View source for Smoking cessation

{{short description|Process of discontinuing tobacco smoking}}
{{Redirect|Quit Smoking|the television episode|Quit Smoking (My Name Is Earl)}}
{{Redirect|Stop Smoking|the Car Seat Headrest song|Twin Fantasy}}
{{protection padlock|small=yes}}
{{cs1 config|name-list-style=vanc|display-authors=6}}

[[File:Healthy lung-smokers lung.jpg|thumb|A healthy lung compared to a smoker's lung|alt=Pale smooth lung contrasted with stained and crumpled lung]]
{{Smoking|hide=yes|expanded=all}}
'''Smoking cessation''', usually called '''quitting smoking''' or '''stopping smoking''', is the process of discontinuing [[tobacco smoking]].<ref name="nhs">{{cite web |year=2022 |title=Take steps NOW to stop smoking |url=https://www.nhs.uk/live-well/quit-smoking/take-steps-now-to-stop-smoking/ |website=www.nhs.uk |location=[[London]] |publisher=[[National Health Service]] |archive-url=https://web.archive.org/web/20220529024422/https://www.nhs.uk/better-health/quit-smoking/ |archive-date=29 May 2022 |access-date=31 May 2022 |url-status=live}}</ref> [[Tobacco smoke]] contains [[nicotine]], which is [[Addiction|addictive]] and can cause [[Substance dependence|dependence]].<ref name=ACS-HowToQuit>{{cite web |year=2022 |title=How to Quit Smoking or Smokeless Tobacco |url=http://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking.html |url-status=live |website=www.cancer.org |location=[[Atlanta|Atlanta, Georgia]] |publisher=[[American Cancer Society]] |archive-url=https://web.archive.org/web/20220525083936/https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking.html |archive-date=25 May 2022 |access-date=31 May 2022}}</ref><ref name="nicotine dependence"/> As a result, [[nicotine withdrawal]] often makes the process of quitting difficult.

Smoking is the [[Leading causes of preventable death|leading cause of preventable death]] and a global [[public health]] concern.<ref name="Kalkhoran2018">{{cite journal | vauthors = Kalkhoran S, Benowitz NL, Rigotti NA | title = Prevention and Treatment of Tobacco Use: JACC Health Promotion Series | journal = Journal of the American College of Cardiology | volume = 72 | issue = 9 | pages = 1030–1045 | date = August 2018 | pmid = 30139432 | pmc = 6261256 | doi = 10.1016/j.jacc.2018.06.036 | publisher = [[Elsevier]] for the [[American College of Cardiology]] | s2cid = 52077567 | doi-access = free }}</ref> Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for [[Myocardial infarction|heart attacks]],<ref name="Harm Reduct. J.">{{cite journal | vauthors = Rodu B, Plurphanswat N | title = Mortality among male cigar and cigarette smokers in the USA | journal = Harm Reduction Journal | volume = 18 | issue = 1 | article-number = 7 | date = January 2021 | pmid = 33413424 | pmc = 7789747 | doi = 10.1186/s12954-020-00446-4 | url = https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-020-00446-4.pdf | url-status = live | publisher = [[BioMed Central]] | s2cid = 230800394 | access-date = 28 August 2021 | lccn = 2004243422 | archive-url = https://web.archive.org/web/20210826115030/https://harmreductionjournal.biomedcentral.com/track/pdf/10.1186/s12954-020-00446-4.pdf | archive-date = 26 August 2021 | doi-access = free }}</ref><ref name="Am. J. Public Health">{{cite journal | vauthors = Nonnemaker J, Rostron B, Hall P, MacMonegle A, Apelberg B | title = Mortality and economic costs from regular cigar use in the United States, 2010 | journal = American Journal of Public Health | volume = 104 | issue = 9 | pages = e86–e91 | date = September 2014 | pmid = 25033140 | pmc = 4151956 | doi = 10.2105/AJPH.2014.301991 | publisher = [[American Public Health Association]] | veditors = Morabia A | s2cid = 207276270 | editor-link = Alfredo Morabia | eissn = 1541-0048 }}</ref> [[stroke]]s,<ref name="Expert Rev. Cardiovasc Ther.">{{cite journal | vauthors = Shah RS, Cole JW | title = Smoking and stroke: the more you smoke the more you stroke | journal = Expert Review of Cardiovascular Therapy | volume = 8 | issue = 7 | pages = 917–932 | date = July 2010 | pmid = 20602553 | pmc = 2928253 | doi = 10.1586/erc.10.56 | publisher = [[Informa]] | s2cid = 207215548 }}</ref> [[chronic obstructive pulmonary disease]] (COPD),<ref name="IJERPH 2009">{{cite journal | vauthors = Laniado-Laborín R | title = Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21 century | journal = International Journal of Environmental Research and Public Health | volume = 6 | issue = 1 | pages = 209–224 | date = January 2009 | pmid = 19440278 | pmc = 2672326 | doi = 10.3390/ijerph6010209 | publisher = [[MDPI]] | s2cid = 19615031 | doi-access = free }}</ref> [[idiopathic pulmonary fibrosis]] (IPF),<ref name="Pulm Med.">{{cite journal | vauthors = Oh CK, Murray LA, Molfino NA | title = Smoking and idiopathic pulmonary fibrosis | journal = Pulmonary Medicine | volume = 2012 | issue =  | article-number = 808260 | date = February 2012 | pmid = 22448328 | pmc = 3289849 | doi = 10.1155/2012/808260 | publisher = [[Hindawi (publisher)|Hindawi Publishing Corporation]] | s2cid = 14090263 | doi-access = free }}</ref> [[emphysema]],<ref name="IJERPH 2009"/> and various types and subtypes of [[cancer]]s<ref name="J. Natl. Cancer Inst.">{{cite journal | vauthors = Shapiro JA, Jacobs EJ, Thun MJ | title = Cigar smoking in men and risk of death from tobacco-related cancers | journal = Journal of the National Cancer Institute | volume = 92 | issue = 4 | pages = 333–337 | date = February 2000 | pmid = 10675383 | doi = 10.1093/jnci/92.4.333 | url = https://academic.oup.com/jnci/article/92/4/333/2624751 | url-status = live | publisher = [[Oxford University Press]] | veditors = Ganz PA N | s2cid = 7772405 | access-date = 28 August 2021 | archive-date = 21 April 2021 | editor-link = Patricia A. Ganz | doi-access = free | archive-url = https://web.archive.org/web/20210421095250/https://academic.oup.com/jnci/article/92/4/333/2624751 | eissn = 1460-2105 }}</ref> (particularly [[lung cancer]], [[Oropharyngeal cancer|cancers of the oropharynx]],<ref name="StatPearls 2020">{{cite book | vauthors=Anjum F, Zohaib J | chapter=Oropharyngeal Squamous Cell Carcinoma |date=4 December 2020 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK563268/ |title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |edition=Updated |id=Bookshelf ID: NBK563268 |doi=10.32388/G6TG1L |pmid=33085415 |s2cid=229252540 |via=[[NCBI]] |access-date=7 February 2021}}{{clarify|reason=this citation is attempting to cite two sources simultaneously; cite book is not capable of doing that; choose one source and cite that or cite both in separate templates;|date=January 2024}}</ref> [[Laryngeal cancer|larynx]],<ref name="StatPearls 2020"/> and [[Oral cancer|mouth]],<ref name="StatPearls 2020"/> [[Esophageal cancer|esophageal]] and [[pancreatic cancer]]).<ref name="Asian Pac. J. Cancer Prev.">{{cite journal | vauthors = Chandrupatla SG, Tavares M, Natto ZS | title = Tobacco Use and Effects of Professional Advice on Smoking Cessation among Youth in India | journal = Asian Pacific Journal of Cancer Prevention | volume = 18 | issue = 7 | pages = 1861–1867 | date = July 2017 | pmid = 28749122 | pmc = 5648391 | doi = 10.22034/APJCP.2017.18.7.1861 }}</ref> Smoking cessation significantly reduces the risk of dying from smoking-related diseases.<ref>{{cite journal | vauthors = Temitayo Orisasami I, Ojo O | title = Evaluating the effectiveness of smoking cessation in the management of COPD | journal = British Journal of Nursing | volume = 25 | issue = 14 | pages = 786–791 | date = July 2016 | pmid = 27467642 | doi = 10.12968/bjon.2016.25.14.786 }}</ref><ref>{{cite web |publisher= World Health Organization. |title=WHO Report on the global tobacco epidemic |date=2015 |url=https://www.who.int/tobacco/global_report/2015/en/ |archive-date=July 8, 2015|archive-url=https://web.archive.org/web/20150708132528/http://www.who.int/tobacco/global_report/2015/en/}}</ref> The risk of heart attack in a smoker decreases by 50% after one year of cessation. Similarly, the risk of lung cancer decreases by 50% in 10 years of cessation <ref>{{Cite web |title=Tobacco |url=https://www.who.int/news-room/fact-sheets/detail/tobacco |access-date=2024-02-24 |website=www.who.int |language=en}}</ref>

From 2001 to 2010, about 70% of smokers in the [[United States]] expressed a desire to quit smoking, and 50% reported having attempted to do so in the past year.<ref name="vaping-2022" /> Many strategies can be used for smoking cessation, including abruptly quitting without assistance ("[[cold turkey]]"), cutting down then quitting, behavioral counseling, and medications such as [[bupropion]], [[cytisine]], [[nicotine replacement therapy]], or [[varenicline]]. In recent years, especially in [[Canada]] and the [[United Kingdom]], many smokers have switched to using [[electronic cigarette]]s to quit smoking tobacco.<ref name="vaping-2022">{{cite web |author=<!--Staff writer(s); no by-line.--> |date=31 March 2022 |title=Vaping and quitting smoking |url=https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/smokers.html |url-status=live |website=www.canada.ca |location=[[Ottawa]] |publisher=[[Government of Canada]] |archive-url=https://web.archive.org/web/20220508060133/https://www.canada.ca/en/health-canada/services/smoking-tobacco/vaping/smokers.html |archive-date=8 May 2022 |access-date=31 May 2022}}</ref><ref>{{cite web |author=<!--Staff writer(s); no by-line.--> |date=29 March 2022 |title=Using e-cigarettes to stop smoking |url=https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/ |url-status=live |website=www.nhs.uk |location=[[London]] |publisher=[[National Health Service]] |archive-url=https://web.archive.org/web/20220511143245/https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking/ |archive-date=11 May 2022 |access-date=31 May 2022}}</ref><ref>{{cite magazine |author=<!--Staff writer(s); no by-line.--> |date=15 November 2019 |title=Long-term smokers who start vaping see health benefits within a month |url=https://www.newscientist.com/article/2223624-long-term-smokers-who-start-vaping-see-health-benefits-within-a-month/ |url-status=live | veditors=Wilson E |editor-link=Emily Wilson (journalist) |magazine=[[New Scientist]] |location=[[London]] |issn=0262-4079 |archive-url=https://web.archive.org/web/20220305003531/https://www.newscientist.com/article/2223624-long-term-smokers-who-start-vaping-see-health-benefits-within-a-month/ |archive-date=5 March 2022 |access-date=31 May 2022}}</ref> However, a 2022 study found that 20% of smokers who tried to use e-cigarettes to quit smoking succeeded but  66% of them ended as dual users of cigarettes and vape products one year out.<ref>{{cite journal | vauthors = Heiden BT, Baker TB, Smock N, Pham G, Chen J, Bierut LJ, Chen LS | title = Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes | journal = Thorax | volume = 78 | issue = 3 | pages = 267–273 | date = July 2022 | pmid = 35863765 | pmc = 9852353 | doi = 10.1136/thorax-2022-218680 }}</ref>

Most smokers who try to quit do so without assistance. However, only 3–6% of quit attempts without assistance are successful long-term.<ref>{{cite journal | vauthors = Rigotti NA | title = Strategies to help a smoker who is struggling to quit | journal = JAMA | volume = 308 | issue = 15 | pages = 1573–1580 | date = October 2012 | pmid = 23073954 | pmc = 4562427 | doi = 10.1001/jama.2012.13043 }}</ref> [[Behavior modification|Behavioral counseling]] and medications each increase the rate of successfully quitting smoking, and a combination of behavioral counseling with a medication such as bupropion is more effective than either intervention alone.<ref>{{cite journal | vauthors = Stead LF, Koilpillai P, Fanshawe TR, Lancaster T | title = Combined pharmacotherapy and behavioural interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 3 | article-number = CD008286 | date = March 2016 | pmid = 27009521 | pmc = 10042551 | doi = 10.1002/14651858.CD008286.pub3 | s2cid = 29033457 }}</ref> A meta-analysis from 2018, conducted on 61 [[randomized controlled trial]]s, showed that among people who quit smoking with a cessation medication and some behavioral help, approximately 20% were still nonsmokers a year later, as compared to 12% who did not take medication.<ref name="RosenGalili2018">{{cite journal | vauthors = Rosen LJ, Galili T, Kott J, Goodman M, Freedman LS | title = Diminishing benefit of smoking cessation medications during the first year: a meta-analysis of randomized controlled trials | journal = Addiction | volume = 113 | issue = 5 | pages = 805–816 | date = May 2018 | pmid = 29377409 | pmc = 5947828 | doi = 10.1111/add.14134 | publisher = [[Wiley-Blackwell]] on behalf of the [[Society for the Study of Addiction]] | s2cid = 4764039 }}</ref>

In nicotine-dependent smokers, quitting smoking can lead to nicotine withdrawal symptoms such as nicotine cravings, [[anxiety]], irritability, [[Depression (mood)|depression]], and weight gain.<ref name="Benowitz2010">{{cite journal | vauthors = Benowitz NL | title = Nicotine addiction | journal = The New England Journal of Medicine | volume = 362 | issue = 24 | pages = 2295–2303 | date = June 2010 | pmid = 20554984 | pmc = 2928221 | doi = 10.1056/NEJMra0809890 }}</ref>{{rp|2298}} Professional smoking cessation support methods generally attempt to address nicotine withdrawal symptoms to help the person break free of nicotine addiction.{{TOC limit|3}}

==Smoking cessation methods==
===Unassisted===
It often takes several attempts, and potentially utilizing different approaches each time, before achieving long-term abstinence. Over 74.7% of smokers attempt to quit without any assistance,<ref>{{cite journal | vauthors = Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA | title = Quit Methods Used by US Adult Cigarette Smokers, 2014-2016 | journal = Preventing Chronic Disease | volume = 14 | pages = E32 | date = April 2017 | article-number = 160600 | pmid = 28409740 | pmc = 5392446 | doi = 10.5888/pcd14.160600 }}</ref> otherwise known as "[[cold turkey]]", or with home remedies. Previous smokers make between an estimated 6 to 30 attempts before successfully quitting.<ref name="ncbi.nlm.nih.gov">{{cite journal | vauthors = Chaiton M, Diemert L, Cohen JE, Bondy SJ, Selby P, Philipneri A, Schwartz R | title = Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers | journal = BMJ Open | volume = 6 | issue = 6 | article-number = e011045 | date = June 2016 | pmid = 27288378 | pmc = 4908897 | doi = 10.1136/bmjopen-2016-011045 }}</ref> Identifying which approach or technique is eventually most successful is difficult. It has been estimated, for example, that only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help.<ref name=ACS-HowToQuit/><ref>{{cite journal | vauthors = Hughes JR, Keely J, Naud S | title = Shape of the relapse curve and long-term abstinence among untreated smokers | journal = Addiction | volume = 99 | issue = 1 | pages = 29–38 | date = January 2004 | pmid = 14678060 | doi = 10.1111/j.1360-0443.2004.00540.x }}</ref> The majority of quit attempts are still unassisted, though the trend seems to be shifting.<ref name="ReferenceA" /> In the U.S., for example, the rate of unassisted quitting fell from 91.8% in 1986 to 52.1% during 2006 to 2009.<ref name="ReferenceA">{{cite journal | vauthors = Edwards SA, Bondy SJ, Callaghan RC, Mann RE | title = Prevalence of unassisted quit attempts in population-based studies: a systematic review of the literature | journal = Addictive Behaviors | volume = 39 | issue = 3 | pages = 512–519 | date = March 2014 | pmid = 24333037 | doi = 10.1016/j.addbeh.2013.10.036 }}</ref> The most frequent unassisted methods were "cold turkey",<ref name="ReferenceA"/> a term that has been used to mean either unassisted quitting or abrupt quitting and "gradually decreased number" of cigarettes, or "cigarette reduction".<ref name="nicotine dependence">{{cite journal | vauthors = Mooney ME, Johnson EO, Breslau N, Bierut LJ, Hatsukami DK | title = Cigarette smoking reduction and changes in nicotine dependence | journal = Nicotine & Tobacco Research | volume = 13 | issue = 6 | pages = 426–430 | date = June 2011 | pmid = 21367813 | pmc = 3103717 | doi = 10.1093/ntr/ntr019 | publisher = [[Oxford University Press]] on behalf of the [[Society for Research on Nicotine and Tobacco]] | lccn = 00244999 | s2cid = 29891495 | editor-link = Marcus Munafo | veditors = Munafò M }}</ref>

