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How effective are physical appearance interventions in changing smoking perceptions, attitudes and behaviours? A systematic review
  1. Keira Flett1,
  2. David Clark-Carter1,
  3. Sarah Grogan1,
  4. Rachel Davey2
  1. 1Psychology Department, Staffordshire University, Stoke on Trent, UK
  2. 2Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia
  1. Correspondence to Keira Flett, Psychology Department, Staffordshire University, Stoke on Trent, Staffordshire, ST4 2DE, UK; k.flett{at}


Objective A systematic review was conducted in order to identify physical appearance interventions related to smoking cessation and to evaluate their effectiveness in order to inform smoking cessation practice.

Methods Articles were only included if they focused on an appearance intervention related to changing smoking attitudes, intentions or behaviour. A total of 17 online databases were searched using date restrictions (1980 to 2011), yielding 4356 articles. After screening, 11 articles were identified that met the review criteria. Seven articles investigated the impacts of facial age-progression software on smoking cessation. Three articles focused on reducing weight concerns in order to improve smoking abstinence rates. One oral health article was identified which focused on physical appearance in order to prevent or reduce smoking.

Results Few studies have focused on physical appearance interventions in smoking cessation however the identified studies report positive impacts on smoking-related cognitions and cessation behaviours. Two different methods of quality analysis were conducted for quantitative and qualitative papers. The consensus was that the quality of the articles was generally weak. Of the 10 quantitative articles, 9 were rated weak and 1 was rated moderate. The one qualitative study provided clear, in-depth information.

Conclusions Questions still remain as to whether physical appearance interventions have an impact on smoking attitudes, intentions or behaviours, particularly in British samples. To inform practice, additional, well-designed, studies are needed. They should include control groups, use robust randomised allocation to conditions, measures with established reliability and validity and take measures pre and post intervention.

  • Smoking cessation
  • physical appearance
  • intervention
  • behaviour
  • addiction
  • cessation
  • prevention

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement I hereby provide permission on behalf of all authors for Tobacco Control to share the data/information provided in this systematic review. I also provide permission for data to be stored on DRYAD.