Key findings

The findings are drawn largely from trials conducted in the USA, Western Europe and Australia, and so relate most directly to the healthcare systems and treatments available in these countries. More research is needed on the development and delivery of such treatment approaches in other parts of the world.

Strength of Evidence

Each key finding has been rated according the strength of evidence supporting it.
Multiple well-designed, randomized clinical trials yielded a consistent pattern of findings.
Some evidence from randomized clinical trials but the scientific support was not optimal.
Limited evidence indicative of a possible effect but not sufficient to support a recommendation.

Behavioural interventions for all smokers irrespective of their interest in and motivation to quit

Brief advice to quit from a primary care physician during a routine consultation increases the number of smokers stopping for at least 6 months.
commentary and supporting evidence

Brief advice from other clinicians may also increase quitting in unmotivated smokers.
commentary and supporting evidence

Self-help interventions (generic, pre-printed, written materials giving advice about ways to quit) provided without personal support have a small effect on quit rates. Their impact is smaller and less certain than face-to-face interventions.
commentary and supporting evidence

Behavioural interventions for smokers who want to quit

Self-help materials tailored to the needs of individual smokers assist quitting and are more effective than standard materials.
commentary and supporting evidence

Telephone based access to counselling and quitting resources increases quitting success rates.
commentary and supporting evidence

Behavioural support with multiple sessions of individual or group counselling aids smoking cessation.
commentary and supporting evidence

The greater the amount of therapist-client contact the greater the chances of successful cessation.
commentary and supporting evidence

There is no evidence that one type of face-to-face therapy is more efficacious than another in promoting long-term quit rates, and relapse prevention skills training in particular has not shown evidence for improving long-term outcomes.
commentary and supporting evidence

Nicotine replacement therapy

Nicotine replacement therapies aid smoking cessation.
commentary and supporting evidence

All forms of NRT are similarly effective and the choice of type should be based on susceptibility to adverse effects, patient preference and availability.
commentary and supporting evidence

Heavy smokers are more successful on 4 mg than 2 mg nicotine gum.
commentary and supporting evidence

The relative effect of NRT does not depend on the amount of face-to-face behavioural support.
commentary and supporting evidence

Adding another form of NRT to the nicotine patch increases success rates.
commentary and supporting evidence

NRT may be used to assist smoking reduction in preparation for a quit attempt.
commentary and supporting evidence

Non-nicotine pharmacotherapies

Bupropion (Zyban) is an efficacious aid to smoking cessation.
commentary and supporting evidence

Varenicline is an efficacious aid to smoking cessation. Varenicline may be more efficacious than bupropion.
commentary and supporting evidence

Clonidine is efficacious but its usefulness is limited by a high incidence of side effects. It should be considered as a second-line therapy.
commentary and supporting evidence

Nortriptyline - there is evidence for efficacy of this tricyclic antidepressant.
commentary and supporting evidence

Several other drugs show promise but are not of proven efficacy as smoking cessation aids. Selective serotonin reuptake inhibitors (SSRIs), lobeline, anxiolytics and silver acetate do not appear efficacious.
commentary and supporting evidence

Alternative therapies

Acupuncture and hypnotherapy have not been shown to aid smoking cessation over and above any placebo effect.
commentary and supporting evidence

Treating special populations

Pregnant women who continue to smoke should be offered behavioural support for cessation.
commentary and supporting evidence

Pharmacotherapy may be considered for pregnant women who have been unsuccessful in quitting with behavioural support only.
commentary and supporting evidence

Hospital inpatients should be offered intensive support with follow-up after discharge.
commentary and supporting evidence

Behavioural and pharmacological cessation interventions can be used to help adolescents quit, but their effectiveness has not been validated in this population.
commentary and supporting evidence

Smokeless tobacco users should be offered behavioural support for quitting.
commentary and supporting evidence

Cost effectiveness

A range of smoking cessation interventions have been shown to be highly cost-effective.
commentary and supporting evidence

Harm reduction

Interventions to reduce the harm from continued tobacco use (e.g. smoking reduction or use of 'less risky' products) may decrease long-term health risks of smoking, but less so than quitting.
commentary and supporting evidence

Infrastructure

Asking patients about tobacco use and documenting their tobacco use status increases the rate of clinician intervention.
commentary and supporting evidence

Population-based approaches

Tobacco control policies are likely to increase motivation to quit and number of quit attempts.
commentary and supporting evidence