====Cold turkey====
"[[Cold turkey]]" is a colloquial term indicating abrupt withdrawal from an addictive drug. In this context, it indicates sudden and complete cessation of all nicotine use. In three studies, it was the quitting method cited by 76%,<ref name=Lee2007>{{cite journal | vauthors = Lee CW, Kahende J | title = Factors associated with successful smoking cessation in the United States, 2000 | journal = American Journal of Public Health | volume = 97 | issue = 8 | pages = 1503–1509 | date = August 2007 | pmid = 17600268 | pmc = 1931453 | doi = 10.2105/AJPH.2005.083527 }}</ref> 85%,<ref name="Fiore1990">{{cite journal | vauthors = Fiore MC, Novotny TE, Pierce JP, Giovino GA, Hatziandreu EJ, Newcomb PA, Surawicz TS, Davis RM | title = Methods used to quit smoking in the United States. Do cessation programs help? | journal = JAMA | volume = 263 | issue = 20 | pages = 2760–2765 | year = 1990 | pmid = 2271019 | doi = 10.1001/jama.1990.03440200064024 }}</ref> or 88%<ref>{{cite journal | vauthors = Doran CM, Valenti L, Robinson M, Britt H, Mattick RP | title = Smoking status of Australian general practice patients and their attempts to quit | journal = Addictive Behaviors | volume = 31 | issue = 5 | pages = 758–766 | date = May 2006 | pmid = 16137834 | doi = 10.1016/j.addbeh.2005.05.054 }}</ref> of long-term successful quitters. In a large British study of ex-smokers in the 1980s, before the advent of pharmacotherapy, 53% of the ex-smokers said that it was "not at all difficult" to stop, 27% said it was "fairly difficult", and the remaining 20% found it very difficult.<ref name="Chapman-MacKenzie">{{cite journal | vauthors = Chapman S, MacKenzie R | title = The global research neglect of unassisted smoking cessation: causes and consequences | journal = PLOS Medicine | volume = 7 | issue = 2 | article-number = e1000216 | date = February 2010 | pmid = 20161722 | pmc = 2817714 | doi = 10.1371/journal.pmed.1000216 | doi-access = free }}</ref> Studies have found that two-thirds of recent quitters reported using the cold turkey method and found it helpful.<ref>{{cite journal | vauthors = Hung WT, Dunlop SM, Perez D, Cotter T | title = Use and perceived helpfulness of smoking cessation methods: results from a population survey of recent quitters | journal = BMC Public Health | volume = 11 | article-number = 592 | date = July 2011 | pmid = 21791111 | pmc = 3160379 | doi = 10.1186/1471-2458-11-592 | doi-access = free }}</ref>

==== Cutting down to quit ====
Gradual reduction involves slowly reducing one's daily intake of nicotine. This method can theoretically be accomplished through repeated changes to cigarettes with lower nicotine levels, by gradually reducing the number of cigarettes smoked daily, or by smoking only a fraction of a cigarette on each occasion. A 2009 systematic review by researchers at the [[University of Birmingham]] found that gradual [[nicotine replacement therapy]] could be effective in smoking cessation.<ref name="LindsonKlemperer2019" /><ref name="ACS-guide" /> There is no significant difference in quit rates between smokers who quit by gradual reduction or abrupt cessation as measured by abstinence from smoking of at least six months from the quit day. The same review also looked at five pharmacological aids for reduction. When reducing the number of smoked cigarettes, it found some evidence that additional [[varenicline]] or fast-acting nicotine replacement therapy can positively affect quitting for six months or longer.<ref name="LindsonKlemperer2019">{{cite journal | vauthors = Lindson N, Klemperer E, Hong B, Ordóñez-Mena JM, Aveyard P | title = Smoking reduction interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 9 | article-number = CD013183 | date = September 2019 | pmid = 31565800 | pmc = 6953262 | doi = 10.1002/14651858.CD013183.pub2 }}</ref>

===Medications===
[[File:Nicoderm.JPG|thumb|A 21mg dose [[nicotine patch]] applied to the left arm]]
The [[American Cancer Society]] notes that "Studies in medical journals have reported that about 25% of smokers who use medicines can stay smoke-free for over 6 months."<ref name=ACS-guide>{{cite web |title= Guide to quitting smoking. What do I need to know about quitting |url= http://www.cancer.org/acs/groups/cid/documents/webcontent/002971-pdf.pdf |publisher= American Cancer Society |year= 2014 |access-date= 2017-01-08 |archive-date= 2016-06-09 |archive-url= https://web.archive.org/web/20160609085602/http://www.cancer.org/acs/groups/cid/documents/webcontent/002971-pdf.pdf }}</ref> Single medications include:
*[[Nicotine replacement therapy]] (NRT): Five medications have been approved by the U.S. [[Food and Drug Administration]] (FDA) to deliver nicotine in a form that does not involve the risks of smoking: transdermal [[nicotine patch]]es, [[nicotine gum]], [[nicotine lozenge]]s, nicotine [[inhaler]]s, nicotine oral sprays, and nicotine nasal sprays.<ref name="sc"/> High-quality evidence indicates that these forms of NRT improve the success rate of people who attempt to stop smoking.<ref name="sc"/> NRTs are meant to be used for a short period of time and should be tapered down to a low dose before stopping. NRTs increase the chance of stopping smoking by 50 to 60% compared to placebo or to no treatment.<ref name="sc">{{cite journal | vauthors = Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T | title = Nicotine replacement therapy versus control for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD000146 | date = May 2018 | pmid = 29852054 | pmc = 6353172 | doi = 10.1002/14651858.CD000146.pub5 }}</ref> Some reported side effects are local slight irritation (inhalers and sprays) and non-ischemic chest pain (rare).<ref name="sc"/><ref name="www.canada.ca-2022"/> Others include mouth soreness and dyspepsia (gum), nausea or heartburn (lozenges), as well as sleep disturbances, insomnia, and a local skin reaction (patches).<ref name="www.canada.ca-2022">{{cite journal | vauthors = Zhou HX | title = The debut of PMC Biophysics | journal = PMC Biophysics | volume = 1 | issue = 1 | article-number = 1 | date = November 2008 | pmid = 19351423 | pmc = 2605105 | doi = 10.1186/1757-5036-1-1 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML | title = Pharmacotherapy for nicotine dependence | journal = CA | volume = 55 | issue = 5 | pages = 281–99; quiz 322–3, 325 | date = 2005 | pmid = 16166074 | doi = 10.3322/canjclin.55.5.281 | s2cid = 25668093 | doi-access = free }}</ref> A study found that 93% of over-the-counter NRT users relapse and return to smoking within six months.<ref>{{cite news| vauthors=Millstone K |title=Nixing the patch: Smokers quit cold turkey|url=http://jscms.jrn.columbia.edu/cns/2007-02-13/millstone-coldturkeyquitters.html|date=2007-02-13 |publisher=Columbia.edu News Service|access-date=2011-02-21 |archive-url=https://web.archive.org/web/20181225010214/http://jscms.jrn.columbia.edu/cns/2007-02-13/millstone-coldturkeyquitters.html |archive-date=2018-12-25}}</ref> There is weak evidence that adding [[mecamylamine]] to nicotine is more effective than nicotine alone.<ref>{{cite journal | vauthors = Lancaster T, Stead LF | title = Mecamylamine (a nicotine antagonist) for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 1998 | issue = 2 | article-number = CD001009 | date = 2000 | pmid = 10796584 | pmc = 7271835 | doi = 10.1002/14651858.CD001009 }}</ref>
*[[Antidepressant]]s: The antidepressant [[bupropion]] is considered a first-line medication for smoking cessation and has been shown in many studies to increase long-term success rates. Although bupropion increases the risk of getting adverse events, there is no clear evidence that the drug has more or less adverse effects when compared to a placebo. [[Nortriptyline]] produces significant rates of abstinence versus placebo.<ref name=":3">{{cite journal | vauthors = Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N | title = Antidepressants for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 5 | article-number = CD000031 | date = May 2023 | pmid = 37230961 | pmc = 10207863 | doi = 10.1002/14651858.CD000031.pub6 }}</ref> Other antidepressants such as [[selective serotonin reuptake inhibitor]]s (SSRIs) and [[St. John's wort]] have not been consistently shown to be effective for smoking cessation.<ref name=":3" />
*[[Varenicline]] decreases the urge to smoke and reduces withdrawal symptoms and is therefore considered a first-line medication for smoking cessation.<ref>{{cite web |url= http://www.pfizer.ca/sites/g/files/g10023216/f/201505/CHAMPIX_PM_E_181247_17Apr2015.pdf |title=Product monograph Champix |publisher=Pfizer Canada |date=April 17, 2015 |archive-url= https://web.archive.org/web/20151116204234/http://www.pfizer.ca/sites/g/files/g10023216/f/201505/CHAMPIX_PM_E_181247_17Apr2015.pdf |archive-date=2015-11-16}}</ref> The number of people stopping smoking with varenicline is higher than with bupropion or NRT.<ref name=":4">{{cite journal | vauthors = Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N | title = Nicotine receptor partial agonists for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 5 | article-number = CD006103 | date = May 2023 | pmid = 37142273 | pmc = 10169257 | doi = 10.1002/14651858.CD006103.pub8 }}</ref> Varenicline more than doubled the chances of quitting compared to placebo, and was also as effective as combining two types of NRT. 2&nbsp;mg/day of varenicline has been found to lead to the highest abstinence rate (33.2%) of any single therapy, while 1&nbsp;mg/day leads to an abstinence rate of 25.4%. A 2016 systematic review and meta-analysis of randomized controlled trials concluded there is no evidence supporting a connection between varenicline and increased cardiovascular events.<ref name="Sterling2016">{{cite journal | vauthors = Sterling LH, Windle SB, Filion KB, Touma L, Eisenberg MJ | title = Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | journal = Journal of the American Heart Association | volume = 5 | issue = 2 | article-number = e002849 | date = February 2016 | pmid = 26903004 | pmc = 4802486 | doi = 10.1161/JAHA.115.002849 }}</ref> Concerns arose that varenicline may cause neuropsychiatric side effects, including suicidal thoughts and behavior.<ref name=":4" /> However, more recent studies indicate less serious neuropsychiatric side effects. For example, a 2016 study involving 8,144 patients treated at 140 centers in 16 countries "did not show a significant increase in neuropsychiatric adverse events attributable to varenicline or bupropion relative to nicotine patch or placebo".<ref>{{cite journal | vauthors = Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, Ascher J, Russ C, Krishen A, Evins AE | title = Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial | journal = Lancet | volume = 387 | issue = 10037 | pages = 2507–2520 | date = June 2016 | pmid = 27116918 | doi = 10.1016/s0140-6736(16)30272-0 | s2cid = 1611308 | url = https://discovery.ucl.ac.uk/id/eprint/1495776/ }}</ref> No link between depressed moods, agitation or suicidal thinking in smokers taking varenicline to decrease the urge to smoke has been identified.<ref name=":4" /> For people who have pre-existing mental health difficulties, varenicline may slightly increase the risk of experiencing these neuropsychiatric adverse events.<ref name=":4" />
*[[Clonidine]] may reduce withdrawal symptoms and "approximately doubles abstinence rates when compared to a placebo," but its side effects include dry mouth and sedation, and abruptly stopping the drug can cause high blood pressure and other side effects.<ref name="USDHHS2008">{{cite book |url=http://bphc.hrsa.gov/buckets/treatingtobacco.pdf |title=Clinical practice guideline: treating tobacco use and dependence: 2008 update|vauthors=Fiore MC, Jaén CR, Baker TB|publisher=U.S. Department of Health and Human Services, Public Health Service|year=2008 |location=Rockville, MD|access-date=2016-07-06|archive-url=https://web.archive.org/web/20160327225607/http://bphc.hrsa.gov/buckets/treatingtobacco.pdf|archive-date=2016-03-27|url-status=unfit}}</ref><ref>{{cite journal | vauthors = Gourlay SG, Stead LF, Benowitz NL | title = Clonidine for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2004 | issue = 3 | article-number = CD000058 | year = 2004 | pmid = 15266422 | pmc = 7038651 | doi = 10.1002/14651858.CD000058.pub2 }}</ref>
*There is no good evidence [[anxiolytics]] are helpful.<ref>{{cite journal | vauthors = Hughes JR, Stead LF, Lancaster T | title = Anxiolytics for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2000 | issue = 4 | article-number = CD002849 | date = 2000 | pmid = 11034774 | pmc = 8407461 | doi = 10.1002/14651858.CD002849 }}</ref>
*Previously, [[rimonabant]], which is a [[cannabinoid receptor type 1]] antagonist, was used to help in quitting and moderate the expected weight gain.<ref name="rimonabant">{{cite journal | vauthors = Cahill K, Ussher MH | title = Cannabinoid type 1 receptor antagonists for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 3 | article-number = CD005353 | date = March 2011 | pmid = 21412887 | pmc = 6486173 | doi = 10.1002/14651858.CD005353.pub4 }}</ref> But it is important to know that the manufacturers of rimonabant and [[taranabant]] stopped production in 2008 due to serious CNS side effects.<ref name="rimonabant" /><nowiki></nowiki>

The 2008 US Guideline specifies that three combinations of medications are effective:<ref name=USDHHS2008/>{{rp|118–120}}
*Long-term nicotine patch and ''[[ad libitum]]'' NRT gum or spray
*Nicotine patch and nicotine inhaler
*Nicotine patch and bupropion (the only combination that the US FDA has approved for smoking cessation)

A [[meta-analysis]] from 2018, conducted on 61 [[Randomized controlled trial|RCTs]], showed that during their first year of trying to quit, approximately 80% of the participants in the studies who got drug assistance (bupropion, NRT, or varenicline) returned to smoking, while 20% continued to not smoke for the entire year (i.e.: remained sustained abstinent).<ref name="RosenGalili2018"/> In comparison, 12% the people who got placebo kept from smoking for (at least) an entire year.<ref name="RosenGalili2018"/> This makes the net benefit of the drug treatment to be 8% after the first 12 months.<ref name="RosenGalili2018"/> In other words, out of 100 people who will take medication, approximately 8 of them would remain non-smoking after one year thanks to the treatment.<ref name="RosenGalili2018"/> During one year, the benefit from using smoking cessation medications (Bupropion, NRT, or varenicline) decreases from 17% in 3 months, to 12% in 6 months to 8% in 12 months.<ref name="RosenGalili2018"/>

