A Review of Smoking Cessation Interventions

Ashish Maseeh, MD, and Gagandeep Kwatra, MD

In This Article


The "5A strategy" is a multicomponent evidence-based approach that includes behavioral therapy and pharmacotherapy; "Ask, Advise, Assess, Assist, and Arrange" is now recommended for planning all smoking cessation programs.[18]

Pairing smokers together to make the quit attempt improves success rates,[53] while women do better when some physical activity is incorporated in the cessation program.[100] Patients should be aware that relapses are quite common and that it takes on average of 4-5 quit-attempts before eventually succeeding. Patients should be encouraged to quit as soon as possible after a failed attempt. Factors that should guide the selection of drug include efficacy, cost, ease of use, adverse effect profile, and patient characteristics (eg, past experience or personal preference).[4]

Most people who stop smoking gain weight, and few smokers will ever return to their precessation weight.[7] Smokers should be informed that weight gain is common but that the associated health risks are far outweighed by the benefits of stopping smoking.[27,101] Nicotine replacement therapy and bupropion can delay but not prevent weight gain, until smokers feel ready to follow a weight control strategy.[83,102]

Pharmacotherapy should be made available to all smokers, and because concomitant behavioral and supportive therapy improves efficacy, these drugs should be encouraged. Regardless of the modality, intensity, or duration of any given intervention to be used to affect smoking cessation, what is evident is that some form of treatment offers a higher probability of quitting than unassisted cessation attempts.


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