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Smoking cessation - Wikipedia
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</button> <ul id="toc-Smoking_cessation_methods-sublist" class="vector-toc-list"> <li id="toc-Unassisted" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Unassisted"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Unassisted</span> </div> </a> <ul id="toc-Unassisted-sublist" class="vector-toc-list"> <li id="toc-Cold_turkey" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Cold_turkey"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1.1</span> <span>Cold turkey</span> </div> </a> <ul id="toc-Cold_turkey-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cutting_down_to_quit" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Cutting_down_to_quit"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1.2</span> <span>Cutting down to quit</span> </div> </a> <ul id="toc-Cutting_down_to_quit-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Medications</span> </div> </a> <ul id="toc-Medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Community_interventions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Community_interventions"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Community interventions</span> </div> </a> <ul id="toc-Community_interventions-sublist" class="vector-toc-list"> <li id="toc-Pharmacist_Interventions" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Pharmacist_Interventions"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3.1</span> <span>Pharmacist Interventions</span> </div> </a> <ul id="toc-Pharmacist_Interventions-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Digital_interventions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Digital_interventions"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.4</span> <span>Digital interventions</span> </div> </a> <ul id="toc-Digital_interventions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Psychosocial_approaches" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Psychosocial_approaches"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5</span> <span>Psychosocial approaches</span> </div> </a> <ul id="toc-Psychosocial_approaches-sublist" class="vector-toc-list"> <li id="toc-How_to_set_a_quit_date" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#How_to_set_a_quit_date"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5.1</span> <span>How to set a quit date</span> </div> </a> <ul id="toc-How_to_set_a_quit_date-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Self-help" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Self-help"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5.2</span> <span>Self-help</span> </div> </a> <ul id="toc-Self-help-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Biochemical_feedback" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Biochemical_feedback"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5.3</span> <span>Biochemical feedback</span> </div> </a> <ul id="toc-Biochemical_feedback-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Competitions_and_incentives" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Competitions_and_incentives"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5.4</span> <span>Competitions and incentives</span> </div> </a> <ul id="toc-Competitions_and_incentives-sublist" class="vector-toc-list"> <li id="toc-Workplace_incentives" class="vector-toc-list-item vector-toc-level-4"> <a class="vector-toc-link" href="#Workplace_incentives"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.5.4.1</span> <span>Workplace incentives</span> </div> </a> <ul id="toc-Workplace_incentives-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Healthcare_systems" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Healthcare_systems"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.6</span> <span>Healthcare systems</span> </div> </a> <ul id="toc-Healthcare_systems-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Substitutes_for_cigarettes" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Substitutes_for_cigarettes"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.7</span> <span>Substitutes for cigarettes</span> </div> </a> <ul id="toc-Substitutes_for_cigarettes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Alternative_approaches" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Alternative_approaches"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.8</span> <span>Alternative approaches</span> </div> </a> <ul id="toc-Alternative_approaches-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Special_populations" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Special_populations"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Special populations</span> </div> </a> <button aria-controls="toc-Special_populations-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Special populations subsection</span> </button> <ul id="toc-Special_populations-sublist" class="vector-toc-list"> <li id="toc-Children_and_adolescents" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children_and_adolescents"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Children and adolescents</span> </div> </a> <ul id="toc-Children_and_adolescents-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pregnant_women" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pregnant_women"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Pregnant women</span> </div> </a> <ul id="toc-Pregnant_women-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Schizophrenia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Schizophrenia"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Schizophrenia</span> </div> </a> <ul id="toc-Schizophrenia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hospitalized_smokers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hospitalized_smokers"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Hospitalized smokers</span> </div> </a> <ul id="toc-Hospitalized_smokers-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mood_disorders" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mood_disorders"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Mood