===Community interventions===
Community interventions using "multiple channels to provide reinforcement, support and norms for not smoking" may have an effect on smoking cessation outcomes among adults.<ref>{{cite journal | vauthors = Secker-Walker RH, Gnich W, Platt S, Lancaster T | title = Community interventions for reducing smoking among adults | journal = The Cochrane Database of Systematic Reviews | volume = 2002 | issue = 3 | article-number = CD001745 | year = 2002 | pmid = 12137631 | pmc = 6464950 | doi = 10.1002/14651858.CD001745 }}</ref> Specific methods used in the community to encourage smoking cessation among adults include:
*Policies making workplaces<ref name=Lee2007/> and public places smoke-free. It is estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12%–38%.<ref name=Lemmens2008>{{cite journal | vauthors = Lemmens V, Oenema A, Knut IK, Brug J | title = Effectiveness of smoking cessation interventions among adults: a systematic review of reviews | journal = European Journal of Cancer Prevention | volume = 17 | issue = 6 | pages = 535–544 | date = November 2008 | pmid = 18941375 | doi = 10.1097/CEJ.0b013e3282f75e48 | url = http://www.cmtabaquismo.com.ar/documentos/Lemmens%20et%20al%20EJCP%202008%20Cochrane%20intervenciones.pdf | s2cid = 46131720 | archive-url = https://web.archive.org/web/20110706080753/http://www.cmtabaquismo.com.ar/documentos/Lemmens%20et%20al%20EJCP%202008%20Cochrane%20intervenciones.pdf | archive-date = 2011-07-06 }}</ref> In 2008, the New York State of Alcoholism and Substance Abuse Services banned smoking by patients, staff, and volunteers at 1,300 addiction treatment centers.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/state-mandated-tobacco-ban-integration-cessation-services-and-other-policies-reduce-smoking |title=State-Mandated Tobacco Ban, Integration of Cessation Services, and Other Policies Reduce Smoking Among Patients and Staff at Substance Abuse Treatment Centers |date=2013-02-27 |access-date=2013-05-13}}</ref>
*Voluntary rules making homes smoke-free, which are thought to promote smoking cessation.<ref name=Lee2007/><ref name=CDC2007>{{cite journal | title = State-specific prevalence of smoke-free home rules--United States, 1992-2003 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 56 | issue = 20 | pages = 501–504 | date = May 2007 | pmid = 17522588 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5620a3.htm | author1 = Centers for Disease Control and Prevention (CDC) }}</ref>
*Initiatives to educate the public regarding the health effects of [[second-hand smoke]],<ref>{{cite journal | vauthors = King BA, Dube SR, Homa DM | title = Smoke-free rules and secondhand smoke exposure in homes and vehicles among US adults, 2009-2010 | journal = Preventing Chronic Disease | volume = 10 | pages = E79 | date = May 2013 | article-number = 120218 | pmid = 23680508 | pmc = 3666976 | doi = 10.5888/pcd10.120218 }}</ref> including the significant dangers of secondhand smoke infiltration for residents of multi-unit housing.<ref>{{cite journal | vauthors = King BA, Babb SD, Tynan MA, Gerzoff RB | title = National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents | journal = Nicotine & Tobacco Research | volume = 15 | issue = 7 | pages = 1316–1321 | date = July 2013 | pmid = 23248030 | pmc = 4571449 | doi = 10.1093/ntr/nts254 }}</ref>
*Increasing the price of tobacco products, for example by [[tax]]ation. The US Task Force on Community Preventive Services found "strong scientific evidence" that this is effective in increasing tobacco use cessation <ref name=Hopkins2001/>{{rp|28–30}} It is estimated that an increase in price of 10% will increase smoking cessation rates by 3–5%.<ref name=Lemmens2008/>
*[[Mass media]] campaigns. There is evidence to suggest that when combined with other types of interventions, mass media campaigns may be of benefit.<ref name=Hopkins2001/>{{rp|30–32}}<ref>{{cite journal | vauthors = Bala MM, Strzeszynski L, Topor-Madry R | title = Mass media interventions for smoking cessation in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 11 | article-number = CD004704 | date = November 2017 | pmid = 29159862 | pmc = 6486126 | doi = 10.1002/14651858.CD004704.pub4 }}</ref>
*Weak evidence suggests that imposing institutional level smoking bans in hospitals and prisons may reduce smoking rates and second hand smoke exposure.<ref>{{cite journal | vauthors = Frazer K, McHugh J, Callinan JE, Kelleher C | title = Impact of institutional smoking bans on reducing harms and secondhand smoke exposure | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 5 | article-number = CD011856 | date = May 2016 | pmid = 27230795 | pmc = 10164285 | doi = 10.1002/14651858.CD011856.pub2 }}</ref>
*Researchers explored whether an opportunistic stop smoking intervention (advice, a vape starter pack and a referral to stop smoking services) was effective for people attending the emergency department. At 6 months, more people who received the intervention had quit smoking compared with people who received advice only.<ref>{{cite journal | vauthors = Pope I, Clark LV, Clark A, Ward E, Belderson P, Stirling S, Parrott S, Li J, Coats T, Bauld L, Holland R, Gentry S, Agrawal S, Bloom BM, Boyle AA, Gray AJ, Morris MG, Livingstone-Banks J, Notley C | title = Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial | journal = Emergency Medicine Journal | volume = 41 | issue = 5 | pages = 276–282 | date = April 2024 | pmid = 38531658 | pmc = 11041600 | doi = 10.1136/emermed-2023-213824 }}</ref><ref>{{Cite journal |date=15 October 2024 |title=Stop smoking intervention in emergency departments helps people quit |url=https://evidence.nihr.ac.uk/alert/stop-smoking-intervention-in-emergency-departments-helps-people-quit/ |journal=NIHR Evidence}}</ref>

==== Pharmacist Interventions ====
Pharmacist-led interventions have proven to be effective in helping smoking cessation attempts. Many [[systematic review]]s have looked at the importance of pharmacist involvement. In [[Malaysia]], their study looked at how pharmacist intervention in patients' overall healthcare showed improvements in [[Screening (medicine)|screening]] early stages of disease.<ref name=":0">{{cite journal | vauthors = Fai SC, Yen GK, Malik N | title = Quit rates at 6 months in a pharmacist-led smoking cessation service in Malaysia | journal = Canadian Pharmacists Journal | volume = 149 | issue = 5 | pages = 303–312 | date = September 2016 | pmid = 27708676 | pmc = 5032936 | doi = 10.1177/1715163516662894 }}</ref> This allowed for earlier treatment starts in smoking-caused [[Chronic obstructive pulmonary disease|COPD]]. In addition, pharmacists in Malaysia could prescribe [[Nicotine replacement therapy|NRT]] products, and when they led a smoking cessation service, it was more successful than other smoking cessation trials in Malaysia.<ref name=":0"/> It was also shown that pharmacist counselling and NRT products were more effective in smoking cessation than using NRT alone.

In pharmacist-led smoking cessation services in [[Ethiopia]], the study found statistically and clinically significant benefits favouring pharmacist intervention.<ref name=":1">{{cite journal | vauthors = Erku DA, Hailemeskel B, Netere AK, Belachew SA | title = Pharmacist-led smoking cessation services in Ethiopia: Knowledge and skills gap analysis | journal = Tobacco Induced Diseases | volume = 17 | issue = January | page = 01 | date = 2019-01-09 | pmid = 31582913 | pmc = 6751994 | doi = 10.18332/tid/99573 }}</ref> They found that structured care, and regular visits, easy accessibility to pharmacists helped more people trying to quit than without. However, the study concluded that more research should be done in the area as they found an unknown risk of bias in the studies included<ref name=":1"/>

Another systematic review analyzed pharmacist intervention in smoking cessation and alcohol and weight interventions.<ref name=":2">{{cite journal | vauthors = Brown TJ, Todd A, O'Malley C, Moore HJ, Husband AK, Bambra C, Kasim A, Sniehotta FF, Steed L, Smith S, Nield L, Summerbell CD | title = Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation | journal = BMJ Open | volume = 6 | issue = 2 | article-number = e009828 | date = February 2016 | pmid = 26928025 | pmc = 4780058 | doi = 10.1136/bmjopen-2015-009828 | doi-access = free }}</ref> They found that evidence suggests that the longer the duration of pharmacist-led intervention, the more influential the attempt at quitting was<ref name=":2"/> In addition, they found that community pharmacists were beneficial in delivering public health information. Pharmacists have a great reach in the community to help with smoking cessation and have proven to help with lifestyle modifications and proper NRT use.<ref name=":2"/>

=== Digital interventions ===

* Interactive web-based and stand-alone computer programs and online communities assist participants in quitting. For example, "quit meters" keep track of statistics such as how long a person has remained abstinent.<ref>{{cite web |vauthors=Hendrick B |title=Computer is an ally in quit-smoking fight |url=https://www.webmd.com/smoking-cessation/news/20090526/computer-is-an-ally-in-quit-smoking-fight |website=WebMD}}</ref> Computerised and interactive tailored interventions may be promising,<ref name="USDHHS2008" />{{rp|93–94}} however, the evidence base for such interventions is weak.<ref>{{cite journal | vauthors = Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM | title = Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials | journal = Archives of Internal Medicine | volume = 169 | issue = 10 | pages = 929–937 | date = May 2009 | pmid = 19468084 | doi = 10.1001/archinternmed.2009.109 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Taylor GM, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J | title = Internet-based interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 9 | article-number = CD007078 | date = September 2017 | pmid = 28869775 | pmc = 6703145 | doi = 10.1002/14651858.CD007078.pub5 }}</ref><ref>{{cite journal | vauthors = Hutton HE, Wilson LM, Apelberg BJ, Tang EA, Odelola O, Bass EB, Chander G | title = A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults | journal = Nicotine & Tobacco Research | volume = 13 | issue = 4 | pages = 227–238 | date = April 2011 | pmid = 21350042 | doi = 10.1093/ntr/ntq252 | doi-access = free }}</ref>
* A [[MHealth|mobile phone-based intervention]] where automated, supportive text messages are sent alongside other forms of support helps more people quit smoking: "The current evidence supports a beneficial impact of mobile phone-based cessation interventions on six-month cessation outcomes."<ref>{{cite journal | vauthors = Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y | title = Mobile phone-based interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | article-number = CD006611 | date = April 2016 | pmid = 27060875 | pmc = 6485940 | doi = 10.1002/14651858.CD006611.pub4 }}</ref><ref>{{Cite journal |date=2020-02-12 |title=Text messaging support helps smokers quit, but apps not yet shown to work |url=https://evidence.nihr.ac.uk/alert/text-messaging-support-helps-smokers-quit-but-apps-not-yet-shown-to-work |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/signal-000876|s2cid=241974258 |url-access=subscription }}</ref><ref>{{Cite journal |title=What is digital health technology and what can it do for me? |website=NIHR Evidence |year=2022 |url=https://evidence.nihr.ac.uk/collection/what-is-digital-health-technology/ |doi=10.3310/nihrevidence_53447 |s2cid=252584020|url-access=subscription }}</ref> A 2011 randomized trial of mobile phone-based smoking cessation support in the UK found that a Txt2Stop cessation program significantly improved cessation rates at six months.<ref>{{cite journal | vauthors = Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I | title = Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial | journal = Lancet | volume = 378 | issue = 9785 | pages = 49–55 | date = July 2011 | pmid = 21722952 | pmc = 3143315 | doi = 10.1016/s0140-6736(11)60701-0 }}</ref> A 2013 meta-analysis also noted "modest benefits" of mobile health interventions.<ref>{{cite journal | vauthors = Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P, Patel V, Haines A | title = The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis | journal = PLOS Medicine | volume = 10 | issue = 1 | article-number = e1001363 | date = 2013 | pmid = 23458994 | pmc = 3566926 | doi = 10.1371/journal.pmed.1001363 | doi-access = free }}</ref>
* Interactive web-based programs combined with a Mobile phone: Two RCTs documented long-term treatment effects (abstinence rate: 20-22%) of such interventions.<ref name="Brendryen">{{cite journal | vauthors = Brendryen H, Kraft P | title = Happy ending: a randomized controlled trial of a digital multi-media smoking cessation intervention | journal = Addiction | volume = 103 | issue = 3 | pages = 478–484; discussion 485–486 | date = March 2008 | pmid = 18269367 | doi = 10.1111/j.1360-0443.2007.02119.x | s2cid = 4638860 }}</ref><ref name="Brendryen, Drozd & Kraft">{{cite journal | vauthors = Brendryen H, Drozd F, Kraft P | title = A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): randomized controlled trial | journal = Journal of Medical Internet Research | volume = 10 | issue = 5 | pages = e51 | date = November 2008 | pmid = 19087949 | pmc = 2630841 | doi = 10.2196/jmir.1005 | doi-access = free }}</ref>

===Psychosocial approaches===
*The [[Great American Smokeout]] is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever.
*The World Health Organization's [[World No Tobacco Day]] is held on May 31 each year.
*Smoking-cessation support is often offered over the telephone [[quitline]]s<ref name=Zhu2002>{{cite journal | vauthors = Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, Gutiérrez-Terrell E | title = Evidence of real-world effectiveness of a telephone quitline for smokers | journal = The New England Journal of Medicine | volume = 347 | issue = 14 | pages = 1087–1093 | date = October 2002 | pmid = 12362011 | doi = 10.1056/NEJMsa020660 | doi-access = free }}</ref><ref name=Helgason2004>{{cite journal | vauthors = Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H | title = Factors related to abstinence in a telephone helpline for smoking cessation | journal = European Journal of Public Health | volume = 14 | issue = 3 | pages = 306–310 | date = September 2004 | pmid = 15369039 | doi = 10.1093/eurpub/14.3.306 | doi-access = free }}</ref> (e.g., the US toll-free number 1-800-QUIT-NOW), or in person. Three meta-analyses have concluded that telephone cessation support is effective when compared with minimal or no counselling or self-help and that telephone cessation support with medication is more effective than medication alone,<ref name=USDHHS2008/>{{rp|91–92}}<ref name=Hopkins2001/>{{rp|40–42}} and that intensive individual counselling is more effective than the brief personal counselling intervention.<ref name="Individual behavioural counselling">{{cite journal | vauthors = Lancaster T, Stead LF | title = Individual behavioural counselling for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 3 | article-number = CD001292 | date = March 2017 | pmid = 28361496 | pmc = 6464359 | doi = 10.1002/14651858.CD001292.pub3 }}</ref> A slight tendency towards better results for more intensive counselling was also observed in another meta-analysis. This analysis distinguished between reactive (smokers calling quitlines) and proactive (smokers receiving calls) interventions. For people who called the quitline themselves, additional calls helped to quit smoking for six months or longer. When proactively initiating contact with a smoker, telephone counselling increased the chances of smoking cessation by 2–4% compared with people who received no calls.<ref>{{cite journal | vauthors = Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J | title = Telephone counselling for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 5 | article-number = CD002850 | date = May 2019 | pmid = 31045250 | pmc = 6496404 | doi = 10.1002/14651858.CD002850.pub4 | collaboration = Cochrane Tobacco Addiction Group }}</ref> There is about 10% to 25% increase in the chance of smoking cessation success with more behavioral support provided in person or via telephone when used as an adjunct to pharmacotherapy.<ref>{{cite journal | vauthors = Hartmann-Boyce J, Hong B, Livingstone-Banks J, Wheat H, Fanshawe TR | title = Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 6 | article-number = CD009670 | date = June 2019 | pmid = 31166007 | pmc = 6549450 | doi = 10.1002/14651858.CD009670.pub4 }}</ref>
*Online social cessation networks attempt to emulate offline group cessation models using purpose built web applications. They are designed to promote [[online social support]] and encouragement for smokers when (usually automatically calculated) milestones are reached. Early studies have shown social cessation to be especially effective with smokers aged 19–29.<ref>{{cite journal | vauthors = Baskerville NB, Azagba S, Norman C, McKeown K, Brown KS | title = Effect of a Digital Social Media Campaign on Young Adult Smoking Cessation | journal = Nicotine & Tobacco Research | volume = 18 | issue = 3 | pages = 351–360 | date = March 2016 | pmid = 26045252 | doi = 10.1093/ntr/ntv119 }}</ref>
*Group or individual psychological support can help people who want to quit. Recently, group therapy has been more helpful than self-help and some other individual intervention.<ref name="Group behaviour therapy programmes">{{cite journal | vauthors = Stead LF, Carroll AJ, Lancaster T | title = Group behaviour therapy programmes for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 3 | article-number = CD001007 | date = March 2017 | pmid = 28361497 | pmc = 6464070 | doi = 10.1002/14651858.CD001007.pub3 }}</ref> The psychological support form of counselling can be effective alone; combining it with medication is more effective, and the number of support sessions with medication correlates with effectiveness.<ref name=USDHHS2008/>{{rp|89–90,101–103}}<ref name="Group behaviour therapy programmes"/><ref name="Individual behavioural counselling"/> The counselling styles that have been effective in smoking cessation activities include [[motivational interviewing]],<ref>{{cite journal | vauthors = Lindson-Hawley N, Thompson TP, Begh R | title = Motivational interviewing for smoking cessation | journal = The Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD006936 | date = March 2015 | pmid = 25726920 | doi = 10.1002/14651858.CD006936.pub3 | pmc = 6699669 }}</ref><ref>{{cite journal | vauthors = Hettema JE, Hendricks PS | title = Motivational interviewing for smoking cessation: a meta-analytic review | journal = Journal of Consulting and Clinical Psychology | volume = 78 | issue = 6 | pages = 868–884 | date = December 2010 | pmid = 21114344 | doi = 10.1037/a0021498 }}</ref><ref>{{cite journal | vauthors = Heckman CJ, Egleston BL, Hofmann MT | title = Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis | journal = Tobacco Control | volume = 19 | issue = 5 | pages = 410–416 | date = October 2010 | pmid = 20675688 | pmc = 2947553 | doi = 10.1136/tc.2009.033175 }}</ref> [[cognitive behavioral therapy]]<ref>{{cite book |vauthors=Perkins KA, Conklin CA, Levine MD |title= Cognitive-behavioral therapy for smoking cessation: a practical guidebook to the most effective treatment |year= 2008 |publisher= Routledge |location= New York |isbn= 978-0-415-95463-1}}</ref> and [[acceptance and commitment therapy]],<ref>{{cite journal |vauthors= Ruiz FJ |year=2010 |title=A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies |journal=International Journal of Psychology and Psychological Therapy |volume=10 |issue=1 |pages=125–162 |url=https://www.ijpsy.com/volumen10/num1/256.html}}</ref> methods based on cognitive behavioral therapy.
*The Freedom From Smoking group clinic includes eight sessions and features a step-by-step plan for quitting smoking. Each session is designed to help smokers gain control over their behavior. The clinic format encourages participants to work on the process and problems of quitting both individually and as part of a group.<ref>{{cite web |title=About Freedom From Smoking|url=https://www.lung.org/stop-smoking/join-freedom-from-smoking/about-freedom-from-smoking.html|website=American Lung Association}}</ref>
*Multiple formats of psychosocial interventions increase quit rates: 10.8% for no intervention, 15.1% for one format, 18.5% for 2 formats, and 23.2% for three or four formats.<ref name=USDHHS2008/>{{rp|91}}
*The [[transtheoretical model]], including "stages of change", has been used in tailoring smoking cessation methods to individuals,<ref>{{cite journal | vauthors = Prochaska JO, Velicer WF, DiClemente CC, Fava J | title = Measuring processes of change: applications to the cessation of smoking | journal = Journal of Consulting and Clinical Psychology | volume = 56 | issue = 4 | pages = 520–528 | date = August 1988 | pmid = 3198809 | doi = 10.1037/0022-006X.56.4.520 | url = https://digitalcommons.uri.edu/psy_facpubs/553 }}</ref><ref>{{cite journal | vauthors = DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS | title = The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change | journal = Journal of Consulting and Clinical Psychology | volume = 59 | issue = 2 | pages = 295–304 | date = April 1991 | pmid = 2030191 | doi = 10.1037/0022-006X.59.2.295 | url = http://www.uri.edu/research/cprc/Publications/PDFs/ByTitle/The%20Process%20of%20smoking%20cessation%20an%20analysis%20of%20precomtemplation.pdf | url-status = unfit | archive-url = https://web.archive.org/web/20110606230703/http://www.uri.edu/research/cprc/Publications/PDFs/ByTitle/The%20Process%20of%20smoking%20cessation%20an%20analysis%20of%20precomtemplation.pdf | archive-date = 2011-06-06 }}</ref><ref>{{cite journal | vauthors = Velicer WF, Prochaska JO, Rossi JS, Snow MG | title = Assessing outcome in smoking cessation studies | journal = Psychological Bulletin | volume = 111 | issue = 1 | pages = 23–41 | date = January 1992 | pmid = 1539088 | doi = 10.1037/0033-2909.111.1.23 | url = https://digitalcommons.uri.edu/psy_facpubs/536 }}</ref><ref>{{cite journal | vauthors = Prochaska JO, DiClemente CC, Velicer WF, Rossi JS | title = Standardized, individualized, interactive, and personalized self-help programs for smoking cessation | journal = Health Psychology | volume = 12 | issue = 5 | pages = 399–405 | date = September 1993 | pmid = 8223364 | doi = 10.1037/0278-6133.12.5.399 | url = http://www.uri.edu/research/cprc/Publications/PDFs/ByTitle/Standardized%20individualized%20interactive%20and%20Personalized.pdf | url-status = unfit | archive-url = https://web.archive.org/web/20110606231216/http://www.uri.edu/research/cprc/Publications/PDFs/ByTitle/Standardized%20individualized%20interactive%20and%20Personalized.pdf | archive-date = 2011-06-06 }}</ref> however, there is some evidence to suggest that "stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling are neither more nor less effective than their non-stage-based equivalents."<ref>{{cite journal | vauthors = Cahill K, Lancaster T, Green N | title = Stage-based interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | issue = 11 | article-number = CD004492 | date = November 2010 | pmid = 21069681 | doi = 10.1002/14651858.CD004492.pub4 | veditors = Cahill K }}</ref>

