Are we pushing the limits of public health interventions for smoking cessation?

The phenomenon of smoking cessation that takes place outside formal programs, which serve a small proportion of smokers, is an important public health issue. Self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large groups of smokers. In this issue of Health Psychology, Gritz, Berman, Bastani, and Wu (1992) demonstrate that the mailing of self-help smoking cessation materials to nonvolunteer women in a health maintenance organization, without any personal contact, produces little behavior change beyond what occurs in the environment without such distribution. This outcome is not surprising and does not illiminate the possibility of efficacious use of self-help materials with a nonvolunteer population. An essential question is: Could these materials have been distributed in such a way as to increase their use and eventual efficacy? Efforts to attract more smokers to use existing materials are an essential element of self-help strategies. An effective public health approach is a comprehensive one that successfully engages the individual and, through multiple channels in the community, provides reinforcement, supports, and norms for not smoking.