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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.
A Multiple well-designed, randomized clinical trials yielded a consistent pattern of findings.
B Some evidence from randomized clinical trials but the scientific support was not optimal.
C 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

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

  2. Brief advice from other health professionals may also increase quitting in smokers unselected for motivation to stop.
    3 commentary and supporting evidence

  3. 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.
    2 commentary and supporting evidence

Behavioural interventions for smokers who want to quit

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

  2. Telephone based quitting resources increase quitting success rates.
    1 commentary and supporting evidence

  3. In person behavioural support with multiple sessions of individual or group counselling aids smoking cessation.
    1 commentary and supporting evidence

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

  5. Both reducing cigarettes gradually and quitting abruptly can be successful approaches to quitting smoking. Because there is some limited evidence that quitting abruptly is more effective, abrupt quitting should be encouraged for those who are willing to quit that way.
    2 commentary and supporting evidence

Relative safety and efficacy of pharmacotherapies

  1. Of the three front line therapies, combination nicotine replacement therapy and varenicline are equally effective and are more effective than single-form NRT or bupropion.
    1 commentary and supporting evidence

Nicotine replacement therapy

  1. Nicotine replacement therapies aid smoking cessation.
    1 commentary and supporting evidence

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

  3. More dependent smokers are more successful on 4 mg than 2 mg nicotine gum.
    1 commentary and supporting evidence

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

  5. Combining the nicotine patch with an ad libitum type of NRT increases success rates.
    1 commentary and supporting evidence

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

Electronic cigarettes

  1. The limited evidence available suggests electronic cigarettes are an efficacious aid to smoking cessation.
    3 commentary and supporting evidence

Non-nicotine pharmacotherapies

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

  2. Varenicline is an efficacious aid to smoking cessation
    1 commentary and supporting evidence

  3. Cytisine is an efficacious aid to smoking cessation
    2 commentary and supporting evidence

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

  5. Nortriptyline, a tricyclic antidepressant, is an efficacious aid to smoking cessation but its use is limited due to its adverse events profile.
    1 commentary and supporting evidence

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

Alternative therapies

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

Treating special populations

  1. Behavioural support is effective in helping pregnant smokers to stop.
    1 commentary and supporting evidence

  2. There is insufficient evidence to assess whether NRT is effective or ineffective in pregnancy. Evidence on the use of bupropion and varenicline in pregnant smokers is too limited to draw conclusions on efficacy.
    3 commentary and supporting evidence

  3. There is evidence that intensive preoperative behavioural smoking cessation interventions increase smoking cessation and reduce postoperative complications.
    2 commentary and supporting evidence

  4. Behavioural support that is maintained post-discharge increases cessation rates for hospital inpatients.
    2 commentary and supporting evidence

  5. There is some evidence that behavioural support increases quit rates in adolescents but no evidence that pharmacotherapy is effective.
    2 commentary and supporting evidence

  6. Smokeless tobacco users should be offered behavioural support. There is limited evidence for pharmacotherapy.
    2 commentary and supporting evidence

  7. There is very limited evidence regarding waterpipe cessation interventions.
    3 commentary and supporting evidence

  8. Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state. Varenicline may also improve smoking cessation rates in schizophrenia, but its possible psychiatric adverse effects cannot be ruled out. There are insufficient studies of NRT or behavioural interventions in this population to be able to make a recommendation.
    3 commentary and supporting evidence

  9. Adding a psychosocial mood management component to a standard smoking cessation intervention increases long-term cessation rates in smokers with both current and past depression, when compared with the standard intervention alone. This successful smoking cessation can lead to improved mental health.
    2 commentary and supporting evidence

  10. Tobacco cessation interventions targeted at smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence and do not appear to threaten sobriety.
    2 commentary and supporting evidence

Cost effectiveness

  1. All smoking cessation interventions that have a detectable effect in raising quit rates are highly cost-effective in preserving life years.
    1 commentary and supporting evidence

Harm reduction

  1. Evidence investigating interventions to reduce the harm from continued tobacco use (e.g. smoking reduction or use of ‘less risky’ products, including snus) is limited; however there is some evidence to suggest that NRT can help people to reduce their smoking and ultimately quit in the long-term. Evidence of any health benefits of harm reduction among continuing smokers is equivocal; therefore the focus of harm reduction should currently be as a stepping stone to quitting, rather than as an end goal.
    3 commentary and supporting evidence

Infrastructure

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

Population-based approaches

  1. Tobacco control policies increase motivation to quit and number of quit attempts.
    2 commentary and supporting evidence
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