==== How to set a quit date ====
Most smoking cessation resources such as the [[Centers for Disease Control and Prevention]] (CDC)<ref name="CDC Web">{{cite web |title=Making a Quit Plan |url=https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/quit-plan.html |access-date=19 October 2015 |website=Centers for Disease Control and Prevention}}</ref> and [[Mayo Clinic|The Mayo Clinic]]<ref name="mayoclinic">{{cite web |title=Preparing for Quit Day |url=https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/in-depth/smoking-cessation/art-20045441 |access-date=19 October 2015 |website=Mayo Clinic }}</ref> encourage smokers to create a quit plan, including setting a quit date, which helps them anticipate and plan for smoking challenges. A quit plan can improve a smoker's chance of a successful quit<ref name="SmitAB">{{cite journal | vauthors = Smit ES, Hoving C, Schelleman-Offermans K, West R, de Vries H | title = Predictors of successful and unsuccessful quit attempts among smokers motivated to quit | journal = Addictive Behaviors | volume = 39 | issue = 9 | pages = 1318–1324 | date = September 2014 | pmid = 24837754 | doi = 10.1016/j.addbeh.2014.04.017 | url = https://dare.uva.nl/personal/pure/en/publications/predictors-of-successful-and-unsuccessful-quit-attempts-among-smokers-motivated-to-quit(f1e3a649-0fc6-41c7-a382-55d223f3943a).html }}</ref><ref>{{cite journal | vauthors = de Vries H, Eggers SM, Bolman C | title = The role of action planning and plan enactment for smoking cessation | journal = BMC Public Health | volume = 13 | article-number = 393 | date = April 2013 | pmid = 23622256 | pmc = 3644281 | doi = 10.1186/1471-2458-13-393 | doi-access = free }}</ref><ref name="bolmana">{{cite journal | vauthors = Bolman C, Eggers SM, van Osch L, Te Poel F, Candel M, de Vries H | title = Is Action Planning Helpful for Smoking Cessation? Assessing the Effects of Action Planning in a Web-Based Computer-Tailored Intervention | journal = Substance Use & Misuse | volume = 50 | issue = 10 | pages = 1249–1260 | date = Oct 2015 | pmid = 26440754 | doi = 10.3109/10826084.2014.977397 | s2cid = 20337590 | url = https://cris.maastrichtuniversity.nl/en/publications/d8f32243-608d-4abb-a015-19aba329421f }}</ref> as can setting Monday, as the quit date, given that research has shown that Monday more than any other day is when smokers are seeking information online to quit smoking<ref name="Ayers">{{cite journal | vauthors = Ayers JW, Althouse BM, Johnson M, Cohen JE | title = Circaseptan (weekly) rhythms in smoking cessation considerations | journal = JAMA Internal Medicine | volume = 174 | issue = 1 | pages = 146–148 | date = January 2014 | pmid = 24166181 | pmc = 4670616 | doi = 10.1001/jamainternmed.2013.11933 }}</ref> and calling state quitlines.<ref>{{cite journal | vauthors = Erbas B, Bui Q, Huggins R, Harper T, White V | title = Investigating the relation between placement of Quit antismoking advertisements and number of telephone calls to Quitline: a semiparametric modelling approach | journal = Journal of Epidemiology and Community Health | volume = 60 | issue = 2 | pages = 180–182 | date = February 2006 | pmid = 16415271 | pmc = 2566152 | doi = 10.1136/jech.2005.038109 }}</ref> In Nepal, '''smokers are not selfish,''' a [[health campaign]] of two weeks is started on the occasion of [[Valentine's Day]] and [[Vasant Panchami]] to motivate individuals to quit smoking as a sacrifice for their loved ones and making it a meaningful decision of life. This campaign is taking public attention.<ref>{{Cite web |title=Dr Anil Om Murthi Archives |url=https://enewspolar.com/tag/dr-anil-om-murthi/ |access-date=2024-02-05 |website=Enewspolar |language=en}}</ref>

==== Self-help ====
[[File:Text messaging used to provide encouragement to quit smoking.png|thumb|right|Some health organizations manage text messaging services to help people avoid smoking.]]
Self-help materials may produce a small increase in quit rates specially when there is no other supporting intervention form.<ref>{{cite journal | vauthors = Livingstone-Banks J, Ordóñez-Mena JM, Hartmann-Boyce J | title = Print-based self-help interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD001118 | date = January 2019 | pmid = 30623970 | pmc = 7112723 | doi = 10.1002/14651858.CD001118.pub4 }}</ref> "The effect of self-help was weak", and the number of types of self-help did not produce higher abstinence rates.<ref name=USDHHS2008/>{{rp|89–91}} Nevertheless, self-help modalities for smoking cessation include:
*In-person self-help groups such as [[Nicotine Anonymous]],<ref>{{cite web |title=Nicotine Anonymous offers help for those who desire to live free from nicotine |url=https://nicotine-anonymous.org/|website=nicotine-anonymous.org}}</ref><ref>{{cite journal | vauthors = Glasser I | title = Nicotine anonymous may benefit nicotine-dependent individuals | journal = American Journal of Public Health | volume = 100 | issue = 2 | pages = 196; author reply 196-196; author reply 197 | date = February 2010 | pmid = 20019295 | pmc = 2804638 | doi = 10.2105/ajph.2009.181545 }}</ref> or web-based cessation resources such as [https://smokefree.gov/ Smokefree.gov], which offers various types of assistance including self-help materials.<ref>{{cite web |last1=U.S. Department of Health and Human Services|title=MySmokeFree: Your personalized quit experience |url=https://smokefree.gov/|website=Smokefree.gov}}</ref>
*WebMD: a resource providing health information, tools for managing health, and support.<ref>{{cite web |title=Slideshow: 13 Best Quit-Smoking Tips Ever|url=https://www.webmd.com/smoking-cessation/ss/slideshow-13-best-quit-smoking-tips-ever|website=WebMD}}</ref>
*[[Self-help|Self-help books]] such as [[Allen Carr]]'s ''Easy Way to Stop Smoking''.<ref name=Carr2004>{{cite book | vauthors=Carr A |title= The easy way to stop smoking |year= 2004 |publisher= Sterling |location= New York |isbn= 978-1-4027-7163-7}}</ref>
*[[Spirituality]]: In one survey of adult smokers, 88% reported a history of spiritual practice or belief, and of those more than three-quarters were of the opinion that using spiritual resources may help them quit smoking.<ref>{{cite journal | vauthors = Gonzales D, Redtomahawk D, Pizacani B, Bjornson WG, Spradley J, Allen E, Lees P | title = Support for spirituality in smoking cessation: results of pilot survey | journal = Nicotine & Tobacco Research | volume = 9 | issue = 2 | pages = 299–303 | date = February 2007 | pmid = 17365761 | doi = 10.1080/14622200601078582 }}</ref>
*A review of [[mindfulness]] training as a treatment for addiction showed reduction in craving and smoking following training.<ref>{{cite journal | vauthors = Tang YY, Tang R, Posner MI | title = Mindfulness meditation improves emotion regulation and reduces drug abuse | journal = Drug and Alcohol Dependence | volume = 163 Suppl 1 | issue = Suppl 1 | pages = S13–S18 | date = June 2016 | pmid = 27306725 | doi = 10.1016/j.drugalcdep.2015.11.041 | doi-access = free }}</ref>
*Physical activities help in the maintenance of smoking cessation even if there is no conclusive evidence of the most appropriate exercise intensity.<ref>{{cite journal | vauthors = Ussher MH, Faulkner GE, Angus K, Hartmann-Boyce J, Taylor AH | title = Exercise interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | date = October 2019 | pmid = 31684691 | pmc = 6819982 | doi = 10.1002/14651858.CD002295.pub6 }}</ref>

====Biochemical feedback====
Various methods allow a smoker to see the impact of their tobacco use and the immediate effects of quitting. Using biochemical feedback methods can allow tobacco users to be identified and assessed, and monitoring throughout an effort to quit can increase motivation to quit.<ref name="Bittoun">{{cite journal |vauthors= Bittoun R |year= 2008 |title= Carbon monoxide meter: The essential clinical tool- the 'stethoscope"-of smoking cessation |journal= Journal of Smoking Cessation |volume= 3 |issue= 2 |pages= 69–70 |doi=10.1375/jsc.3.2.69|doi-access= free }}</ref><ref>{{cite journal | vauthors = Jamrozik K, Vessey M, Fowler G, Wald N, Parker G, Van Vunakis H | title = Controlled trial of three different antismoking interventions in general practice | journal = British Medical Journal | volume = 288 | issue = 6429 | pages = 1499–1503 | date = May 1984 | pmid = 6426618 | pmc = 1441184 | doi = 10.1136/bmj.288.6429.1499 }}</ref> Evidence-wise, little is known about the effects of using biomechanical tests to determine a person's risk related to smoking cessation.<ref>{{cite journal | vauthors = Clair C, Mueller Y, Livingstone-Banks J, Burnand B, Camain JY, Cornuz J, Rège-Walther M, Selby K, Bize R | title = Biomedical risk assessment as an aid for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 3 | article-number = CD004705 | date = March 2019 | pmid = 30912847 | pmc = 6434771 | doi = 10.1002/14651858.CD004705.pub5 }}</ref>

*Breath carbon monoxide (CO) monitoring: [[carbon monoxide]] is a significant component of cigarette smoke, and a [[breath carbon monoxide monitor]] can be used to detect current cigarette use. Carbon monoxide concentration in breath is directly correlated with the CO concentration in blood, known as percent [[carboxyhemoglobin]]. The value of demonstrating blood CO concentration to a smoker through a non-invasive breath sample is that it links the smoking habit with the physiological harm associated with smoking.<ref>{{cite journal | vauthors = Irving JM, Clark EC, Crombie IK, Smith WC | title = Evaluation of a portable measure of expired-air carbon monoxide | journal = Preventive Medicine | volume = 17 | issue = 1 | pages = 109–115 | date = January 1988 | pmid = 3362796 | doi = 10.1016/0091-7435(88)90076-x }}</ref> CO concentrations show a noticeable decrease within hours of quitting, which can encourage someone to work on quitting. Breath CO monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback, similar to how other diagnostic tools such as the stethoscope, the blood pressure cuff, and the cholesterol test have been used by treatment professionals in medicine.<ref name="Bittoun"/>
*Cotinine: [[Cotinine]], a [[metabolite]] of nicotine, is present in smokers. Like carbon monoxide, a cotinine test can be a reliable biomarker to determine smoking status.<ref>{{cite journal | vauthors = Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G | title = Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology | journal = Therapeutic Drug Monitoring | volume = 31 | issue = 1 | pages = 14–30 | date = February 2009 | pmid = 19125149 | pmc = 3644554 | doi = 10.1097/FTD.0b013e3181957a3b }}</ref> Cotinine levels can be tested through urine, saliva, blood, or hair samples. One of the main concerns of cotinine testing is the invasiveness of typical sampling methods.

While both measures offer high sensitivity and specificity, they differ in usage method and cost. For example, breath CO monitoring is non-invasive, while cotinine testing relies on bodily fluid. For instance, these two methods can be used alone or together when abstinence verification needs additional confirmation.<ref>{{cite journal | vauthors = McClure JB | title = Are biomarkers a useful aid in smoking cessation? A review and analysis of the literature | journal = Behavioral Medicine | volume = 27 | issue = 1 | pages = 37–47 | year = 2001 | pmid = 11575171 | doi = 10.1080/08964280109595770 | s2cid = 25616883 }}</ref>

====Competitions and incentives====
Financial or material incentives to entice people to quit smoking improve smoking cessation while the motivation is in place.<ref name=":6">{{cite journal | vauthors = Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M, Hartmann-Boyce J | title = Incentives for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD004307 | date = January 2025 | pmid = 39799985 | pmc = 11725379 | doi = 10.1002/14651858.CD004307.pub7 | pmc-embargo-date = January 13, 2026 }}</ref> Competitions that require participants to deposit their own money, "betting" that they will succeed in quitting smoking, appear to be an effective incentive.<ref name=":6" /> However, it is more difficult to recruit participants for this type of contest in head-to-head comparisons with other incentive models, such as giving participants [[Nicotine replacement therapy|NRT]] or placing them in a more typical rewards program.<ref name="SmokCessIncentives">{{cite journal | vauthors = Halpern SD, French B, Small DS, Saulsgiver K, Harhay MO, Audrain-McGovern J, Loewenstein G, Brennan TA, Asch DA, Volpp KG | title = Randomized trial of four financial-incentive programs for smoking cessation | journal = The New England Journal of Medicine | volume = 372 | issue = 22 | pages = 2108–2117 | date = May 2015 | pmid = 25970009 | pmc = 4471993 | doi = 10.1056/NEJMoa1414293 | author3-link = Dylan S. Small }}</ref> Evidence also shows that incentive programs are effective for pregnant mothers who smoke both during pregnancy and post-partum.<ref name=":6" /> As of 2019, there is an insufficient number of studies on "quit and win," and other competition-based interventions and results from the existing studies were inconclusive.<ref name="FanshaweHartmann-Boyce2019">{{cite journal | vauthors = Fanshawe TR, Hartmann-Boyce J, Perera R, Lindson N | title = Competitions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 2 | article-number = CD013272 | date = February 2019 | pmid = 30784046 | pmc = 6953205 | doi = 10.1002/14651858.CD013272 }}</ref>

===== Workplace incentives =====
A 2008 [[Cochrane Library|Cochrane]] review of smoking cessation activities in work-places concluded that "interventions directed towards individual smokers increase the likelihood of quitting smoking".<ref>{{cite journal | vauthors = Cahill K, Lancaster T | title = Workplace interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | article-number = CD003440 | date = February 2014 | pmid = 24570145 | pmc = 11285308 | doi = 10.1002/14651858.CD003440.pub4 }}</ref> A 2010 systematic review determined that worksite incentives and competitions needed to be combined with additional interventions to produce significant increases in smoking cessation rates.<ref name="Leeks2010">{{cite journal | vauthors = Leeks KD, Hopkins DP, Soler RE, Aten A, Chattopadhyay SK | title = Worksite-based incentives and competitions to reduce tobacco use. A systematic review | journal = American Journal of Preventive Medicine | volume = 38 | issue = 2 Suppl | pages = S263–S274 | date = February 2010 | pmid = 20117611 | doi = 10.1016/j.amepre.2009.10.034 }}</ref>