disorders</span> </div> </a> <ul id="toc-Mood_disorders-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Homeless_and_poverty" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Homeless_and_poverty"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.6</span> <span>Homeless and poverty</span> </div> </a> <ul id="toc-Homeless_and_poverty-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Concurrent_substance_use_disorders" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Concurrent_substance_use_disorders"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.7</span> <span>Concurrent substance use disorders</span> </div> </a> <ul id="toc-Concurrent_substance_use_disorders-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Comparison_of_success_rates" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Comparison_of_success_rates"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Comparison of success rates</span> </div> </a> <ul id="toc-Comparison_of_success_rates-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Factors_affecting_success" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Factors_affecting_success"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Factors affecting success</span> </div> </a> <ul id="toc-Factors_affecting_success-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Side_effects" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Side_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Side effects</span> </div> </a> <button aria-controls="toc-Side_effects-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Side effects subsection</span> </button> <ul id="toc-Side_effects-sublist" class="vector-toc-list"> <li id="toc-Withdrawal_symptoms" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Withdrawal_symptoms"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Withdrawal symptoms</span> </div> </a> <ul id="toc-Withdrawal_symptoms-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Weight_gain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Weight_gain"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Weight gain</span> </div> </a> <ul id="toc-Weight_gain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mental_health" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mental_health"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Mental health</span> </div> </a> <ul id="toc-Mental_health-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Health_benefits" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Health_benefits"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Health benefits</span> </div> </a> <ul id="toc-Health_benefits-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cost-effectiveness" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Cost-effectiveness"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Cost-effectiveness</span> </div> </a> <ul id="toc-Cost-effectiveness-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Statistical_trends" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Statistical_trends"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Statistical trends</span> </div> </a> <ul id="toc-Statistical_trends-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bibliography" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Bibliography"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Bibliography</span> </div> </a> <ul id="toc-Bibliography-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Smoking cessation</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" 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Available in 23 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-23" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">23 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A5%D9%82%D9%84%D8%A7%D8%B9_%D8%B9%D9%86_%D8%A7%D9%84%D8%AA%D8%AF%D8%AE%D9%8A%D9%86" title="إقلاع عن التدخين – Arabic" lang="ar" hreflang="ar" data-title="إقلاع عن التدخين" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Cessaci%C3%B3_tab%C3%A0quica" title="Cessació tabàquica – Catalan" lang="ca" hreflang="ca" data-title="Cessació tabàquica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Odvyk%C3%A1n%C3%AD_kou%C5%99en%C3%AD" title="Odvykání kouření – Czech" lang="cs" hreflang="cs" data-title="Odvykání kouření" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Cesaci%C3%B3n_tab%C3%A1quica" title="Cesación tabáquica – Spanish" lang="es" hreflang="es" data-title="Cesación tabáquica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AA%D8%B1%DA%A9_%D8%B3%DB%8C%DA%AF%D8%A7%D8%B1" title="ترک سیگار – Persian" lang="fa" hreflang="fa" data-title="ترک سیگار" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Sevrage_tabagique" title="Sevrage tabagique – French" lang="fr" hreflang="fr" data-title="Sevrage tabagique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Daina_shan_taba" title="Daina shan taba – Hausa" lang="ha" hreflang="ha" data-title="Daina shan taba" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target"><span>Hausa</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%86%D5%AB%D5%AF%D5%B8%D5%BF%D5%AB%D5%B6%D5%A1%D5%B5%D5%AB%D5%B6_%D5%AF%D5%A1%D5%AD%D5%BE%D5%A1%D5%AE%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6%D5%AB%D6%81_%D5%A2%D5%B8%D6%82%D5%AA%D5%B8%D6%82%D5%B4" title="Նիկոտինային կախվածությունից բուժում – Armenian" lang="hy" hreflang="hy" data-title="Նիկոտինային կախվածությունից բուժում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Penghentian_merokok" title="Penghentian merokok – Indonesian" lang="id" hreflang="id" data-title="Penghentian merokok" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%92%D7%9E%D7%99%D7%9C%D7%94_%D7%9E%D7%A2%D7%99%D7%A9%D7%95%D7%9F" title="גמילה מעישון – Hebrew" lang="he" hreflang="he" data-title="גמילה מעישון" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%9C%E1%83%98%E1%83%99%E1%83%9D%E1%83%A2%E1%83%98%E1%83%9C%E1%83%9D%E1%83%9B%E1%83%90%E1%83%9C%E1%83%98%E1%83%90" title="ნიკოტინომანია – Georgian" lang="ka" hreflang="ka" data-title="ნიკოტინომანია" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Kuacha_kuvuta_sigara" title="Kuacha kuvuta sigara – Swahili" lang="sw" hreflang="sw" data-title="Kuacha kuvuta sigara" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target"><span>Kiswahili</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Stoppen_met_roken" title="Stoppen met roken – Dutch" lang="nl" hreflang="nl" data-title="Stoppen met roken" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/R%C3%B8ykeslutt" title="Røykeslutt – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Røykeslutt" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Cessa%C3%A7%C3%A3o_tab%C3%A1gica" title="Cessação tabágica – Portuguese" lang="pt" hreflang="pt" data-title="Cessação tabágica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9B%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D0%B5_%D0%BD%D0%B8%D0%BA%D0%BE%D1%82%D0%B8%D0%BD%D0%BE%D0%B2%D0%BE%D0%B9_%D0%B7%D0%B0%D0%B2%D0%B8%D1%81%D0%B8%D0%BC%D0%BE%D1%81%D1%82%D0%B8" title="Лечение никотиновой зависимости – Russian" lang="ru" hreflang="ru" data-title="Лечение никотиновой зависимости" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Opustitev_kajenja" title="Opustitev kajenja – Slovenian" lang="sl" hreflang="sl" data-title="Opustitev kajenja" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Tupakoinnin_lopettaminen" title="Tupakoinnin lopettaminen – Finnish" lang="fi" hreflang="fi" data-title="Tupakoinnin lopettaminen" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/R%C3%B6kavv%C3%A4njning" title="Rökavvänjning – Swedish" lang="sv" hreflang="sv" data-title="Rökavvänjning" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a 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of discontinuing tobacco smoking</div> <p class="mw-empty-elt"> </p> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Quit Smoking" redirects here. For the television episode, see <a href="/wiki/Quit_Smoking_(My_Name_Is_Earl)" class="mw-redirect" title="Quit Smoking (My Name Is Earl)">Quit Smoking (My Name Is Earl)</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">"Stop Smoking" redirects here. For the Car Seat Headrest song, see <a href="/wiki/Twin_Fantasy" title="Twin Fantasy">Twin Fantasy</a>.</div> <p class="mw-empty-elt"> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Healthy_lung-smokers_lung.jpg" class="mw-file-description"><img alt="Pale smooth lung contrasted with stained and crumpled lung" src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c6/Healthy_lung-smokers_lung.jpg/220px-Healthy_lung-smokers_lung.jpg" decoding="async" width="220" height="174" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/c/c6/Healthy_lung-smokers_lung.jpg 1.5x" data-file-width="316" data-file-height="250" /></a><figcaption>A healthy lung compared to a smoker's lung</figcaption></figure> <style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist 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a{color:var(--color-progressive)!important}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-list-title,html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle{background:transparent!important}html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle a{color:var(--color-progressive)!important}}@media print{body.ns-0 .mw-parser-output .sidebar{display:none!important}}</style><table class="sidebar sidebar-collapse nomobile nowraplinks hlist" style="width: 20em;"><tbody><tr><td class="sidebar-pretitle">Part of <a href="/wiki/Category:Smoking" title="Category:Smoking">a series</a> on</td></tr><tr><th class="sidebar-title-with-pretitle"><a href="/wiki/Smoking" title="Smoking">Smoking</a></th></tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background-color: #eee; text-align: center; padding-top:0.4em;;color: var(--color-base)"><a href="/wiki/Tobacco_smoking" title="Tobacco smoking">Tobacco</a></div><div class="sidebar-list-content mw-collapsible-content"> <ul><li><a href="/wiki/Tobacco" title="Tobacco">Tobacco</a></li> <li><a href="/wiki/Health_effects_of_tobacco" title="Health effects of tobacco">Health effects</a></li> <li><a href="/wiki/Tobacco_advertising" class="mw-redirect" title="Tobacco advertising">Advertising</a></li> <li><a class="mw-selflink selflink">Cessation</a></li> <li><a href="/wiki/Tobacco_industry" title="Tobacco industry">Industry</a></li> <li><a href="/wiki/Tobacco_politics" title="Tobacco politics">Politics</a></li> <li><a href="/wiki/Prevalence_of_tobacco_consumption" class="mw-redirect" title="Prevalence of tobacco consumption">Prevalence of consumption</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background-color: #eee; text-align: center; padding-top:0.4em;;color: var(--color-base)"><a href="/wiki/Cannabis_smoking" title="Cannabis smoking">Cannabis</a></div><div class="sidebar-list-content mw-collapsible-content"> <ul><li><a href="/wiki/Cannabis_(drug)" title="Cannabis (drug)">Cannabis</a></li> <li><a href="/wiki/Cannabis" title="Cannabis">Plant</a></li> <li><a href="/wiki/Effects_of_cannabis" title="Effects of cannabis">Effects</a></li> <li><a href="/wiki/Legality_of_cannabis" title="Legality of cannabis">Legality</a></li> <li><a href="/wiki/Medical_cannabis" title="Medical cannabis">Medical use</a></li> <li><a href="/wiki/Religious_and_spiritual_use_of_cannabis" class="mw-redirect" title="Religious and spiritual use of cannabis">Religious and spiritual use</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background-color: #eee; text-align: center; padding-top:0.4em;;color: var(--color-base)"><a href="/wiki/Opium" title="Opium">Opium</a></div><div class="sidebar-list-content mw-collapsible-content"> <ul><li><a href="/wiki/Opium_den" title="Opium den">Den</a></li> <li><a href="/wiki/Opiate" title="Opiate">Opiate</a></li> <li><a href="/wiki/Opioid" title="Opioid">Opioid</a></li> <li><a href="/wiki/Papaver_somniferum" title="Papaver somniferum"><i>Papaver somniferum</i> (opium poppy)</a></li> <li><a href="/wiki/Psychoactive_drug" title="Psychoactive drug">Psychoactive drug</a></li> <li><a href="/wiki/First_Opium_War" title="First Opium War">First Opium War</a><span class="nowrap"> </span><a