Smoking Cessation: What Works?

It is no longer appropriate for physicians to wonder if it is their job to address patients' tobacco use or if they will be directly reimbursed for such work. It is time for them to turn to this question instead: What works?

New prevention and cessation treatments, medications, and approaches have been proven effective. Although our knowledge about tobacco control remains imperfect, we know more than enough to act now. Smoking rates among teens and adults could be cut in half within the decade if we fully implement antismoking programs using effective approaches that are already available.

My report "Reducing Tobacco Use" is a science-based blueprint for action. Physicians are critical to the success of the goals it lays out. For example, brief physician advice to quit smoking can double or quadruple normal quit rates, while a combination of behavioral counseling and pharmacologic treatment can boost success up to three times.

Clinicians have access to more than 70% of smokers each year. They must take advantage of that unique position. Here is a range of action physicians should take.

* Advice. Substantial evidence suggests that minimal intervention, such as a physician's repeated advice to quit, fosters smoking cessation, is effective in increasing smokers' motivation to quit, and is cost effective. Even simple measures, such as physicians advising their patients to quit smoking, can reduce tobacco use by 5%-10%.

* Intensive clinical interventions. Broader, more systematic programs, including counseling, patient educational materials, and support groups, are more successful. Some multicomponent programs have cut smoking rates by 30%-50%.

* Nicotine replacement therapies (NRTs). Abundant evidence confirms that nicotine gum and nicotine patches are effective. The efficacy of the gum may depend on the amount of behavioral counseling with which it is paired. The patch appears to exert an effect independent of behavioral support, but absolute abstinence rates increase as more counseling is ...