===Healthcare systems===
Interventions delivered via healthcare providers and healthcare systems have been shown to improve smoking cessation among people who visit those services.
*A clinic screening system (e.g., computer prompts) to identify whether or not a person smokes doubled abstinence rates, from 3.1% to 6.4%.<ref name=USDHHS2008/>{{rp|78–79}} Similarly, the Task Force on Community Preventive Services determined that provider reminders alone or with provider education effectively promote smoking cessation.<ref name=Hopkins2001>{{cite journal | vauthors = Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woollery TA, Harris KW | title = Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke | journal = American Journal of Preventive Medicine | volume = 20 | issue = 2 Suppl | pages = 16–66 | date = February 2001 | pmid = 11173215 | doi = 10.1016/S0749-3797(00)00297-X }}</ref>{{rp|33–38}}
*A 2008 Guideline meta-analysis estimated that physician advice to quit smoking led to a quit rate of 10.2%, as opposed to a quit rate of 7.9% among patients who did not receive physician advice to quit smoking.<ref name=USDHHS2008/>{{rp|82–83}} Even brief advice from physicians may have "a small effect on cessation rates",<ref>{{cite journal | vauthors = Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T | title = Physician advice for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 5 | article-number = CD000165 | date = May 2013 | pmid = 23728631 | pmc = 7064045 | doi = 10.1002/14651858.CD000165.pub4 }}</ref> and there is evidence that the physicians' probability of giving smoking cessation advice declines with the person who smokes age.<ref>{{cite journal | vauthors = Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB | title = Do patient age and medical condition influence medical advice to stop smoking? | journal = Age and Ageing | volume = 29 | issue = 3 | pages = 264–266 | date = May 2000 | pmid = 10855911 | doi = 10.1093/ageing/29.3.264 | doi-access = free }}</ref> There is evidence that only 81% of smokers age 50 or greater received advice on quitting from their physicians in the preceding year.<ref name="Ossip-Klein-2000">{{cite journal | vauthors = Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J | title = Smokers ages 50+: who gets physician advice to quit? | journal = Preventive Medicine | volume = 31 | issue = 4 | pages = 364–369 | date = October 2000 | pmid = 11006061 | doi = 10.1006/pmed.2000.0721 }}</ref>
*For one-to-one or person-to-person counselling sessions, the duration of each session, the total contact time, and the number of sessions all correlated with the effectiveness of smoking cessation. For example, "Higher intensity" interventions (>10 minutes) produced a quit rate of 22.1% as opposed to 10.9% for "no contact" over 300 minutes of contact time made a quit rate of 25.5% as opposed to 11.0% for "no minutes" and more than 8 sessions produced a quit rate of 24.7% as opposed to 12.4% for 0–1 sessions.<ref name=USDHHS2008/>{{rp|83–86}}
*Both physicians and non-physicians increased abstinence rates compared with self-help or no clinicians.<ref name=USDHHS2008/>{{rp|87–88}} For example, a Cochrane review of 58 studies found that nursing interventions increased the likelihood of quitting.<ref>{{cite journal | vauthors = Rice VH, Heath L, Livingstone-Banks J, Hartmann-Boyce J | title = Nursing interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 12 | article-number = CD001188 | date = December 2017 | pmid = 29243221 | pmc = 6486227 | doi = 10.1002/14651858.CD001188.pub5 }}</ref> Another review found some positive effects when trained community pharmacists support patients in their smoking cessation trials.<ref>{{cite journal | vauthors = Carson-Chahhoud KV, Livingstone-Banks J, Sharrad KJ, Kopsaftis Z, Brinn MP, To-A-Nan R, Bond CM | title = Community pharmacy personnel interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | date = October 2019 | pmid = 31684695 | pmc = 6822095 | doi = 10.1002/14651858.CD003698.pub3 }}</ref>
*Dental professionals also provide a key component in increasing tobacco abstinence rates in the community through counseling patients on the effects of tobacco on oral health in conjunction with an oral exam.<ref>{{cite journal | vauthors = Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM | title = Interventions for tobacco cessation delivered by dental professionals | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 2 | article-number = CD005084 | date = February 2021 | pmid = 33605440 | pmc = 8095016 | doi = 10.1002/14651858.CD005084.pub4 }}</ref>
*According to the 2008 Guideline, based on two studies the training of clinicians in smoking cessation methods may increase abstinence rates;<ref name=USDHHS2008/>{{rp|130}} however, a Cochrane review found and measured that such training decreased smoking in patients.<ref>{{cite journal | vauthors = Carson KV, Verbiest ME, Crone MR, Brinn MP, Esterman AJ, Assendelft WJ, Smith BJ | title = Training health professionals in smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 5 | article-number = CD000214 | date = May 2012 | pmid = 22592671 | pmc = 10088066 | doi = 10.1002/14651858.CD000214.pub2 | hdl-access = free | veditors = Carson KV | hdl = 2066/110023 }}</ref>
*Reducing or eliminating the costs of cessation therapies for smokers increased quit rates in three meta-analyses.<ref name=USDHHS2008/>{{rp|139–140}}<ref name=Hopkins2001/>{{rp|38–40}}<ref>{{cite journal | vauthors = van den Brand FA, Nagelhout GE, Reda AA, Winkens B, Evers SM, Kotz D, van Schayck OC | title = Healthcare financing systems for increasing the use of tobacco dependence treatment | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 9 | article-number = CD004305 | date = September 2017 | pmid = 28898403 | pmc = 6483741 | doi = 10.1002/14651858.CD004305.pub5 }}</ref>
*In one systematic review and meta-analysis, multi-component interventions increased quit rates in [[primary care]] settings.<ref>{{cite journal | vauthors = Papadakis S, McDonald P, Mullen KA, Reid R, Skulsky K, Pipe A | title = Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis | journal = Preventive Medicine | volume = 51 | issue = 3–4 | pages = 199–213 | year = 2010 | pmid = 20600264 | doi = 10.1016/j.ypmed.2010.06.007 }}</ref> "Multi-component" interventions were defined as those that combined two or more of the following strategies known as the "5 A's":<ref name=USDHHS2008/>{{rp|38–43}}
**Ask — Systematically identify all tobacco users at every visit
**Advise — Strongly urge all tobacco users to quit[[File:Breath CO Monitor.jpg|thumb|upright=.65|Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with its corresponding percent concentration of carboxyhemoglobin]]
**Assess — Determine willingness to make a quit attempt
**Assist — Aid the patient in quitting (provide counselling-style support and medication)
**Arrange — Ensure follow-up contact

===Substitutes for cigarettes===
{{Main|Nicotine replacement therapy|Electronic cigarette#Smoking cessation}}

*[[Nicotine replacement therapy]] (NRT) is the general term for using products that contain nicotine but not tobacco to aid smoking cessation. These include nicotine lozenges, [[nicotine gum]] and inhalers, [[nicotine patch]]es, and electronic cigarettes. In a review of 136 NRT-related Cochrane Tobacco Addiction Group studies, substantial evidence supported NRT use in increasing the chances of successfully quitting smoking by 50 to 60% in comparison to placebo or a non-NRT control group.<ref>{{cite journal | vauthors = Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T | title = Nicotine replacement therapy versus control for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD000146 | date = May 2018 | pmid = 29852054 | pmc = 6353172 | doi = 10.1002/14651858.CD000146.pub5 | collaboration = Cochrane Tobacco Addiction Group }}</ref>
*[[Electronic cigarette|Electronic cigarettes (ECs)]]: There is high‐certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate‐certainty evidence that they increase quit rates compared to ECs without nicotine.<ref>{{cite journal | vauthors = Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P | title = Electronic cigarettes for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | article-number = CD010216 | date = November 2022 | pmid = 36384212 | pmc = 9668543 | doi = 10.1002/14651858.CD010216.pub7 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/38189560|date = February 2024}} Little is known regarding the long-term harms related to vaping.<ref name=FormanekSalisbury-Afshar2018>{{cite journal | vauthors = Formanek P, Salisbury-Afshar E, Afshar M | title = Helping Patients With ESRD and Earlier Stages of CKD to Quit Smoking | journal = American Journal of Kidney Diseases | volume = 72 | issue = 2 | pages = 255–266 | date = August 2018 | pmid = 29661542 | pmc = 6057817 | doi = 10.1053/j.ajkd.2018.01.057 }}</ref> A 2016 UK [[Royal College of Physicians]] report supports using e-cigarettes as a smoking cessation tool.<ref>{{cite web |last1=Royal College of Physicians|title=RCP statement on e-cigarettes |url=https://www.rcplondon.ac.uk/news/rcp-statement-e-cigarettes|website=RCP London|date=25 June 2014}}</ref> A 2015 [[Public Health England]] report stated that "Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support."<ref name=McNeill2015>{{cite web |vauthors= McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H |url= https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454516/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England.pdf |title=E-cigarettes: an evidence update|location=UK|publisher=Public Health England |page=6 |date=August 2015}}</ref> However, since little is known about long term effects, other regulated options such as nicotine replacement therapy, varenicline or bupropion should be discussed primarily.

===Alternative approaches===
[[File:PEZ PEZ.Die.süße.Freude Braun 5way DE.AT-01.png|thumb|150px|A [[Pez]] vending machine. Pez was invented in 1927 as a smoking cessation aid, serving as an alternative to tobacco.<ref>{{Cite web |title=The History of PEZ - About Us |url=https://us.pez.com/pages/history |access-date=2024-06-01 |website=PEZ Candy |language=en}}</ref>]]
It is important to note that most of the alternative approaches below have minimal evidence to support their use, and their efficacy and safety should be discussed with a healthcare professional before starting. 
*[[Acupuncture]]: Acupuncture has been explored as an adjunct treatment method for smoking cessation.<ref name="He">{{cite journal | vauthors = He D, Berg JE, Høstmark AT | title = Effects of acupuncture on smoking cessation or reduction for motivated smokers | journal = Preventive Medicine | volume = 26 | issue = 2 | pages = 208–214 | date = March 1997 | pmid = 9085389 | doi = 10.1006/pmed.1996.0125 }}</ref> A 2014 Cochrane review was unable to make conclusions regarding acupuncture as the evidence is poor.<ref>{{cite journal | vauthors = White AR, Rampes H, Liu JP, Stead LF, Campbell J | title = Acupuncture and related interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 1 | article-number = CD000009 | date = January 2014 | pmid = 24459016 | pmc = 7263424 | doi = 10.1002/14651858.CD000009.pub4 }}</ref> A 2008 guideline found no difference between acupuncture and placebo, found no scientific studies supporting laser therapy based on acupuncture principles but without the needles.<ref name="USDHHS2008" />{{rp|99}}
*[[Hypnosis]]: Hypnosis often involves the hypnotherapist suggesting the unpleasant outcomes of smoking to the patient.<ref>{{cite web |url=https://www.webmd.com/smoking-cessation/hypnosis-for-quitting-smoking|title=Hypnosis for Quitting Smoking|publisher=WebMD|access-date=19 May 2012}}</ref> Clinical trials studying hypnosis and [[hypnotherapy]] as a method for smoking cessation have been inconclusive.<ref name="USDHHS2008" />{{rp|100}}<ref name="Barnes)2019" /><ref name="Johnson">{{cite journal | vauthors = Johnson DL, Karkut RT | title = Performance by gender in a stop-smoking program combining hypnosis and aversion | journal = Psychological Reports | volume = 75 | issue = 2 | pages = 851–857 | date = October 1994 | pmid = 7862796 | doi = 10.2466/pr0.1994.75.2.851 | s2cid = 39850409 }}</ref><ref name="Law">{{cite journal | vauthors = Law M, Tang JL | title = An analysis of the effectiveness of interventions intended to help people stop smoking | journal = Archives of Internal Medicine | volume = 155 | issue = 18 | pages = 1933–1941 | date = October 1995 | pmid = 7575046 | doi = 10.1001/archinte.1995.00430180025004 }}</ref> A Cochrane review was unable to find evidence of benefit of hypnosis in smoking cessation, and suggested if there is a beneficial effect, it is small at best.<ref name="Barnes)2019">{{cite journal | vauthors = Barnes J, McRobbie H, Dong CY, Walker N, Hartmann-Boyce J | title = Hypnotherapy for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 6 | article-number = CD001008 | date = June 2019 | pmid = 31198991 | pmc = 6568235 | doi = 10.1002/14651858.CD001008.pub3 }}</ref> However, a randomized trial published in 2008 found that hypnosis and nicotine patches "compares favorably" with standard behavioral counseling and nicotine patches in 12-month quit rates.<ref>{{cite journal | vauthors = Carmody TP, Duncan C, Simon JA, Solkowitz S, Huggins J, Lee S, Delucchi K | title = Hypnosis for smoking cessation: a randomized trial | journal = Nicotine & Tobacco Research | volume = 10 | issue = 5 | pages = 811–818 | date = May 2008 | pmid = 18569754 | doi = 10.1080/14622200802023833 | s2cid = 36395279 }}</ref>
*[[Herbal medicine]]: Many herbs have been studied as a method for smoking cessation, including [[lobelia]] and [[Hypericum perforatum|St John's wort]].<ref>{{cite web |last1=Mayo Clinic|title=St. John's wort (Hypericum perforatum) Evidence |url=https://www.mayoclinic.org/drugs-supplements-st-johns-wort/art-20362212|website=Mayo Clinic}}</ref><ref>{{cite journal | vauthors = Sood A, Ebbert JO, Prasad K, Croghan IT, Bauer B, Schroeder DR | title = A randomized clinical trial of St. John's wort for smoking cessation | journal = Journal of Alternative and Complementary Medicine | volume = 16 | issue = 7 | pages = 761–767 | date = July 2010 | pmid = 20590478 | pmc = 3110810 | doi = 10.1089/acm.2009.0445 }}</ref> The results are inconclusive, but St. Johns Wort shows few adverse events, but is a contraindication to many medications. Lobelia has been used to treat respiratory diseases like [[asthma]] and bronchitis, and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the [[Food and Drug Administration|FDA]]'s Poisonous Plant Database.<ref>{{cite web|last1=U.S. Food and Drug Administration|title=FDA Poisonous Plant Database|url=https://www.accessdata.fda.gov/scripts/plantox/|website=www.accessdata.fda.gov|access-date=2019-11-11|archive-date=2022-01-21|archive-url=https://web.archive.org/web/20220121131935/https://www.accessdata.fda.gov/scripts/Plantox/}}</ref> Lobelia can still be found in many products sold for smoking cessation and should be used with caution. Herbal products should be discussed with healthcare professionals before use to confirm safety with other medications.
*[[Smokeless tobacco]]: There is little smoking in Sweden, which is reflected in the very low cancer rates for Swedish men. Use of [[snus]] (a form of steam-pasteurized, rather than heat-pasteurized, air-cured smokeless tobacco) is an observed cessation method for Swedish men and even recommended by some Swedish doctors.<ref>{{cite report |author= Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) |title= Health Effects of Smokeless Tobacco Products |page= 103 |url= http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_009.pdf}}</ref> However, the report by the [[Scientific Committee on Emerging and Newly Identified Health Risks]] (SCENIHR) concludes "STP (smokeless tobacco products) are addictive and their use is hazardous to health. Evidence on the effectiveness of STP as a smoking cessation aid is insufficient."<ref>{{cite web |last1=Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR)|title=Health effects of smokeless tobacco products|url=http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_013.pdf}}</ref> A recent national study on the use of alternative tobacco products, including snus, did not show that these products promote cessation.<ref>{{cite journal | vauthors = Popova L, Ling PM | title = Alternative tobacco product use and smoking cessation: a national study | journal = American Journal of Public Health | volume = 103 | issue = 5 | pages = 923–930 | date = May 2013 | pmid = 23488521 | pmc = 3661190 | doi = 10.2105/ajph.2012.301070 }}</ref>
*[[Aversion therapy]]: It is a method of treatment works by pairing the pleasurable stimulus of smoking with other unpleasant stimuli. A Cochrane review reported that there is insufficient evidence of its efficacy.<ref>{{cite journal | vauthors = Hajek P, Stead LF | title = Aversive smoking for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2001 | issue = 3 | article-number = CD000546 | date = 2004 | pmid = 15266433 | pmc = 7045729 | doi = 10.1002/14651858.CD000546.pub2 }}</ref>
*[[Nicotine vaccine]]s: Nicotine vaccines (e.g., [[NicVAX]] and [[TA-NIC]]) work by reducing the amount of nicotine reaching the brain; however, this method of therapy needs more investigations to establish its role and determine its side effects.<ref>{{cite journal | vauthors = Hartmann-Boyce J, Cahill K, Hatsukami D, Cornuz J | title = Nicotine vaccines for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 8 | article-number = CD007072 | date = August 2012 | pmid = 22895958 | pmc = 6486305 | doi = 10.1002/14651858.CD007072.pub2 }}</ref>
*Technology and machine learning: Research studies using machine learning or [[artificial intelligence]] tools to provide feedback and communication with those who are trying to quit smoking are increasing, yet the findings are so far inconclusive.<ref>{{cite journal | vauthors = Coughlin LN, Tegge AN, Sheffer CE, Bickel WK | title = A Machine-Learning Approach to Predicting Smoking Cessation Treatment Outcomes | journal = Nicotine & Tobacco Research | volume = 22 | issue = 3 | pages = 415–422 | date = March 2020 | pmid = 30508122 | pmc = 7297111 | doi = 10.1093/ntr/nty259 }}</ref><ref>{{cite journal | vauthors = Sadasivam RS, Borglund EM, Adams R, Marlin BM, Houston TK | title = Impact of a Collective Intelligence Tailored Messaging System on Smoking Cessation: The Perspect Randomized Experiment | journal = Journal of Medical Internet Research | volume = 18 | issue = 11 | pages = e285 | date = November 2016 | pmid = 27826134 | pmc = 5120237 | doi = 10.2196/jmir.6465 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Patrick H, Fujii CA, Glaser DB, Utley DS, Marler JD | title = A Comprehensive Digital Program for Smoking Cessation: Assessing Feasibility in a Single-Group Cohort Study | journal = JMIR mHealth and uHealth | volume = 6 | issue = 12 | article-number = e11708 | date = December 2018 | pmid = 30563807 | pmc = 6315234 | doi = 10.2196/11708 | doi-access = free }}</ref>
*[[Psilocybin]] has been being investigated as a potential smoking cessation aid for several years. In 2021, [[Johns Hopkins School of Medicine|Johns Hopkins Medicine]] has been awarded a grant from the National Institutes of Health to explore the potential impacts of psilocybin and talk therapy on tobacco addiction.<ref>{{Cite web| vauthors=Marisol M |date=2021-10-20|title=Johns Hopkins receives first federal grant for psychedelic treatment research in 50 years|website=The Hub|language=en |url=https://hub.jhu.edu/2021/10/20/first-nih-grant-for-psychedelics-in-50-years/|access-date=2022-01-29}}</ref>