href="/wiki/Second_Opium_War" title="Second Opium War">Second Opium War</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background-color: #eee; text-align: center; padding-top:0.4em;;color: var(--color-base)"><a href="/wiki/Crack_cocaine" title="Crack cocaine">Crack</a></div><div class="sidebar-list-content mw-collapsible-content"> <ul><li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></li> <li><a href="/wiki/Crack_epidemic" class="mw-redirect" title="Crack epidemic">Epidemic</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background-color: #eee; text-align: center; padding-top:0.4em;;color: var(--color-base)">Other</div><div class="sidebar-list-content mw-collapsible-content"> <ul><li><a href="/wiki/Dimethyltryptamine" class="mw-redirect" title="Dimethyltryptamine">DMT</a></li> <li><a href="/wiki/Heroin" title="Heroin">Heroin</a></li> <li><a href="/wiki/Methamphetamine" title="Methamphetamine">Meth</a></li> <li><a href="/wiki/Narcotic" title="Narcotic">Narcotics</a></li> <li><a href="/wiki/Phencyclidine" title="Phencyclidine">PCP</a></li></ul></div></div></td> </tr><tr><td class="sidebar-navbar"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Smoking" title="Template:Smoking"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Smoking" title="Template talk:Smoking"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Smoking" title="Special:EditPage/Template:Smoking"><abbr title="Edit this template">e</abbr></a></li></ul></div></td></tr></tbody></table> <p><b>Smoking cessation</b>, usually called <b>quitting smoking</b> or <b>stopping smoking</b>, is the process of discontinuing <a href="/wiki/Tobacco_smoking" title="Tobacco smoking">tobacco smoking</a>.<sup id="cite_ref-nhs_1-0" class="reference"><a href="#cite_note-nhs-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Tobacco_smoke" title="Tobacco smoke">Tobacco smoke</a> contains <a href="/wiki/Nicotine" title="Nicotine">nicotine</a>, which is <a href="/wiki/Addiction" title="Addiction">addictive</a> and can cause <a href="/wiki/Substance_dependence" title="Substance dependence">dependence</a>.<sup id="cite_ref-ACS-HowToQuit_2-0" class="reference"><a href="#cite_note-ACS-HowToQuit-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-nicotine_dependence_3-0" class="reference"><a href="#cite_note-nicotine_dependence-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> As a result, <a href="/wiki/Nicotine_withdrawal" title="Nicotine withdrawal">nicotine withdrawal</a> often makes the process of quitting difficult. </p><p>Smoking is the <a href="/wiki/Leading_causes_of_preventable_death" class="mw-redirect" title="Leading causes of preventable death">leading cause of preventable death</a> and a global <a href="/wiki/Public_health" title="Public health">public health</a> concern.<sup id="cite_ref-Kalkhoran2018_4-0" class="reference"><a href="#cite_note-Kalkhoran2018-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Tobacco use leads most commonly to diseases affecting the heart and lungs, with smoking being a major risk factor for <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">heart attacks</a>,<sup id="cite_ref-Harm_Reduct._J._5-0" class="reference"><a href="#cite_note-Harm_Reduct._J.-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Am._J._Public_Health_6-0" class="reference"><a href="#cite_note-Am._J._Public_Health-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Stroke" title="Stroke">strokes</a>,<sup id="cite_ref-Expert_Rev._Cardiovasc_Ther._7-0" class="reference"><a href="#cite_note-Expert_Rev._Cardiovasc_Ther.-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">chronic obstructive pulmonary disease</a> (COPD),<sup id="cite_ref-IJERPH_2009_8-0" class="reference"><a href="#cite_note-IJERPH_2009-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Idiopathic_pulmonary_fibrosis" title="Idiopathic pulmonary fibrosis">idiopathic pulmonary fibrosis</a> (IPF),<sup id="cite_ref-Pulm_Med._9-0" class="reference"><a href="#cite_note-Pulm_Med.-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Emphysema" title="Emphysema">emphysema</a>,<sup id="cite_ref-IJERPH_2009_8-1" class="reference"><a href="#cite_note-IJERPH_2009-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> and various types and subtypes of <a href="/wiki/Cancer" title="Cancer">cancers</a><sup id="cite_ref-J._Natl._Cancer_Inst._10-0" class="reference"><a href="#cite_note-J._Natl._Cancer_Inst.-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> (particularly <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>, <a href="/wiki/Oropharyngeal_cancer" title="Oropharyngeal cancer">cancers of the oropharynx</a>,<sup id="cite_ref-StatPearls_2020_11-0" class="reference"><a href="#cite_note-StatPearls_2020-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Laryngeal_cancer" title="Laryngeal cancer">larynx</a>,<sup id="cite_ref-StatPearls_2020_11-1" class="reference"><a href="#cite_note-StatPearls_2020-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Oral_cancer" title="Oral cancer">mouth</a>,<sup id="cite_ref-StatPearls_2020_11-2" class="reference"><a href="#cite_note-StatPearls_2020-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Esophageal_cancer" title="Esophageal cancer">esophageal</a> and <a href="/wiki/Pancreatic_cancer" title="Pancreatic cancer">pancreatic cancer</a>).<sup id="cite_ref-Asian_Pac._J._Cancer_Prev._12-0" class="reference"><a href="#cite_note-Asian_Pac._J._Cancer_Prev.-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Smoking cessation significantly reduces the risk of dying from smoking-related diseases.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> 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 <sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>From 2001 to 2010, about 70% of smokers in the <a href="/wiki/United_States" title="United States">United States</a> expressed a desire to quit smoking, and 50% reported having attempted to do so in the past year.