Nonpharmacologic Therapy for Smoking Cessation: Characteristics and Efficacy of Current Approaches

  • Raymond Niaura
    Requests for reprints should be addressed to Raymond Niaura, PhD, Department of Psychiatry and Human Behavior, Butler Hospital, 345 Blackstone Boulevard, Providence, Rhode Island 02906.
    Department of Psychiatry and Human Behavior, Butler Hospital, Providence, Rhode Island, USA
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      This article reviews the most common nonpharmacologic approaches used to support smoking cessation and, where possible, provides estimates of their efficacy in controlled clinical trials. Virtually all of the approaches that have been systematically evaluated to date have demonstrated modest efficacy in increasing quit rates. A cornerstone of effective treatment is tobacco dependence counseling, for which there is a dose-response relation between the intensity of counseling (total minutes of contact) and its effectiveness. New approaches in which treatment is tailored to individual patient characteristics appear promising for the future but require further study. Also, new technologies that permit delivery of smoking interventions to a wider range of patients could have a significant impact on reducing smoking prevalence worldwide in the future. Overall, the clinical literature strongly endorses combining nonpharmacologic interventions with pharmacotherapy to optimize support for smokers who are trying to quit.


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        • Centers for Disease Control and Prevention
        Tobacco use among adults—United States, 2005.
        MMWR Morb Mortal Wkly Rep. 2006; 55: 1145-1148
        • Centers for Disease Control and Prevention
        Cigarette smoking among adults—United States, 1995.
        MMWR Morb Mortal Wkly Rep. 1997; 46: 1217-1220
        • Fagerström K.
        The epidemiology of smoking: health consequences and benefits of cessation.
        Drugs. 2002; 62: 1-9
        • Mallin R.
        Smoking cessation: integration of behavioral and drug therapies.
        Am Fam Physician. 2002; 65: 1107-1114
        • Stitzer M.L.
        Combined behavioral and pharmacological treatments for smoking cessation.
        Nicotine Tob Res. 1999; 1: S181-S187
        • Nides M.
        Update on pharmacologic options for smoking cessation treatment.
        Am J Med. 2008; 121: S20-S31
        • Hughes J.R.
        Motivating and helping smokers to stop smoking.
        J Gen Intern Med. 2003; 18: 1053-1057
        • Lancaster T.
        • Stead L.F.
        Self-help interventions for smoking cessation.
        Cochrane Database Syst Rev. 2005; 3 (CD001118)
        • Stead L.F.
        • Lancaster T.
        • Perera R.
        Telephone counselling for smoking cessation.
        Cochrane Database Syst Rev. 2003; 1 (CD002850)
        • Lancaster T.
        • Stead L.F.
        Individual behavioural counselling for smoking cessation.
        Cochrane Database Syst Rev. 2005; 2 (CD001292)
        • Stead L.F.
        • Lancaster T.
        Group behaviour therapy programmes for smoking cessation.
        Cochrane Database Syst Rev. 2005; 2 (CD001007)
        • Gorin S.S.
        • Heck J.E.
        Meta-analysis of the efficacy of tobacco counseling by health care providers.
        Cancer Epidemiol Biomarkers Prev. 2004; 13: 2012-2022
        • Ussher M.
        Exercise interventions for smoking cessation.
        Cochrane Database Syst Rev. 2005; 1 (CD002295)
        • Marcus B.H.
        • Albrecht A.E.
        • King T.K.
        • et al.
        The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial.
        Arch Intern Med. 1999; 159: 1229-1234
        • Curry S.J.
        Self-help interventions for smoking cessation.
        J Consult Clin Psychol. 1993; 61: 790-803
        • Strecher V.J.
        • Marcus A.
        • Bishop K.
        • et al.
        A randomized controlled trial of multiple tailored messages for smoking cessation among callers to the cancer information service.
        J Health Commun. 2005; 10: 105-118
        • Mermelstein R.
        • Hedeker D.
        • Wong S.C.
        Extended telephone counseling for smoking cessation: does content matter?.
        J Consult Clin Psychol. 2003; 71: 565-574
        • Stead L.F.
        • Perera R.
        • Lancaster T.
        Telephone counselling for smoking cessation.
        Cochrane Database Syst Rev. 2006; 3 (CD002850)
        • Solomon L.J.
        • Marcy T.W.
        • Howe K.D.
        • Skelly J.M.
        • Reinier K.
        • Flynn B.S.
        Does extended proactive telephone support increase smoking cessation among low-income women using nicotine patches?.