== Special populations ==

===Children and adolescents===
Methods used with children and adolescents include:
*Motivational enhancement<ref name="Fanshawe-2017">{{cite journal | vauthors = Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone-Banks J, Hartmann-Boyce J | title = Tobacco cessation interventions for young people | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 11 | article-number = CD003289 | date = November 2017 | pmid = 29148565 | pmc = 6486118 | doi = 10.1002/14651858.CD003289.pub6 }}</ref>
*Psychological support<ref name="Fanshawe-2017"/>
*Youth anti-tobacco activities, including participation in sports
*School-based curricula, like [[life skills|life-skills]] training
*[[School nursing|School-based nurse]] counseling sessions<ref>{{cite web |vauthors= Phert L |title=Intensive Counseling of Students by School Nurses Does Not Have Larger Impact on Long-Term Smoking Rates Than Briefer Sessions {{!}} AHRQ Health Care Innovations Exchange |url=https://innovations.ahrq.gov/profiles/intensive-counseling-students-school-nurses-does-not-have-larger-impact-long-term-smoking|website=innovations.ahrq.gov |access-date=19 July 2016}}</ref>
*Access reduction to tobacco
*Anti-tobacco media<ref>{{cite journal | vauthors = Davis KC, Farrelly MC, Messeri P, Duke J | title = The impact of national smoking prevention campaigns on tobacco-related beliefs, intentions to smoke and smoking initiation: results from a longitudinal survey of youth in the United States | journal = International Journal of Environmental Research and Public Health | volume = 6 | issue = 2 | pages = 722–740 | date = February 2009 | pmid = 19440412 | pmc = 2672353 | doi = 10.3390/ijerph6020722 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Allen JA, Duke JC, Davis KC, Kim AE, Nonnemaker JM, Farrelly MC | title = Using mass media campaigns to reduce youth tobacco use: a review | journal = American Journal of Health Promotion | volume = 30 | issue = 2 | pages = e71–e82 | date = Nov–Dec 2015 | pmid = 25372236 | doi = 10.4278/ajhp.130510-lit-237 | s2cid = 9297116 }}</ref>
*Family communication
Cochrane reviews, mainly of studies combining motivational enhancement and psychological support, concluded that "complex approaches" for smoking cessation among young people show promise.<ref name="Fanshawe-2017"/><ref>{{cite journal | vauthors = Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ | title = Community interventions for preventing smoking in young people | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 7 | article-number = CD001291 | date = July 2011 | pmid = 21735383 | pmc = 11384554 | doi = 10.1002/14651858.CD001291.pub2 }}</ref> The 2008 US Guideline recommends counselling-style support for adolescent smokers on the basis of a meta-analysis of seven studies.<ref name=USDHHS2008/>{{rp|159–161}} Neither the Cochrane review nor the 2008 Guideline recommend medications for adolescents who smoke.

===Pregnant women===
[[Smoking and pregnancy|Smoking during pregnancy]] can cause adverse health effects in both the woman and the fetus. The 2008 US Guideline determined that "person-to-person psychosocial interventions" (typically including "intensive counseling") increased abstinence rates in pregnant women who smoke to 13.3%, compared with 7.6% in usual care.<ref name=USDHHS2008/>{{rp|165–167}} Mothers who smoke during pregnancy have a greater tendency towards [[Preterm birth|premature births]]. Their babies are often underdeveloped, have smaller organs, and weigh much less than the average baby weight. In addition, these babies have weaker immune systems, making them more susceptible to many diseases such as middle ear inflammations and asthmatic bronchitis, as well as metabolic conditions such as diabetes and hypertension, all of which can bring significant morbidity.<ref>{{cite journal | vauthors = Mund M, Louwen F, Klingelhoefer D, Gerber A | title = Smoking and pregnancy--a review on the first major environmental risk factor of the unborn | journal = International Journal of Environmental Research and Public Health | volume = 10 | issue = 12 | pages = 6485–6499 | date = November 2013 | pmid = 24351784 | pmc = 3881126 | doi = 10.3390/ijerph10126485 | doi-access = free }}</ref> Additionally, a study published by [[American Academy of Pediatrics]] shows that smoking during pregnancy increases the chance of [[SIDS|sudden unexpected infant death]] ((SUID) or (SIDS)).<ref>{{cite journal | vauthors = Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA | title = Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death | journal = Pediatrics | volume = 143 | issue = 4 | pages = e20183325 | date = April 2019 | pmid = 30858347 | pmc = 6564075 | doi = 10.1542/peds.2018-3325 }}</ref> There is also an increased chance that the child will be a smoker in adulthood. A systematic review showed that psychosocial interventions help women quit smoking in late pregnancy and can reduce the incidence of low birth weight infants.<ref>{{cite journal | vauthors = Chamberlain C, O'Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE | title = Psychosocial interventions for supporting women to stop smoking in pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 2 | article-number = CD001055 | date = February 2017 | pmid = 28196405 | pmc = 4022453 | doi = 10.1002/14651858.CD001055.pub5 }}</ref>

It is a myth that a female smoker can cause harm to a fetus by quitting immediately upon discovering she is pregnant. This idea is not based on any medical study or fact.<ref>{{cite web |vauthors= Bowen M |title=Pregnancy and smoking|url=https://www.netdoctor.co.uk/conditions/pregnancy-and-family/a9099/pregnancy-and-smoking/|website=Netdoctor|access-date=19 July 2016|date=25 February 2013}}</ref>

In a UK study that included 1140 pregnant women, e-cigarettes were found to be as effective as nicotine patches at helping pregnant women to quit smoking. The safety of the two products was also similar.<ref>{{Cite journal |date=2022-11-04 |title=E-cigarettes may be better than nicotine patches in helping pregnant women stop smoking |url=https://evidence.nihr.ac.uk/alert/e-cigarettes-better-than-nicotine-patches-helping-pregnant-women-stop-smoking/ |journal=NIHR Evidence |language=en |doi=10.3310/nihrevidence_54425|s2cid=253360129 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Hajek P, Przulj D, Pesola F, Griffiths C, Walton R, McRobbie H, Coleman T, Lewis S, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Myers Smith K | title = Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial | journal = Nature Medicine | volume = 28 | issue = 5 | pages = 958–964 | date = May 2022 | pmid = 35577966 | pmc = 9117131 | doi = 10.1038/s41591-022-01808-0 }}</ref> However, life style modification are the preferred method for pregnant women, and they should discuss smoking cessation techniques with a healthcare professional.

===Schizophrenia===
{{Main|Schizophrenia and tobacco smoking}}
Studies across 20 countries show a strong association between patients with schizophrenia and smoking. People with schizophrenia are much more likely to smoke than those without the disease.<ref>{{cite journal | vauthors = de Leon J, Diaz FJ | title = A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors | journal = Schizophrenia Research | volume = 76 | issue = 2–3 | pages = 135–157 | date = July 2005 | pmid = 15949648 | doi = 10.1016/j.schres.2005.02.010 | s2cid = 32975940 }}</ref> For example, in the United States, 80% or more of people with schizophrenia smoke, compared to 20% of the general population in 2006.<ref>{{cite journal | vauthors = Keltner NL, Grant JS | title = Smoke, smoke, smoke that cigarette | journal = Perspectives in Psychiatric Care | volume = 42 | issue = 4 | pages = 256–261 | date = November 2006 | pmid = 17107571 | doi = 10.1111/j.1744-6163.2006.00085.x }}</ref>

===Hospitalized smokers===
[[File:Smoking cessation-West&Shiffman.png|thumb|alt=Simple bar chart says "Varenicline + support" about 16, "NRT/bupropion + support" about 12.5, "NRT alone" about 7, "Telephone support" about 6, "Group support" about 5, "One-to-one support" about 4 and "Tailored online support" about 2.5.|Percent increase of success for six months over unaided attempts for each type of quitting (chart from West & Shiffman based on Cochrane review data<ref name=WestShiffman2007>{{cite book |vauthors=West R, Shiffman S |title=Fast facts: smoking cessation |publisher=Health Press Ltd|location=Abingdon, England |year=2007|edition=2nd|isbn=978-1-903734-98-8}}</ref>{{rp|59}})]]
Smokers who are hospitalised may be particularly motivated to quit.<ref name=USDHHS2008/>{{rp|149–150}} A 2012 Cochrane review found that interventions beginning during a hospital stay and continuing for one month or more after discharge were effective in producing abstinence.<ref>{{cite journal | vauthors = Streck JM, Rigotti NA, Livingstone-Banks J, Tindle HA, Clair C, Munafò MR, Sterling-Maisel C, Hartmann-Boyce J | title = Interventions for smoking cessation in hospitalised patients | journal = The Cochrane Database of Systematic Reviews | volume = 2024 | issue = 5 | article-number = CD001837 | date = May 2024 | pmid = 38770804 | pmc = 11106804 | doi = 10.1002/14651858.CD001837.pub4 }}</ref>

Patients undergoing elective surgery may get benefits of preoperative smoking cessation interventions, when starting 4–8 weeks before surgery with weekly counseling for behavioral support and use of [[nicotine replacement therapy]].<ref name="preop.">{{cite journal | vauthors = Thomsen T, Villebro N, Møller AM | title = Interventions for preoperative smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 3 | article-number = CD002294 | date = March 2014 | pmid = 24671929 | pmc = 7138216 | doi = 10.1002/14651858.CD002294.pub4 }}</ref> It is found to reduce the complications and the number of postoperative morbidity.<ref name="preop."/>

===Mood disorders===

People with [[mood disorder]]s or [[attention deficit hyperactivity disorder]]s have a greater chance to begin smoking and a lower chance of quitting smoking.<ref name="Moylan-2013" /> A higher correlation with smoking has also been seen in people diagnosed with the [[major depressive disorder]] at any time throughout their lifetime compared to those without it. Success rates in quitting smoking were lower for those with a major depressive disorder diagnosis versus people without the diagnosis.<ref name="Baggett-2013" /> Exposure to cigarette smoke early on in life, during pregnancy, infancy, or adolescence, may negatively impact a child's neurodevelopment and increase the risk of developing [[anxiety disorder]]s in the future.<ref name="Moylan-2013">{{cite journal | vauthors = Moylan S, Jacka FN, Pasco JA, Berk M | title = How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways | journal = Brain and Behavior | volume = 3 | issue = 3 | pages = 302–326 | date = May 2013 | pmid = 23785661 | pmc = 3683289 | doi = 10.1002/brb3.137 }}</ref>

===Homeless and poverty===
Homelessness doubles the likelihood of an individual currently being a smoker. Homelessness is independent of other socioeconomic factors and behavioral health conditions. Homeless individuals have the same rates of desire to quit smoking. Still, they are less likely than the general population to attempt to stop successfully.<ref name="Baggett-2013">{{cite journal | vauthors = Baggett TP, Lebrun-Harris LA, Rigotti NA | title = Homelessness, cigarette smoking and desire to quit: results from a US national study | journal = Addiction | volume = 108 | issue = 11 | pages = 2009–2018 | date = November 2013 | pmid = 23834157 | pmc = 3797258 | doi = 10.1111/add.12292 }}</ref><ref name="smokingcessationleadership.ucsf.edu-2015">{{cite web |url=https://smokingcessationleadership.ucsf.edu/other-vulnerable-populations|title=Other Vulnerable Populations |website=Smoking Cessation Leadership Center|date=8 September 2015|access-date=2017-06-29}}</ref>

In the United States, 60–80% of homeless adults are smokers. This is a considerably higher rate than the general adult population of 19%.<ref name="Baggett-2013"/> Many current smokers who are homeless report smoking as a means of coping with "all the pressure of being homeless."<ref name="Baggett-2013"/> The perception that homeless people smoking being "socially acceptable" can reinforce these trends.<ref name="Baggett-2013"/>

Americans under the poverty line have higher rates of smoking and lower rates of quitting than those over the poverty line.<ref name="smokingcessationleadership.ucsf.edu-2015"/><ref name="www.nationalhomeless.org">{{cite web |url=http://www.nationalhomeless.org/factsheets/tobacco.html|title=National Coalition for the Homeless|website=www.nationalhomeless.org|access-date=2017-06-29}}</ref><ref>{{cite web |url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/|title=CDC – Fact Sheet – Adult Cigarette Smoking in the United States – Smoking & Tobacco Use |author= CDC's Office on Smoking and Health |website=Smoking and Tobacco Use|language=en-us|access-date=2017-06-29}}</ref> While the homeless population is concerned about short-term effects of smoking, such as shortness of breath or recurrent bronchitis, they are not as concerned with long-term consequences.<ref name="www.nationalhomeless.org"/> The homeless population has unique barriers to quitting smoking, such as unstructured days, the stress of finding a job, and immediate survival needs that supersede the desire to quit smoking.<ref name="www.nationalhomeless.org"/>

These unique barriers can be combated through pharmacotherapy and behavioral counseling for high levels of nicotine dependence. The emphasis of immediate financial benefits to those who concern themselves with the short-term over the long-term, partnering with shelters to reduce the social acceptability of smoking in this population, and increased taxes on cigarettes and alternative tobacco products to further make the addiction more difficult to fund.<ref>{{cite journal | vauthors = Baggett TP, Tobey ML, Rigotti NA | title = Tobacco use among homeless people--addressing the neglected addiction | journal = The New England Journal of Medicine | volume = 369 | issue = 3 | pages = 201–204 | date = July 2013 | pmid = 23863048 | doi = 10.1056/NEJMp1301935 | doi-access = free }}</ref>

=== Concurrent substance use disorders ===
Over three-quarters of people in treatment or recovery from substance misuse issues are current smokers.<ref name=":5">{{cite journal | vauthors = Iyahen EO, Omoruyi OO, Rowa-Dewar N, Dobbie F | title = Exploring the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from problematic drug or alcohol use: A qualitative systematic review | journal = PLOS ONE | volume = 18 | issue = 7 | article-number = e0288409 | date = 2023-07-13 | pmid = 37440505 | pmc = 10343091 | doi = 10.1371/journal.pone.0288409 | doi-access = free | bibcode = 2023PLoSO..1888409I }}</ref><ref>{{cite journal | vauthors = Campbell BK, Le T, Andrews KB, Pramod S, Guydish J | title = Smoking among patients in substance use disorders treatment: associations with tobacco advertising, anti-tobacco messages, and perceived health risks | journal = The American Journal of Drug and Alcohol Abuse | volume = 42 | issue = 6 | pages = 649–656 | date = November 2016 | pmid = 27314450 | pmc = 5093078 | doi = 10.1080/00952990.2016.1183021 }}</ref> Providing behavioural interventions (such as counseling and advice) and pharmacotherapy including nicotine replacement therapy (such as the use of patches or gum, varenicline, and/or bupropion) increase tobacco abstinence that is sustainable and also reduces the risk of returning to other substance use.<ref name=":5" /><ref>{{cite journal | vauthors = Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P | title = Behavioural interventions for smoking cessation: an overview and network meta-analysis | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD013229 | date = January 2021 | pmid = 33411338 | pmc = 11354481 | doi = 10.1002/14651858.CD013229.pub2 | s2cid = 230814023 }}</ref><ref>{{cite journal | vauthors = Apollonio D, Philipps R, Bero L | title = Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | article-number = CD010274 | date = November 2016 | pmid = 27878808 | pmc = 6464324 | doi = 10.1002/14651858.CD010274.pub2 }}</ref><ref>{{cite journal | vauthors = Prochaska JJ, Delucchi K, Hall SM | title = A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery | journal = Journal of Consulting and Clinical Psychology | volume = 72 | issue = 6 | pages = 1144–1156 | date = December 2004 | pmid = 15612860 | doi = 10.1037/0022-006X.72.6.1144 | url = https://www.escholarship.org/uc/item/0r8673wv }}</ref>

==Comparison of success rates==
Comparison of  success rates across interventions can be difficult because of different definitions of "success" used by the different studies.<ref name="ReferenceB">{{cite journal | vauthors = Rigotti NA, Clair C, Munafò MR, Stead LF | title = Interventions for smoking cessation in hospitalised patients | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | article-number = CD001837 | date = May 2012 | pmid = 22592676 | pmc = 4498489 | doi = 10.1002/14651858.CD001837.pub3 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/38770804|date = March 2025}} Robert West and Saul Shiffman, authorities in this field recognized by government health departments in a number of countries,<ref name=WestShiffman2007/>{{rp|73,76,80}} have concluded that, used together, "behavioral support" and "medication" can quadruple the chances that a quit attempt will be successful.