<sup id="cite_ref-vaping-2022_16-0" class="reference"><a href="#cite_note-vaping-2022-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Many strategies can be used for smoking cessation, including abruptly quitting without assistance ("<a href="/wiki/Cold_turkey" title="Cold turkey">cold turkey</a>"), cutting down then quitting, behavioral counseling, and medications such as <a href="/wiki/Bupropion" title="Bupropion">bupropion</a>, <a href="/wiki/Cytisine" title="Cytisine">cytisine</a>, <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">nicotine replacement therapy</a>, or <a href="/wiki/Varenicline" title="Varenicline">varenicline</a>. In recent years, especially in <a href="/wiki/Canada" title="Canada">Canada</a> and the <a href="/wiki/United_Kingdom" title="United Kingdom">United Kingdom</a>, many smokers have switched to using <a href="/wiki/Electronic_cigarette" title="Electronic cigarette">electronic cigarettes</a> to quit smoking tobacco.<sup id="cite_ref-vaping-2022_16-1" class="reference"><a href="#cite_note-vaping-2022-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Most smokers who try to quit do so without assistance. However, only 3–6% of quit attempts without assistance are successful long-term.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Behavior_modification" title="Behavior modification">Behavioral counseling</a> 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.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> A meta-analysis from 2018, conducted on 61 <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trials</a>, 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.<sup id="cite_ref-RosenGalili2018_22-0" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p> In nicotine-dependent smokers, quitting smoking can lead to nicotine withdrawal symptoms such as nicotine cravings, <a href="/wiki/Anxiety" title="Anxiety">anxiety</a>, irritability, <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a>, and weight gain.<sup id="cite_ref-Benowitz2010_23-0" class="reference"><a href="#cite_note-Benowitz2010-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 2298">: 2298 </span></sup> Professional smoking cessation support methods generally attempt to address nicotine withdrawal symptoms to help the person break free of nicotine addiction.<style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style></p><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Smoking_cessation_methods">Smoking cessation methods</h2></div> <div class="mw-heading mw-heading3"><h3 id="Unassisted">Unassisted</h3></div> <p>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,<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> otherwise known as "<a href="/wiki/Cold_turkey" title="Cold turkey">cold turkey</a>", or with home remedies. Previous smokers make between an estimated 6 to 30 attempts before successfully quitting.<sup id="cite_ref-ncbi.nlm.nih.gov_25-0" class="reference"><a href="#cite_note-ncbi.nlm.nih.gov-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-ACS-HowToQuit_2-1" class="reference"><a href="#cite_note-ACS-HowToQuit-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> The majority of quit attempts are still unassisted, though the trend seems to be shifting.<sup id="cite_ref-ReferenceA_27-0" class="reference"><a href="#cite_note-ReferenceA-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> In the U.S., for example, the rate of unassisted quitting fell from 91.8% in 1986 to 52.1% during 2006 to 2009.<sup id="cite_ref-ReferenceA_27-1" class="reference"><a href="#cite_note-ReferenceA-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> The most frequent unassisted methods were "cold turkey",<sup id="cite_ref-ReferenceA_27-2" class="reference"><a href="#cite_note-ReferenceA-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> a term that has been used to mean either unassisted quitting or abrupt quitting and "gradually decreased number" of cigarettes, or "cigarette reduction".<sup id="cite_ref-nicotine_dependence_3-1" class="reference"><a href="#cite_note-nicotine_dependence-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Cold_turkey">Cold turkey</h4></div> <p>"<a href="/wiki/Cold_turkey" title="Cold turkey">Cold turkey</a>" 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%,<sup id="cite_ref-Lee2007_28-0" class="reference"><a href="#cite_note-Lee2007-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> 85%,<sup id="cite_ref-Fiore1990_29-0" class="reference"><a href="#cite_note-Fiore1990-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> or 88%<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Chapman-MacKenzie_31-0" class="reference"><a href="#cite_note-Chapman-MacKenzie-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Studies have found that two-thirds of recent quitters reported using the cold turkey method and found it helpful.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Cutting_down_to_quit">Cutting down to quit</h4></div> <p>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 <a href="/wiki/University_of_Birmingham" title="University of Birmingham">University of Birmingham</a> found that gradual <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">nicotine replacement therapy</a> could be effective in smoking cessation.<sup id="cite_ref-LindsonKlemperer2019_33-0" class="reference"><a href="#cite_note-LindsonKlemperer2019-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ACS-guide_34-0" class="reference"><a href="#cite_note-ACS-guide-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Varenicline" title="Varenicline">varenicline</a> or fast-acting nicotine replacement therapy can positively affect quitting for six months or longer.<sup id="cite_ref-LindsonKlemperer2019_33-1" class="reference"><a href="#cite_note-LindsonKlemperer2019-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medications">Medications</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Nicoderm.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/Nicoderm.JPG/220px-Nicoderm.JPG" decoding="async" width="220" height="146" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/94/Nicoderm.JPG/330px-Nicoderm.