        Prev Med. 2005; 40: 306-313
        • An L.C.
        • Zhu S.H.
        • Nelson D.B.
        • et al.
        Benefits of telephone care over primary care for smoking cessation: a randomized trial.
        Arch Intern Med. 2006; 166: 536-542
        • Boyle R.G.
        • Solberg L.I.
        • Asche S.E.
        • et al.
        Offering telephone counseling to smokers using pharmacotherapy.
        Nicotine Tob Res. 2005; 7: S19-S27
      1. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, MD: US Dept of Health and Human Services, Public Health Service. (in press)

        • Dornelas E.A.
        • Magnavita J.J.
        High-impact therapy for smoking cessation.
        J Clin Psychol. 2001; 57: 1311-1322
        • Judge K.
        • Bauld L.
        • Chesterman J.
        • Ferguson J.
        The English smoking treatment services: short-term outcomes.
        Addiction. 2005; 100: 46-58
        • Katz D.A.
        • Muehlenbruch D.R.
        • Brown R.L.
        • et al.
        Effectiveness of implementing the agency for healthcare research and quality smoking cessation clinical practice guideline: a randomized, controlled trial.
        J Natl Cancer Inst. 2004; 96: 594-603
        • Crealey G.E.
        • McElnay J.C.
        • Maguire T.A.
        • O’Neill C.
        Costs and effects associated with a community pharmacy-based smoking-cessation programme.
        Pharmacoeconomics. 1998; 14: 323-333
        • Buck D.J.
        • Richmond R.L.
        • Mendelsohn C.P.
        Cost-effectiveness analysis of a family physician delivered smoking cessation program.
        Prev Med. 2000; 31: 641-648
        • Groner J.
        • French G.
        • Ahijevych K.
        • Wewers M.E.
        Process evaluation of a nurse-delivered smoking relapse prevention program for new mothers.
        J Community Health Nurs. 2005; 22: 157-167
        • Sinclair H.K.
        • Bond C.M.
        • Stead L.F.
        Community pharmacy personnel interventions for smoking cessation.
        Cochrane Database Syst Rev. 2004; 1 (CD003698)
        • Hyland A.
        • Li Q.
        • Bauer J.E.
        • et al.
        State and community tobacco-control programs and smoking-cessation rates among adult smokers: what can we learn from the COMMIT intervention cohort?.
        Am J Health Promot. 2006; 20: 272-281
        • Moher M.
        • Hey K.
        • Lancaster T.
        Workplace interventions for smoking cessation.
        Cochrane Database Syst Rev. 2005; 2 (CD003440)
        • Smedslund G.
        • Fisher K.J.
        • Boles S.M.
        • Lichtenstein E.
        The effectiveness of workplace smoking cessation programmes: a meta-analysis of recent studies.
        Tob Control. 2004; 13: 197-204
        • Nafziger A.N.
        • Erb T.A.
        • Jenkins P.L.
        • et al.
        The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US.
        Scand J Public Health Suppl. 2001; 56: 21-32
        • Gallus S.
        • Zuccaro P.
        • Colombo P.
        • et al.
        Effects of new smoking regulations in Italy.
        Ann Oncol. 2006; 17: 346-347
        • Osinubi O.Y.
        • Sinha S.
        • Rovner E.
        • et al.
        Efficacy of tobacco dependence treatment in the context of a “smoke-free grounds” worksite policy: a case study.
        Am J Ind Med. 2004; 46: 180-187
        • Turner L.R.
        • Morera O.F.
        • Johnson T.P.
        • et al.
        Examining the effectiveness of a community-based self-help program to increase women’s readiness for smoking cessation.
        Am J Community Psychol. 2001; 29: 465-491
        • Carlson L.E.
        • Taenzer P.
        • Koopmans J.
        • Bultz B.D.
        Eight-year follow-up of a community-based large group behavioral smoking cessation intervention.
        Addict Behav. 2000; 25: 725-741
        • Croghan I.T.
        • O’Hara M.R.
        • Schroeder D.R.
        • et al.
        A community-wide smoking cessation program: Quit and Win 1998 in Olmsted county.
        Prev Med. 2001; 33: 229-238
        • Secker-Walker R.H.
        • Gnich W.
        • Platt S.
        • Lancaster T.
        Community interventions for reducing smoking among adults.
        Cochrane Database Syst Rev. 2002; 3 (CD001745)
        • Hey K.
        • Perera R.
        Quit and Win contests for smoking cessation.
