracts and full texts, resolving disagreements by discussion; reasons for exclusion were recorded. Data extraction: Using a structured tool, reviewers extracted study characteristics (author, year, setting, population, sample size), intervention and comparator details (components, frequency, duration, delivery mode, provider), outcomes (measures, follow-up), and theoretical underpinnings/guidelines. BCTs were coded using the BCT Taxonomy v1 by two experienced coders. Interrater reliability was assessed with Cohen’s kappa; disagreements were resolved through discussion or a third reviewer. Risk of bias: Two reviewers independently appraised studies using the Joanna Briggs Institute Critical Appraisal tool for RCTs. Data synthesis and analysis: - Aim 1: Descriptive statistics summarized BCTs and intervention features. Effective interventions were those showing a statistically significant between-group difference (p < .05) at final follow-up. - Aim 2: Meta-analysis of 6-month cessation outcomes (biochemically verified where available; active comparator arms selected where multiple arms) was conducted using DerSimonian–Laird random-effects models to compute pooled odds ratios (ORs) with 95% CIs. Heterogeneity was assessed with I²; subgroup analyses contrasted continuous abstinence vs point prevalence at 6 months. Given limited studies, 7- and 30-day point prevalence were combined. - Aim 3: Random-effects meta-analyses evaluated associations between inclusion of BCT domains/specific BCTs (appearing in ≥2 trials with 6-month outcomes) and cessation at 6 months. Publication bias was assessed via funnel plots and Egger’s regression (p < .05).

- Study inclusion and characteristics: 19 RCTs met inclusion criteria; 10 were conducted in the United States, with others in India (n=3), Denmark, Nigeria, Spain, China, and Italy. Interventions were delivered in community (n=9) and healthcare settings (n=9), primarily face-to-face, most commonly by clinical psychologists, nurses, physicians, or substance use therapists. Mean number of group sessions was 5.31 (SD 3.09), typically 30–120 minutes per session. - BCT identification: A total of 28 specific BCTs across 13 domains were identified. Interventions used a mean of 5.42 BCTs (SD 2.0), ranging from 2 to 8. Most frequent BCTs: Information about health consequences (n=13), Problem solving (n=13), Avoidance/reducing exposure to cues for the behavior (n=12), Goal setting (outcome) (n=10), Reduce prompts/cues (n=7), Pharmacological support (n=7). Intercoder reliability for BCT coding was high (mean kappa 0.89 ± 0.09; 16 studies with ≥0.81). - Overall effectiveness at 6 months (Aim 2): Among 11 studies reporting 6-month outcomes, pooled cessation favored group-based interventions (OR 1.75; 95% CI 1.12–2.72; p < .001; I² = 73.1%). Subgroup by outcome type: Continuous abstinence at 6 months showed a significant effect (OR 3.08; 95% CI 1.73–5.46; p = .02; I² = 61.8%), whereas point prevalence abstinence did not show a significant difference. Funnel plot symmetry and non-significant Egger’s test suggested no small-study effects. - Effective trials: Eight of the 19 trials reported significant intervention effects at final follow-up, with adjusted odds ratios ranging from ~2-fold (AOR 1.93; 95% CI 1.31–2.85) to >6-fold (AOR 6.42; 95% CI 2.46–13.28). Most were community-based and delivered over 2–7 sessions. - BCT domains associated with higher 6-month cessation (Aim 3): • Goals and planning (OR 1.88; 95% CI 1.10–3.22; p = .02) • Natural consequences (OR 1.75; 95% CI 1.05–2.91; p = .03) • Reward and threat (OR 2.13; 95% CI 1.19–3.82; p = .01) • Self-belief (OR 1.84; 95% CI 1.07–3.16; p = .03) - Specific BCTs significantly associated with higher 6-month cessation: • Information about social and environmental consequences (OR 8.55; 95% CI 3.50–20.88; p < .001) • Information about health consequences (OR 2.58; 95% CI 1.20–5.55; p = .02) • Problem solving (OR 2.10; 95% CI 1.10–4.02; p = .02) • Reward (outcome) (OR 2.15; 95% CI 1.54–3.00; p = .001) - Methodological quality: JBI scores mostly 8–10/13; common reporting gaps included blinding and allocation concealment.

This systematic review and meta-analysis demonstrates that group-based smoking cessation programs, on average, increase the odds of quitting by 6 months compared with comparators, especially when continuous abstinence is the outcome measure. The use of the BCT taxonomy clarified which components likely drive effectiveness. Interventions commonly used information about health consequences and problem solving, and those incorporating BCT domains of goals/planning, natural consequences, reward/threat, and self-belief were more effective. Notably, providing information about social and environmental consequences showed a particularly strong association with cessation. The number of BCTs per intervention was modest (mean ~5.4), lower than some digital cessation interventions; prior evidence suggests that more BCTs can enhance effect size, indicating scope to strengthen group programs by incorporating a broader suite of techniques. Despite group formats lending themselves to social learning, explicit social support techniques were less frequently reported, and fewer than half of interventions integrated pharmacotherapy, despite best-practice guidance to combine behavioral support with medications. Findings align with prior evidence (e.g., Cochrane review) that group therapy is generally more effective than self-help and brief individual support. However, insufficient data prevented comparison with intensive individual counseling and limited conclusions on point-prevalence outcomes at 6 months. The results underscore the potential for carefully designed group programs, especially in community settings, to improve cessation, and suggest specific BCT packages that may optimize outcomes.

Group-based smoking cessation interventions approximately double the odds of 6-month abstinence compared with comparators, with stronger effects evident for continuous abstinence. Effective programs commonly include BCTs such as information about health and social/environmental consequences, problem solving, and outcome rewards, within domains like goals/planning, natural consequences, reward/threat, and self-belief. Implementing group programs that purposefully integrate multiple effective BCTs and, where appropriate, pharmacotherapy is recommended. Future research should improve intervention reporting (BCT detail), evaluate real-world and cost-effectiveness, compare with intensive individual counseling, tailor and test BCT packages for diverse populations, and address evidence gaps among Indigenous peoples.

- BCT coding relied on published descriptions; incomplete reporting may have led to under-identification of techniques, limiting accuracy and comparability. Access to full intervention materials (manuals, patient resources) could yield more precise coding. - Limited number of eligible studies required combining trials with varied comparators; shared BCTs across arms may have attenuated observed effects, and potential confounding could not be fully addressed. - Heterogeneity in populations, settings, outcome definitions, and intervention dose/delivery was substantial, affecting precision and generalizability. - Insufficient studies prevented robust comparison of group-based versus intensive individual counseling and limited power to detect effects on point-prevalence outcomes. - No included RCTs focused on Indigenous populations, limiting applicability to these groups.