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/94/Nicoderm.JPG/440px-Nicoderm.JPG 2x" data-file-width="3008" data-file-height="2000" /></a><figcaption>A 21mg dose <a href="/wiki/Nicotine_patch" title="Nicotine patch">nicotine patch</a> applied to the left arm</figcaption></figure> <p>The <a href="/wiki/American_Cancer_Society" title="American Cancer Society">American Cancer Society</a> notes that "Studies in medical journals have reported that about 25% of smokers who use medicines can stay smoke-free for over 6 months."<sup id="cite_ref-ACS-guide_34-1" class="reference"><a href="#cite_note-ACS-guide-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Single medications include: </p> <ul><li><a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">Nicotine replacement therapy</a> (NRT): Five medications have been approved by the U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) to deliver nicotine in a form that does not involve the risks of smoking: transdermal <a href="/wiki/Nicotine_patch" title="Nicotine patch">nicotine patches</a>, <a href="/wiki/Nicotine_gum" title="Nicotine gum">nicotine gum</a>, <a href="/wiki/Nicotine_lozenge" title="Nicotine lozenge">nicotine lozenges</a>, nicotine <a href="/wiki/Inhaler" title="Inhaler">inhalers</a>, nicotine oral sprays, and nicotine nasal sprays.<sup id="cite_ref-sc_35-0" class="reference"><a href="#cite_note-sc-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> High-quality evidence indicates that these forms of NRT improve the success rate of people who attempt to stop smoking.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-sc_35-1" class="reference"><a href="#cite_note-sc-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Some reported side effects are local slight irritation (inhalers and sprays) and non-ischemic chest pain (rare).<sup id="cite_ref-sc_35-2" class="reference"><a href="#cite_note-sc-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-www.canada.ca-2022_37-0" class="reference"><a href="#cite_note-www.canada.ca-2022-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Others include mouth soreness and dyspepsia (gum), nausea or heartburn (lozenges), as well as sleep disturbances, insomnia, and a local skin reaction (patches).<sup id="cite_ref-www.canada.ca-2022_37-1" class="reference"><a href="#cite_note-www.canada.ca-2022-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> A study found that 93% of over-the-counter NRT users relapse and return to smoking within six months.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> There is weak evidence that adding <a href="/wiki/Mecamylamine" title="Mecamylamine">mecamylamine</a> to nicotine is more effective than nicotine alone.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a>: The antidepressant <a href="/wiki/Bupropion" title="Bupropion">bupropion</a> 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. <a href="/wiki/Nortriptyline" title="Nortriptyline">Nortriptyline</a> produces significant rates of abstinence versus placebo.<sup id="cite_ref-:3_41-0" class="reference"><a href="#cite_note-:3-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Other antidepressants such as <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitors</a> (SSRIs) and <a href="/wiki/St._John%27s_wort" class="mw-redirect" title="St. John's wort">St. John's wort</a> have not been consistently shown to be effective for smoking cessation.<sup id="cite_ref-:3_41-1" class="reference"><a href="#cite_note-:3-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Varenicline" title="Varenicline">Varenicline</a> decreases the urge to smoke and reduces withdrawal symptoms and is therefore considered a first-line medication for smoking cessation.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> The number of people stopping smoking with varenicline is higher than with bupropion or NRT.<sup id="cite_ref-:4_43-0" class="reference"><a href="#cite_note-:4-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Varenicline more than doubled the chances of quitting compared to placebo, and was also as effective as combining two types of NRT. 2 mg/day of varenicline has been found to lead to the highest abstinence rate (33.2%) of any single therapy, while 1 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.<sup id="cite_ref-Sterling2016_44-0" class="reference"><a href="#cite_note-Sterling2016-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Concerns arose that varenicline may cause neuropsychiatric side effects, including suicidal thoughts and behavior.<sup id="cite_ref-:4_43-1" class="reference"><a href="#cite_note-:4-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> 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".<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> No link between depressed moods, agitation or suicidal thinking in smokers taking varenicline to decrease the urge to smoke has been identified.<sup id="cite_ref-:4_43-2" class="reference"><a href="#cite_note-:4-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> For people who have pre-existing mental health difficulties, varenicline may slightly increase the risk of experiencing these neuropsychiatric adverse events.<sup id="cite_ref-:4_43-3" class="reference"><a href="#cite_note-:4-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Clonidine" title="Clonidine">Clonidine</a> 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.<sup id="cite_ref-USDHHS2008_46-0" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup></li> <li>There is no good evidence <a href="/wiki/Anxiolytics" class="mw-redirect" title="Anxiolytics">anxiolytics</a> are helpful.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></li> <li>Previously, <a href="/wiki/Rimonabant" title="Rimonabant">rimonabant</a>, which is a <a href="/wiki/Cannabinoid_receptor_type_1" class="mw-redirect" title="Cannabinoid receptor type 1">cannabinoid receptor type 1</a> antagonist, was used to help in quitting and moderate the expected weight gain.<sup id="cite_ref-rimonabant_49-0" class="reference"><a href="#cite_note-rimonabant-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> But it is important to know that the manufacturers of rimonabant and <a href="/wiki/Taranabant" title="Taranabant">taranabant</a> stopped production in 2008 due to serious CNS side effects.