A 2008 systematic review in the ''[[European Journal of Cancer Prevention]]'' found that group behavioural therapy was the most effective intervention strategy for smoking cessation, followed by [[bupropion]], intensive physician advice, nicotine replacement therapy, individual counselling, telephone counselling, nursing interventions, and tailored self-help interventions; the study did not discuss [[varenicline]].<ref>{{cite journal | vauthors = Lemmens V, Oenema A, Knut IK, Brug J | title = Effectiveness of smoking cessation interventions among adults: a systematic review of reviews | journal = European Journal of Cancer Prevention | volume = 17 | issue = 6 | pages = 535–544 | date = November 2008 | pmid = 18941375 | doi = 10.1097/cej.0b013e3282f75e48 | s2cid = 46131720 }}</ref>

==Factors affecting success==
[[File:Smoking insula.jpg|thumb|Individuals who sustained damage to the [[Insular cortex|insula]] were able to more easily abstain from smoking.<ref>{{cite journal | vauthors = Naqvi NH, Rudrauf D, Damasio H, Bechara A | title = Damage to the insula disrupts addiction to cigarette smoking | journal = Science | volume = 315 | issue = 5811 | pages = 531–534 | date = January 2007 | pmid = 17255515 | pmc = 3698854 | doi = 10.1126/science.1135926 | bibcode = 2007Sci...315..531N }}</ref>]]There is an important social component to smoking. The spread of smoking cessation from person to person contributes to the decrease in smoking among different populations or groups.<ref name=autogenerated1>{{cite journal | vauthors = Christakis NA, Fowler JH | title = The collective dynamics of smoking in a large social network | journal = The New England Journal of Medicine | volume = 358 | issue = 21 | pages = 2249–2258 | date = May 2008 | pmid = 18499567 | pmc = 2822344 | doi = 10.1056/NEJMsa0706154 }}</ref> A 2008 study of a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%.<ref name=autogenerated1 /><!--For preceding ref, pmc deleted because PubMed Central version is author manuscript, not final.--> Nevertheless, a [[Cochrane (organization)|Cochrane]] review determined that interventions to increase social support for a smoker's cessation attempt did not improve long-term quit rates.<ref>{{cite journal | vauthors = Faseru B, Richter KP, Scheuermann TS, Park EW | title = Enhancing partner support to improve smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | article-number = CD002928 | date = August 2018 | pmid = 30101972 | pmc = 6326744 | doi = 10.1002/14651858.CD002928.pub4 }}</ref>

Smokers trying to quit are faced with social influences that may persuade them to conform and continue smoking. Cravings are easier to detain when one's environment does not provoke the habit. Suppose a person who stopped smoking has close relationships with active smokers. In that case, they are often put into situations that make the urge to conform more tempting. However, in a small group with at least one other not smoking, the likelihood of conformity decreases. The social influence of smoking cigarettes has been proven to rely on simple variables. One researched variable depends on whether there is influence from a friend or non-friend.<ref name="Hitchman-2014" /> The research shows that individuals are 77% more likely to conform to non-friends, while close friendships decrease conformity. Therefore, if an acquaintance offers a cigarette as a polite gesture, the person who has stopped smoking will be likelier to break his commitment than if a friend had suggested it. Recent research from the International Tobacco Control (ITC) Four Country Survey of over 6,000 smokers found that smokers with fewer smoking friends were more likely to intend to quit and to succeed in their quit attempt.<ref name="Hitchman-2014">{{cite journal | vauthors = Hitchman SC, Fong GT, Zanna MP, Thrasher JF, Laux FL | title = The relation between number of smoking friends, and quit intentions, attempts, and success: findings from the International Tobacco Control (ITC) Four Country Survey | journal = Psychology of Addictive Behaviors | volume = 28 | issue = 4 | pages = 1144–1152 | date = December 2014 | pmid = 24841185 | pmc = 4266625 | doi = 10.1037/a0036483 }}</ref>

Expectations and attitude are significant factors. A self-perpetuating cycle occurs when a person feels bad for smoking yet smokes to alleviate feeling bad. Breaking that cycle can be a key in changing the sabotaging attitude.<ref>{{cite web|last1=American Cancer Society|title=Guide to Quitting Smoking|website=www.cancer.org|url=http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/|access-date=6 July 2016|archive-date=8 August 2016|archive-url=https://web.archive.org/web/20160808163637/http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/}}</ref>

Smokers with [[major depressive disorder]] may be less successful at quitting smoking than non-depressed smokers.<ref name=USDHHS2008/>{{rp|81}}<ref name=Glassman1990>{{cite journal | vauthors = Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J | title = Smoking, smoking cessation, and major depression | journal = JAMA | volume = 264 | issue = 12 | pages = 1546–1549 | date = September 1990 | pmid = 2395194 | doi = 10.1001/jama.1990.03450120058029 }}</ref>

Relapse (resuming smoking after quitting) has been related to psychological issues such as low [[self-efficacy]],<ref>{{cite journal | vauthors = Condiotte MM, Lichtenstein E | title = Self-efficacy and relapse in smoking cessation programs | journal = Journal of Consulting and Clinical Psychology | volume = 49 | issue = 5 | pages = 648–658 | date = October 1981 | pmid = 7287974 | doi = 10.1037/0022-006X.49.5.648 }}</ref><ref>{{cite journal | vauthors = Elfeddali I, Bolman C, Candel MJ, Wiers RW, De Vries H | title = The role of self-efficacy, recovery self-efficacy, and preparatory planning in predicting short-term smoking relapse | journal = British Journal of Health Psychology | volume = 17 | issue = 1 | pages = 185–201 | date = February 2012 | pmid = 22107073 | doi = 10.1111/j.2044-8287.2011.02032.x | s2cid = 32854923 | url = https://cris.maastrichtuniversity.nl/en/publications/a145623f-f9ca-4a27-981f-83bf5b45b69d }}</ref> or non-optimal coping responses;<ref>{{cite journal | vauthors = Shiffman S | title = Relapse following smoking cessation: a situational analysis | journal = Journal of Consulting and Clinical Psychology | volume = 50 | issue = 1 | pages = 71–86 | date = February 1982 | pmid = 7056922 | doi = 10.1037/0022-006X.50.1.71 }}</ref> however, psychological approaches to prevent relapse have not been proven to be successful.<ref name="Livingstone-Banks-2019">{{cite journal | vauthors = Livingstone-Banks J, Norris E, Hartmann-Boyce J, West R, Jarvis M, Chubb E, Hajek P | title = Relapse prevention interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | date = October 2019 | pmid = 31684681 | pmc = 6816175 | doi = 10.1002/14651858.CD003999.pub6 }}</ref> In contrast, [[varenicline]] is suggested to have some effects and [[nicotine replacement therapy]] may help the unassisted abstainers.<ref name="Livingstone-Banks-2019" /><ref>{{cite journal | vauthors = Agboola SA, Coleman T, McNeill A, Leonardi-Bee J | title = Abstinence and relapse among smokers who use varenicline in a quit attempt-a pooled analysis of randomized controlled trials | journal = Addiction | volume = 110 | issue = 7 | pages = 1182–1193 | date = July 2015 | pmid = 25846123 | doi = 10.1111/add.12941 | url = https://nottingham-repository.worktribe.com/output/1106489 }}</ref>

Although some studies have suggested that increased melanin levels are associated with reduced levels of quitting smoking, other studies have not found this result and overall the literature is inconclusive on the topic. Suggestions that this may be due to a biological cause (melanin levels having an effect on nicotine metabolism) have been questioned, and it has suggested that if an effect is present it may be more attributable to social discrimination as a result of [[colorism]], with further research needed to rule out sociological factors.<ref>{{Cite journal |last1=King |first1=Lindsey M. |last2=Barnett |first2=Tracey E. |last3=Allen |first3=Acquel C. |last4=Maizel |first4=Jennifer L. |last5=Wilson |first5=Roneé E. |date=August 2024 |title=Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences |url=https://www.tandfonline.com/doi/full/10.1080/15332640.2022.2093812 |journal=Journal of Ethnicity in Substance Abuse |language=en |volume=23 |issue=3 |pages=381–411 |doi=10.1080/15332640.2022.2093812 |pmid=35839212 |issn=1533-2640|url-access=subscription }}</ref>

==Side effects==
{| class="wikitable" align="right"
|+Duration of nicotine withdrawal symptoms
|-
|Craving for tobacco
|3 to 8 weeks<ref name=Kaiser/>
|-
|Dizziness
|Few days<ref name=Kaiser/>
|-
|Insomnia
|1 to 2 weeks<ref name=Kaiser/>
|-
|Headaches
|1 to 2 weeks<ref name=Kaiser/>
|-
|Chest discomfort
|1 to 2 weeks<ref name=Kaiser/>
|-
|Constipation
|1 to 2 weeks<ref name=Kaiser/>
|-
|Irritability
|2 to 4 weeks<ref name=Kaiser/>
|-
|Fatigue
|2 to 4 weeks<ref name=Kaiser/>
|-
|Cough or nasal drip
|Few weeks<ref name=Kaiser/>
|-
|Lack of concentration
|Few weeks<ref name=Kaiser/>
|-
|Hunger
|Up to several weeks<ref name=Kaiser>{{cite book |author=Kaiser Foundation Health Plan of the Northwest|title=Cultivating Health: Freedom From Tobacco Kit|year=2008|publisher=Kaiser Permanente|isbn=978-0-9744864-8-2}}{{page needed|date=December 2013}}</ref>
|}

=== Withdrawal symptoms ===
The [[Centers for Disease Control and Prevention|CDC]] recognizes seven common nicotine withdrawal symptoms that people often face when stopping smoking: "cravings to smoke, feeling irritated, grouchy, or upset, feeling jumpy and restless, having a hard time concentrating, having trouble sleeping, feeling hungry or gaining weight, or feeling anxious, sad or depressed."<ref>{{Cite web |date=2022-09-12 |title=7 Common Withdrawal Symptoms {{!}} Quit Smoking {{!}} Tips From Former Smokers {{!}} CDC |url=https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/7-common-withdrawal-symptoms/index.html |access-date=2022-12-06 |website=www.cdc.gov |language=en-us}}</ref> Studies have shown that the use of pharmacotherapies, such as [[varenicline]]<ref>{{cite journal | vauthors = Lopes LC, Zhang Y, Ross S, Fulone I, Zhu M, O'Brien KK, Pavalagantharajah S, Leone FT, Sachs DP, Kathuria H, Murray RL, Zhang YQ | title = Varenicline for Tobacco-Dependent Adults Who Are Not Ready to Discontinue Use: A Systematic Review and Meta-Analysis | journal = Annals of the American Thoracic Society | volume = 19 | issue = 12 | pages = 2077–2086 | date = December 2022 | pmid = 36129426 | doi = 10.1513/AnnalsATS.202110-1122OC | s2cid = 252406073 }}</ref><ref>{{cite journal | vauthors = Zaso MJ, Hendershot CS | title = Effects of varenicline and bupropion on laboratory smoking outcomes: Meta-analysis of randomized, placebo-controlled human laboratory studies | journal = Addiction Biology | volume = 27 | issue = 5 | article-number = e13218 | date = September 2022 | pmid = 36001439 | pmc = 9413474 | doi = 10.1111/adb.13218 }}</ref> can be useful in reducing withdrawal symptoms during the quitting process.

===Weight gain===
Giving up smoking is associated with an average weight gain of {{convert|4|-|5|kg|lb}} after 12 months, most of which occurs within the first three months of quitting.<ref>{{cite journal | vauthors = Aubin HJ, Farley A, Lycett D, Lahmek P, Aveyard P | title = Weight gain in smokers after quitting cigarettes: meta-analysis | journal = BMJ | volume = 345 | issue = 345 | article-number = e4439 | date = July 2012 | pmid = 22782848 | pmc = 3393785 | doi = 10.1136/bmj.e4439 }}</ref>

The possible causes of the weight gain include:
*Smoking over-expresses the gene [[AZGP1]] which stimulates [[lipolysis]], so smoking cessation may decrease lipolysis.<ref name=Vanni2009>{{cite journal | vauthors = Vanni H, Kazeros A, Wang R, Harvey BG, Ferris B, De BP, Carolan BJ, Hübner RH, O'Connor TP, Crystal RG | title = Cigarette smoking induces overexpression of a fat-depleting gene AZGP1 in the human | journal = Chest | volume = 135 | issue = 5 | pages = 1197–1208 | date = May 2009 | pmid = 19188554 | pmc = 2679098 | doi = 10.1378/chest.08-1024 }}</ref>
*Smoking suppresses appetite, which may be caused by nicotine's effect on central [[Autonomic nervous system|autonomic]] neurons (e.g., via regulation of [[melanin concentrating hormone]] neurons in the [[hypothalamus]]).<ref name=Jo2002>{{cite journal | vauthors = Jo YH, Talmage DA, Role LW | title = Nicotinic receptor-mediated effects on appetite and food intake | journal = Journal of Neurobiology | volume = 53 | issue = 4 | pages = 618–632 | date = December 2002 | pmid = 12436425 | pmc = 2367209 | doi = 10.1002/neu.10147 }}</ref> Smoking cessation will increase the persons appetite once again, especially as taste buds can return to its normal function. 
*Heavy smokers are reported to burn 200 calories per day more than non-smokers eating the same diet.<ref>{{cite book |title= Johns Hopkins family health book | vauthors=Klag MJ |year=1999|page=86|publisher=HarperCollins |location= New York |isbn=978-0-06-270149-7}}</ref> Possible reasons for this phenomenon include nicotine's ability to increase energy metabolism or nicotine's effect on [[Peripheral nervous system|peripheral neurons]].<ref name=Jo2002/>

The [[United States Department of Health and Human Services|U.S. Department of Health and Human Services]] guideline suggests that sustained-release bupropion, nicotine gum, and nicotine lozenge be used "to delay weight gain after quitting."<ref>Fiore MC, Jaén CR, Baker TB, et al. ''Treating Tobacco Use and Dependence: 2008 Update.'' Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.</ref> There is not currently enough evidence to suggest one method of weight loss works better than others in preventing weight gain during the smoking cessation process.<ref>{{cite journal | vauthors = Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, Aveyard P | title = Interventions for preventing weight gain after smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 10 | article-number = CD006219 | date = October 2021 | pmid = 34611902 | pmc = 8493442 | doi = 10.1002/14651858.CD006219.pub4 }}</ref><ref>{{cite journal | vauthors = Ussher MH, Faulkner GE, Angus K, Hartmann-Boyce J, Taylor AH | title = Exercise interventions for smoking cessation | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | article-number = CD002295 | date = October 2019 | pmid = 31684691 | pmc = 6819982 | doi = 10.1002/14651858.CD002295.pub6 }}</ref> It is helpful to reach for healthy snacks, such as celery and carrots, to aid in the increased appetite while also helping to limit weight gain. Regardless of post-cessation weight gain, there is a significant decrease in risk of [[cardiovascular disease]] in those who have quit smoking.<ref>{{cite journal | vauthors = Wang X, Qin LQ, Arafa A, Eshak ES, Hu Y, Dong JY | title = Smoking Cessation, Weight Gain, Cardiovascular Risk, and All-Cause Mortality: A Meta-analysis | journal = Nicotine & Tobacco Research | volume = 23 | issue = 12 | pages = 1987–1994 | date = November 2021 | pmid = 33876246 | doi = 10.1093/ntr/ntab076 | doi-access = free }}</ref> The risks of rebound weight gain is significantly less than the risks of continued smoking.

