What Works

An Overview of Effective Tobacco Cessation Treatments and Activities

What do we know about the effectiveness of tobacco cessation activities and how to approach the treatment of tobacco dependence in the clinical and community settings?

Based on suggestions from leading cessation experts, two existing cessation guidelines, and extensive literature searches there is broad agreement that the evidence base supporting tobacco cessation interventions is one of the strongest and most complete in existence. Here we provide an overview of “what works” for tobacco cessation.

Physician Intervention

The clinical and community guidelines found physician intervention (including the 5A’s strategy: Asking if patients smoke, advising them to quit, assessing readiness to quit, assisting with counseling and pharmacological treatments, and arranging for follow up) to be effective in encouraging cessation.

Counseling

The clinical guideline found counseling to be an effective treatment for tobacco dependence. Counseling can be provided in a number of different venues, including face-to-face (individual or in a group), or via telephone. When combined with pharmacological treatment, the effectiveness of treatment doubles or triples (compared to counseling alone). For pregnant women, counseling alone may be advised as primary treatment.

Pharmacotherapy

The clinical and community guidelines recommend pharmacotherapy (i.e., medications) as an effective treatment for tobacco dependence. Currently, five medications have been approved by the FDA for smoking cessation, including nicotine gum, nicotine patch, nicotine inhaler, nicotine nasal spray, and the antidepressant, bupropion.

Reducing Patient Out-of-Pocket Costs for Cessation Treatment

The community guide demonstrated that the reduction of patient out-of-pocket costs for tobacco dependence treatments increases cessation rates. Techniques include providing the service within the healthcare system, providing coverage for or reimbursement of patients for expenditures on counseling and pharmacotherapy, and reducing co-payments.

Mass Media Campaigns

The community guide found that mass media campaigns, when part of multi-component interventions, are effective in increasing cessation rates. The media campaigns do not necessarily have to be cessation-focused; print and broadcast media efforts may refer the audience to quitlines.

Increasing the Unit Price of Tobacco

The community guide recommends increasing the unit price of tobacco, primarily through an increase in excise tax, as an effective cessation activity that decreases smoking prevalence and tobacco consumption. A 10% increase in the price of tobacco products results in a 4% decrease in the amount of tobacco used by the general population. Adolescents are especially sensitive to price increases.

Workplace Smoking Bans

Research indicates that smoking bans in the workplace can create an environment favorable to cessation. Workplace smoking bans decrease daily tobacco consumption while increasing quit attempts and the successfulness of these attempts.