<sup id="cite_ref-rimonabant_49-1" class="reference"><a href="#cite_note-rimonabant-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup></li></ul> <p>The 2008 US Guideline specifies that three combinations of medications are effective:<sup id="cite_ref-USDHHS2008_46-1" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 118–120">: 118–120 </span></sup> </p> <ul><li>Long-term nicotine patch and <i><a href="/wiki/Ad_libitum" title="Ad libitum">ad libitum</a></i> NRT gum or spray</li> <li>Nicotine patch and nicotine inhaler</li> <li>Nicotine patch and bupropion (the only combination that the US FDA has approved for smoking cessation)</li></ul> <p>A <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> from 2018, conducted on 61 <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">RCTs</a>, 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).<sup id="cite_ref-RosenGalili2018_22-1" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> In comparison, 12% the people who got placebo kept from smoking for (at least) an entire year.<sup id="cite_ref-RosenGalili2018_22-2" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> This makes the net benefit of the drug treatment to be 8% after the first 12 months.<sup id="cite_ref-RosenGalili2018_22-3" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-RosenGalili2018_22-4" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-RosenGalili2018_22-5" class="reference"><a href="#cite_note-RosenGalili2018-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Community_interventions">Community interventions</h3></div> <p>Community interventions using "multiple channels to provide reinforcement, support and norms for not smoking" may have an effect on smoking cessation outcomes among adults.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> Specific methods used in the community to encourage smoking cessation among adults include: </p> <ul><li>Policies making workplaces<sup id="cite_ref-Lee2007_28-1" class="reference"><a href="#cite_note-Lee2007-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> and public places smoke-free. It is estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12%–38%.<sup id="cite_ref-Lemmens2008_51-0" class="reference"><a href="#cite_note-Lemmens2008-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup></li> <li>Voluntary rules making homes smoke-free, which are thought to promote smoking cessation.<sup id="cite_ref-Lee2007_28-2" class="reference"><a href="#cite_note-Lee2007-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CDC2007_53-0" class="reference"><a href="#cite_note-CDC2007-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup></li> <li>Initiatives to educate the public regarding the health effects of <a href="/wiki/Second-hand_smoke" class="mw-redirect" title="Second-hand smoke">second-hand smoke</a>,<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> including the significant dangers of secondhand smoke infiltration for residents of multi-unit housing.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup></li> <li>Increasing the price of tobacco products, for example by <a href="/wiki/Tax" title="Tax">taxation</a>. The US Task Force on Community Preventive Services found "strong scientific evidence" that this is effective in increasing tobacco use cessation <sup id="cite_ref-Hopkins2001_56-0" class="reference"><a href="#cite_note-Hopkins2001-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 28–30">: 28–30 </span></sup> It is estimated that an increase in price of 10% will increase smoking cessation rates by 3–5%.<sup id="cite_ref-Lemmens2008_51-1" class="reference"><a href="#cite_note-Lemmens2008-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Mass_media" title="Mass media">Mass media</a> campaigns. There is evidence to suggest that when combined with other types of interventions, mass media campaigns may be of benefit.<sup id="cite_ref-Hopkins2001_56-1" class="reference"><a href="#cite_note-Hopkins2001-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 30–32">: 30–32 </span></sup><sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup></li> <li>Weak evidence suggests that imposing institutional level smoking bans in hospitals and prisons may reduce smoking rates and second hand smoke exposure.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading4"><h4 id="Pharmacist_Interventions">Pharmacist Interventions</h4></div> <p>Pharmacist-led interventions have proven to be effective in helping smoking cessation attempts. Many <a href="/wiki/Systematic_review" title="Systematic review">systematic reviews</a> have looked at the importance of pharmacist involvement. In <a href="/wiki/Malaysia" title="Malaysia">Malaysia</a>, their study looked at how pharmacist intervention in patients' overall healthcare showed improvements in <a href="/wiki/Screening_(medicine)" title="Screening (medicine)">screening</a> early stages of disease.<sup id="cite_ref-:0_59-0" class="reference"><a href="#cite_note-:0-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> This allowed for earlier treatment starts in smoking-caused <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">COPD</a>. In addition, pharmacists in Malaysia could prescribe <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">NRT</a> products, and when they led a smoking cessation service, it was more successful than other smoking cessation trials in Malaysia.<sup id="cite_ref-:0_59-1" class="reference"><a href="#cite_note-:0-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> It was also shown that pharmacist counselling and NRT products were more effective in smoking cessation than using NRT alone. </p><p>In pharmacist-led smoking cessation services in <a href="/wiki/Ethiopia" title="Ethiopia">Ethiopia</a>, the study found statistically and clinically significant benefits favouring pharmacist intervention.<sup id="cite_ref-:1_60-0" class="reference"><a href="#cite_note-:1-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> 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<sup id="cite_ref-:1_60-1" class="reference"><a href="#cite_note-:1-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> </p><p>Another systematic review analyzed pharmacist intervention in smoking cessation and alcohol and weight interventions.