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 health professionals may also increase quitting in smokers unselected for motivation to stop.
commentary and supporting evidence
Self-help interventions (generic, pre-printed, written or online 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 assistquitting and are more effective than standard materials.
commentary and supporting evidence
Access to telephone based counselling and quitting resources increases quitting success rates.
commentary and supporting evidence
Behavioural support with multiplesessions 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
Combining the nicotine patch with an ad libitum type of NRT 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 and cytisine are efficacious aids to smoking cessation. Varenicline is more efficacious than bupropion and may be more efficacious than nicotine patch.
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, a tricyclic antidepressant, is an efficacious aid to smoking cessation.
commentary and supporting evidence
Several other drugs show promise but most 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

Behavioural support is effective in helping pregnant smokers to stop.
commentary and supporting evidence
Nicotine replacement therapy or bupropion may be helpful for pregnant smokers who have been unsuccessful in quitting with behavioural support alone.
commentary and supporting evidence
Behavioural support that is maintained post-discharge increases cessation rates for hospital inpatients.
commentary and supporting evidence
There is some preliminary evidence that behavioural support increases quit rates in adolescents but no evidence that pharmacotherapy is effective.
commentary and supporting evidence
Smokeless tobacco users should be offered behavioural support. There is limited evidence for pharmacotherapy.
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Cost effectiveness

All smoking cessation interventions that have a detectable effect in raising quit rates are highly cost-effective in preserving life years.
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 increase motivation to quit and number of quit attempts.
commentary and supporting evidence