===Mental health===
Like other physically addictive drugs, nicotine addiction causes a down-regulation of the production of [[dopamine]] and other stimulatory neurotransmitters as the brain attempts to compensate for the artificial stimulation caused by smoking. Some studies from the 1990s found that when people stop smoking, depressive symptoms such as suicidal tendencies or actual depression may result,<ref name=Glassman1990/><ref>{{cite journal | vauthors = Covey LS, Glassman AH, Stetner F | title = Major depression following smoking cessation | journal = The American Journal of Psychiatry | volume = 154 | issue = 2 | pages = 263–265 | date = February 1997 | pmid = 9016279 | doi = 10.1176/ajp.154.2.263 }}</ref> although a recent international study comparing smokers who had stopped for 3 months with continuing smokers found that stopping smoking did not appear to increase anxiety or depression.<ref>{{cite journal | vauthors = Shahab L, Andrew S, West R | title = Changes in prevalence of depression and anxiety following smoking cessation: results from an international cohort study (ATTEMPT) | journal = Psychological Medicine | volume = 44 | issue = 1 | pages = 127–141 | date = January 2014 | pmid = 23507203 | doi = 10.1017/s0033291713000391 | s2cid = 36478156 | url = https://discovery.ucl.ac.uk/id/eprint/1389484/1/1389484.pdf }}</ref> A 2021 review found that quitting smoking lessens anxiety and depression.<ref>{{cite journal | vauthors = Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P | title = Smoking cessation for improving mental health | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 3 | article-number = CD013522 | date = March 2021 | pmid = 33687070 | pmc = 8121093 | doi = 10.1002/14651858.CD013522.pub2 }}</ref>

A 2013 study by ''[[The British Journal of Psychiatry]]'' has found that smokers who successfully quit feel less anxious afterward, with the effect being greater among those who had [[Mood disorder|mood]] and [[anxiety disorder]]s than those who smoked for pleasure.<ref name=bjp>{{cite journal | vauthors = McDermott MS, Marteau TM, Hollands GJ, Hankins M, Aveyard P | title = Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study | journal = The British Journal of Psychiatry | volume = 202 | issue = 1 | pages = 62–67 | date = January 2013 | pmid = 23284151 | doi = 10.1192/bjp.bp.112.114389 | doi-access = free }}</ref>

==Health benefits==
[[File:British doctors study 35.svg|thumb|upright=1.35|Survival from age 35 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 25 and 34 years old.<ref name="Doll2004">{{cite journal | vauthors = Doll R, Peto R, Boreham J, Sutherland I | title = Mortality in relation to smoking: 50 years' observations on male British doctors | journal = BMJ | volume = 328 | issue = 7455 | page = 1519 | date = June 2004 | pmid = 15213107 | pmc = 437139 | doi = 10.1136/bmj.38142.554479.AE }}</ref> The ex-smokers line follows closely the non-smokers line.]]
Many of tobacco's detrimental health effects can be reduced or largely removed through smoking cessation. The health benefits over time of stopping smoking include:<ref name="www.cancer.org">{{Cite web |title=Health Benefits of Quitting Smoking Over Time |url=https://www.cancer.org/healthy/stay-away-from-tobacco/benefits-of-quitting-smoking-over-time.html |access-date=2022-12-06 |website=www.cancer.org |language=en}}</ref>

* Within 20 minutes after quitting, [[blood pressure]] and [[heart rate]] decrease
* Within a few days, [[carbon monoxide]] levels in the blood decrease to normal
* Within 48 hours, nerve endings and sense of smell and taste both start recovering
* Within 3 months, [[Circulatory system|circulation]] and [[Spirometry|lung function]] improve
* Within 1 year, there are decreases in cough and shortness of breath
* Within 1–2 years, the risk of [[Coronary disease|coronary heart disease]] is cut in half
* Within 5–10 years, the risk of [[stroke]] falls to the same as a non-smoker, and the risks of many cancers (mouth, throat, esophagus, bladder, cervix) decrease significantly
* Within 10 years, the risk of dying from [[lung cancer]] is cut in half, and the risks of larynx and pancreas cancers decrease
* Within 15 years, the risk of coronary heart disease drops to the level of a non-smoker; lowered risk for developing COPD (chronic obstructive pulmonary disease)<ref name="www.cancer.org" />

The [[British Doctors Study]] showed that those who stopped smoking before they reached 30 years old lived almost as long as those who never smoked.<ref name="Doll2004" /> Stopping in one's sixties can still add three years of healthy life.<ref name="Doll2004" /> Randomized U.S. and Canadian trials showed that a ten-week smoking cessation program decreased mortality from all causes over 14 years later.<ref>{{cite journal | vauthors = Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE | title = The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial | journal = Annals of Internal Medicine | volume = 142 | issue = 4 | pages = 233–239 | date = February 2005 | pmid = 15710956 | doi = 10.7326/0003-4819-142-4-200502150-00005 | s2cid = 20252771 | doi-access =  }}</ref> A recent article on mortality in a cohort of 8,645 smokers who were followed up after 43 years determined that "current smoking and lifetime persistent smoking were associated with an increased risk of all-cause, CVD [cardiovascular disease], COPD [chronic obstructive pulmonary disease], and any cancer, and lung cancer mortality."<ref>{{cite journal | vauthors = Taghizadeh N, Vonk JM, Boezen HM | title = Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up | journal = PLOS ONE | volume = 11 | issue = 4 | article-number = e0153310 | date = 7 April 2016 | pmid = 27055053 | pmc = 4824471 | doi = 10.1371/journal.pone.0153310 | doi-access = free | bibcode = 2016PLoSO..1153310T }}</ref>

The significant increase in the risk of all-cause mortality that is present in people who smoke is decreased with long-term smoking cessation.<ref>{{cite journal | vauthors = Zhu D, Zhao G, Wang X | title = Association of Smoking and Smoking Cessation With Overall and Cause-Specific Mortality | journal = American Journal of Preventive Medicine | volume = 60 | issue = 4 | pages = 504–512 | date = April 2021 | pmid = 33745522 | doi = 10.1016/j.amepre.2020.11.003 | s2cid = 232311701 | doi-access = free }}</ref> Smoking cessation can improve health status and quality of life at any age.<ref name="Smoking cessation">Smoking cessation: A report of the surgeon general—executive summary. US Public Health Service; US Department of Health and Human Services, Rockville, MD 2020.</ref> Evidence shows that cessation of smoking reduces risk of [[Lung cancer|lung]], [[Laryngeal cancer|laryngeal]], [[Oral cancer|oral cavity and pharynx]], [[Esophageal cancer|esophageal]], [[Pancreatic cancer|pancreatic]], [[Bladder cancer|bladder]], [[Stomach cancer|stomach]], [[Colorectal cancer|colorectal]], [[Cervical cancer|cervical]], and [[Kidney cancer|kidney]] cancer, in addition to reducing the risk of [[acute myeloid leukemia]].<ref name="Smoking cessation" />

Another published study, "Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis," examined six randomized trials and 15 observational studies to examine preoperative smoking cessation's effects on postoperative complications. The findings were: 1) taken together, the studies demonstrated a decreased likelihood of postoperative complications in patients who ceased smoking before surgery; 2) overall, each week of cessation before surgery increased the magnitude of the effect by 19%. A significant positive effect was noted in trials where smoking cessation occurred at least four weeks before surgery; 3) For the six randomized trials, they demonstrated, on average, a relative risk reduction of 41% for postoperative complications.<ref>{{cite journal | vauthors = Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO | title = Smoking cessation reduces postoperative complications: a systematic review and meta-analysis | journal = The American Journal of Medicine | volume = 124 | issue = 2 | pages = 144–154.e8 | date = February 2011 | pmid = 21295194 | doi = 10.1016/j.amjmed.2010.09.013 }}</ref>

==Cost-effectiveness==
[[File:Smokers-as-a-percentage-of-adult-pop.jpg|thumb|upright=1.35|Smokers as a percentage of the population for the United States, the Netherlands, Norway, Japan, and Finland]]
[[Cost-effectiveness analysis|Cost-effectiveness analyses]] of smoking cessation activities have shown that they increase [[quality-adjusted life year]]s (QALYs) at costs comparable with other types of interventions to treat and prevent disease.<ref name=USDHHS2008/>{{rp|134–137}} Studies of the cost-effectiveness of smoking cessation include:
*In a 1997 U.S. analysis, the estimated cost per QALY varied by the type of cessation approach, ranging from group intensive counselling without nicotine replacement at $1108 per QALY to minimal counselling with nicotine gum at $4542 per QALY.<ref>{{cite journal | vauthors = Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T | title = Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research | journal = JAMA | volume = 278 | issue = 21 | pages = 1759–1766 | date = December 1997 | pmid = 9388153 | doi = 10.1001/jama.278.21.1759 }}</ref>
*A study from [[Erasmus University Rotterdam]] limited to people with [[chronic obstructive pulmonary disease]] found that the cost-effectiveness of minimal counselling, intensive counselling, and drug therapy were €16,900, €8,200, and €2,400 per QALY gained respectively.<ref>{{cite journal | vauthors = Hoogendoorn M, Feenstra TL, Hoogenveen RT, Rutten-van Mölken MP | title = Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD | journal = Thorax | volume = 65 | issue = 8 | pages = 711–718 | date = August 2010 | pmid = 20685746 | doi = 10.1136/thx.2009.131631 | doi-access = free | hdl = 1765/60639 | hdl-access = free }}</ref>
*Among [[National Health Service]] smoking cessation clients in [[Glasgow]], pharmacy one-to-one counselling cost £2,600 per QALY gained and group support cost £4,800 per QALY gained.<ref>{{cite journal | vauthors = Bauld L, Boyd KA, Briggs AH, Chesterman J, Ferguson J, Judge K, Hiscock R | title = One-year outcomes and a cost-effectiveness analysis for smokers accessing group-based and pharmacy-led cessation services | journal = Nicotine & Tobacco Research | volume = 13 | issue = 2 | pages = 135–145 | date = February 2011 | pmid = 21196451 | doi = 10.1093/ntr/ntq222 }}</ref>

==Statistical trends==
The frequency of smoking cessation among smokers varies across countries. Smoking cessation increased in Spain between 1965 and 2000,<ref>{{cite journal | vauthors = Schiaffino A, Fernández E, Kunst A, Borrell C, García M, Borràs JM, Mackenbach JP | title = Time trends and educational differences in the incidence of quitting smoking in Spain (1965-2000) | journal = Preventive Medicine | volume = 45 | issue = 2–3 | pages = 226–232 | year = 2007 | pmid = 17604832 | doi = 10.1016/j.ypmed.2007.05.009 }}</ref> in Scotland between 1998 and 2007,<ref>{{cite journal | vauthors = Fowkes FJ, Stewart MC, Fowkes FG, Amos A, Price JF | title = Scottish smoke-free legislation and trends in smoking cessation | journal = Addiction | volume = 103 | issue = 11 | pages = 1888–1895 | date = November 2008 | pmid = 19032538 | doi = 10.1111/j.1360-0443.2008.02350.x }}</ref> and in Italy after 2000.<ref>{{cite journal | vauthors = Federico B, Costa G, Ricciardi W, Kunst AE | title = Educational inequalities in smoking cessation trends in Italy, 1982-2002 | journal = Tobacco Control | volume = 18 | issue = 5 | pages = 393–398 | date = October 2009 | pmid = 19617220 | doi = 10.1136/tc.2008.029280 | s2cid = 9911187 }}</ref> In contrast, in the U.S. the cessation rate was "stable (or varied little)" between 1998 and 2008,<ref>{{cite journal | title = Cigarette smoking among adults and trends in smoking cessation - United States, 2008 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 58 | issue = 44 | pages = 1227–1232 | date = November 2009 | pmid = 19910909 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm | author1 = Centers for Disease Control and Prevention (CDC) }}</ref> and in China smoking cessation rates declined between 1998 and 2003.<ref>{{cite journal | vauthors = Qian J, Cai M, Gao J, Tang S, Xu L, Critchley JA | title = Trends in smoking and quitting in China from 1993 to 2003: National Health Service Survey data | journal = Bulletin of the World Health Organization | volume = 88 | issue = 10 | pages = 769–776 | date = October 2010 | pmid = 20931062 | pmc = 2947036 | doi = 10.2471/BLT.09.064709 }}</ref>

Nevertheless, in a growing number of countries there are now more ex-smokers than smokers.<ref name=Chapman-MacKenzie/> In the United States, 61.7% of adult smokers (55.0 million adults) who had ever smoked had quit by 2018, an increase from 51.7% in 2009.<ref>{{cite journal | vauthors = Creamer MR, Wang TW, Babb S, Cullen KA, Day H, Willis G, Jamal A, Neff L | title = Tobacco Product Use and Cessation Indicators Among Adults - United States, 2018 | language = en-us | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 45 | pages = 1013–1019 | date = November 2019 | pmid = 31725711 | pmc = 6855510 | doi = 10.15585/mmwr.mm6845a2 }}</ref> As of 2020, the [[Centers for Disease Control and Prevention|CDC]] reports that the number of adults who smoke in the U.S. has fallen to 30.8 million.<ref>{{Cite web |last=CDCTobaccoFree |date=2022-08-08 |title=Burden of Tobacco Use in the U.S. |url=https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html |access-date=2022-12-06 |website=Centers for Disease Control and Prevention |language=en-us}}</ref>

== See also ==
{{Div col|colwidth=22em}}
*[[Breath carbon monoxide monitor]]
*[[Bupropion]]
*[[Coerced abstinence]]
*[[Health effects of tobacco]]
*[[Health promotion]]
*[[Massachusetts Tobacco Cessation and Prevention Program]]
*[[Nicotine Anonymous]]
*[[Nicotine replacement therapy]]
*[[Smoking cessation programs in Canada]]
*[[Tobacco cessation clinics in India]]
*[[Tobacco control]]
*[[Tobacco Control (journal)|''Tobacco Control'']] (journal)
*[[Truth Initiative]] (formerly American Legacy Foundation)
*[[U.S. government and smoking cessation]]
*[[Vaping cessation]]
*[[Varenicline]]
*[[Youth Tobacco Cessation Collaborative]]
*[[World No Tobacco Day]]
{{Div col end}}

==Bibliography==
{{Reflist|30em}}

== Further reading ==
{{Commons category}}
{{Refbegin}}
* {{cite journal | vauthors = Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML | title = Pharmacotherapy for nicotine dependence | journal = CA | volume = 55 | issue = 5 | pages = 281–99; quiz 322–3, 325 | year = 2005 | pmid = 16166074 | doi = 10.3322/canjclin.55.5.281 | s2cid = 25668093 | doi-access = free }}
* {{cite journal | vauthors = Hughes JR, Keely J, Naud S | title = Shape of the relapse curve and long-term abstinence among untreated smokers | journal = Addiction | volume = 99 | issue = 1 | pages = 29–38 | date = January 2004 | pmid = 14678060 | doi = 10.1111/j.1360-0443.2004.00540.x }}
* {{cite journal | vauthors = Hutter H, Moshammer H, Neuberger M | title = Smoking cessation at the workplace: 1 year success of short seminars | journal = International Archives of Occupational and Environmental Health | volume = 79 | issue = 1 | pages = 42–48 | date = January 2006 | pmid = 16133522 | doi = 10.1007/s00420-005-0034-y | s2cid = 44288956 | bibcode = 2006IAOEH..79...42H }}
* {{cite book |title=Overcoming your smoking habit: a self-help guide using cognitive behavioral techniques |vauthors=Marks DF |author-link=David Marks (psychologist) |year=2005 |publisher=Robinson |location=London |isbn=978-1-84529-067-2}}
* {{cite journal | vauthors = Peters MJ, Morgan LC | title = The pharmacotherapy of smoking cessation | journal = The Medical Journal of Australia | volume = 176 | issue = 10 | pages = 486–490 | date = May 2002 | pmid = 12065013 | doi = 10.5694/j.1326-5377.2002.tb04521.x | s2cid = 98235 }}
* {{cite journal | vauthors = West R | title = Tobacco control: present and future | journal = British Medical Bulletin | volume = 77-78 | issue = 1 | pages = 123–136 | year = 2006 | pmid = 17106058 | doi = 10.1093/bmb/ldl012 | doi-access = free }}
* {{cite book |vauthors=McFarland JW, Folkenberg EJ |title=How to stop smoking in five days |year=1964 |publisher=Prentice-Hall |location=Englewood Cliffs, NJ |url=http://www.uhs.wisc.edu/health-topics/tobacco/documents/Five_Day_Plan.pdf |url-status=unfit |archive-url=https://web.archive.org/web/20150213084432/http://www.uhs.wisc.edu/health-topics/tobacco/documents/Five_Day_Plan.pdf |archive-date=2015-02-13}}
{{Refend}}

<!-- == External links == -->

<!-- {{No more links}}

 Please be cautious adding more external links.

Wikipedia is not a collection of links and should not be used for advertising.

 Excessive or inappropriate links will be removed.

 See [[Wikipedia:External links]] and [[Wikipedia:Spam]] for details.

If there are already suitable links, propose additions or replacements on
the article's talk page.

-->

{{Public health}}
{{Smoking nav}}

[[Category:Smoking cessation| ]]
[[Category:Drug rehabilitation]]
[[Category:General practice]]
[[Category:Health effects of tobacco]]