        Cochrane Database Syst Rev. 2005; 2 (CD004986)
        • Lang T.
        • Nicaud V.
        • Slama K.
        • et al.
        Smoking cessation at the workplace: results of a randomised controlled intervention study.
        J Epidemiol Community Health. 2000; 54: 349-354
        • Hutter H.
        • Moshammer H.
        • Neuberger M.
        Smoking cessation at the workplace: 1 year success of short seminars.
        Int Arch Occup Environ Health. 2006; 79: 42-48
        • Hailstone S.
        • Wyndham A.
        • Mitchell E.
        Delivering smoking cessation information in the workplace using Quit Online.
        N S W Public Health Bull. 2005; 16: 18-22
        • McAlister A.
        • Morrison T.C.
        • Hu S.
        • et al.
        Media and community campaign effects on adult tobacco use in Texas.
        J Health Commun. 2004; 9: 95-109
        • Woodruff S.I.
        • Conway T.L.
        • Edwards C.C.
        Effect of an eight week smoking ban on women at US Navy recruit training command.
        Tob Control. 2000; 9: 40-46
        • Sorensen G.
        • Beder B.
        • Prible C.R.
        • Pinney J.
        Reducing smoking at the workplace: implementing a smoking ban and hypnotherapy.
        J Occup Environ Med. 1995; 37: 453-460
        • Strecher V.J.
        • Velicer W.F.
        Tailoring smoking cessation programs to the specific needs and interests of the patient: what’s the next generation of research?.
        BMJ. 2003; 327: 57-58
        • Velicer W.F.
        • Prochaska J.O.
        • Fava J.L.
        • et al.
        Interactive versus noninteractive interventions and dose-response relationships for stage-matched smoking cessation programs in a managed care setting.
        Health Psychol. 1999; 18: 21-28
        • Niaura R.
        • Abrams D.B.
        Smoking cessation: progress, priorities, and prospectus.
        J Consult Clin Psychol. 2002; 70: 494-509
        • Reid R.
        • Pipe A.
        • Higginson L.
        • et al.
        Stepped care approach to smoking cessation in patients hospitalized for coronary artery disease.
        J Cardiopulm Rehabil. 2003; 23: 176-182
        • Bock B.
        • Graham A.
        • Sciamanna C.
        • et al.
        Smoking cessation treatment on the Internet: content, quality, and usability.
        Nicotine Tob Res. 2004; 6: 207-219
        • Feil E.G.
        • Noell J.
        • Lichtenstein E.
        • et al.
        Evaluation of an Internet-based smoking cessation program: lessons learned from a pilot study.
        Nicotine Tob Res. 2003; 5: 189-194
        • Hollis J.F.
        • Polen M.R.
        • Whitlock E.P.
        • et al.
        Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.
        Pediatrics. 2005; 115: 981-989
        • Rodgers A.
        • Corbett T.
        • Bramley D.
        • et al.
        Do u smoke after txt?.
        Tob Control. 2005; 14: 255-261
        • Crawford M.A.
        • Harrington T.M.
        • Russell T.V.
        • et al.
        Practice extenders and PDA-based counseling for smoking and unhealthy diet.
        Ann Fam Med. 2005; 3: S41-S43
        • McDaniel A.M.
        • Benson P.L.
        • Roesener G.H.
        • Martindale J.
        An integrated computer-based system to support nicotine dependence treatment in primary care.
        Nicotine Tob Res. 2005; 7: S57-S66
        • Hall S.M.
        • Reus V.I.
        • Munoz R.F.
        • et al.
        Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking.
        Arch Gen Psychiatry. 1998; 55: 683-690
        • Shiffman S.
        • Paty J.A.
        • Rohay J.M.
        • et al.
        The efficacy of computer-tailored smoking cessation material as a supplement to nicotine patch therapy.
        Drug Alcohol Depend. 2001; 64: 35-46
        • Steinberg M.B.
        • Foulds J.
        • Richardson D.L.
        • et al.
        Pharmacotherapy and smoking cessation at a tobacco dependence clinic.
        Prev Med. 2005; 42: 114-119
        • Hall S.M.
        • Humfleet G.L.
        • Reus V.I.
        • et al.
        Extended nortriptyline and psychological treatment for cigarette smoking.
        Am J Psychiatry. 2004; 161: 2100-2107
        • Hughes J.R.
        Combining behavioral therapy and pharmacotherapy for smoking cessation: an update.
        NIDA Res Monogr. 1995; 150: 92-109