<sup id="cite_ref-:2_61-0" class="reference"><a href="#cite_note-:2-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> They found that evidence suggests that the longer the duration of pharmacist-led intervention, the more influential the attempt at quitting was<sup id="cite_ref-:2_61-1" class="reference"><a href="#cite_note-:2-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-:2_61-2" class="reference"><a href="#cite_note-:2-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Digital_interventions">Digital interventions</h3></div> <ul><li>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.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> Computerised and interactive tailored interventions may be promising,<sup id="cite_ref-USDHHS2008_46-2" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 93–94">: 93–94 </span></sup> however, the evidence base for such interventions is weak.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup></li> <li>A <a href="/wiki/MHealth" title="MHealth">mobile phone-based intervention</a> 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."<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> A 2013 meta-analysis also noted "modest benefits" of mobile health interventions.<sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup></li> <li>Interactive web-based programs combined with a Mobile phone: Two RCTs documented long-term treatment effects (abstinence rate: 20-22%) of such interventions.<sup id="cite_ref-Brendryen_71-0" class="reference"><a href="#cite_note-Brendryen-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Brendryen,_Drozd_&_Kraft_72-0" class="reference"><a href="#cite_note-Brendryen,_Drozd_&_Kraft-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Psychosocial_approaches">Psychosocial approaches</h3></div> <ul><li>The <a href="/wiki/Great_American_Smokeout" title="Great American Smokeout">Great American Smokeout</a> is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever.</li> <li>The World Health Organization's <a href="/wiki/World_No_Tobacco_Day" title="World No Tobacco Day">World No Tobacco Day</a> is held on May 31 each year.</li> <li>Smoking-cessation support is often offered over the telephone <a href="/wiki/Quitline" title="Quitline">quitlines</a><sup id="cite_ref-Zhu2002_73-0" class="reference"><a href="#cite_note-Zhu2002-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Helgason2004_74-0" class="reference"><a href="#cite_note-Helgason2004-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> (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,<sup id="cite_ref-USDHHS2008_46-3" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 91–92">: 91–92 </span></sup><sup id="cite_ref-Hopkins2001_56-2" class="reference"><a href="#cite_note-Hopkins2001-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 40–42">: 40–42 </span></sup> and that intensive individual counselling is more effective than the brief personal counselling intervention.<sup id="cite_ref-Individual_behavioural_counselling_75-0" class="reference"><a href="#cite_note-Individual_behavioural_counselling-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup></li> <li>Online social cessation networks attempt to emulate offline group cessation models using purpose built web applications. They are designed to promote <a href="/wiki/Online_social_support" title="Online social support">online social support</a> 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.<sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup></li> <li>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.<sup id="cite_ref-Group_behaviour_therapy_programmes_79-0" class="reference"><a href="#cite_note-Group_behaviour_therapy_programmes-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-USDHHS2008_46-4" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 89–90, 101–103">: 89–90, 101–103 </span></sup><sup id="cite_ref-Group_behaviour_therapy_programmes_79-1" class="reference"><a href="#cite_note-Group_behaviour_therapy_programmes-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Individual_behavioural_counselling_75-1" class="reference"><a href="#cite_note-Individual_behavioural_counselling-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> The counselling styles that have been effective in smoking cessation activities include <a href="/wiki/Motivational_interviewing" title="Motivational interviewing">motivational interviewing</a>,<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a><sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Acceptance_and_commitment_therapy" title="Acceptance and commitment therapy">acceptance and commitment therapy</a>,<sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> methods based on cognitive behavioral therapy.</li> <li>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.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup></li> <li>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.<sup id="cite_ref-USDHHS2008_46-5" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 91">: 91 </span></sup></li> <li>The <a href="/wiki/Transtheoretical_model" title="Transtheoretical model">transtheoretical model</a>, including "stages of change", has been used in tailoring smoking cessation methods to individuals,<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-89" class="reference"><a href="#cite_note-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> 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."<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading4"><h4 id="How_to_set_a_quit_date">How to set a quit date</h4></div> <p>Most smoking cessation resources such as the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> (CDC)<sup id="cite_ref-CDC_Web_91-0" class="reference"><a href="#cite_note-CDC_Web-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Mayo_Clinic" title="Mayo Clinic">The Mayo Clinic</a><sup id="cite_ref-mayoclinic_92-0" class="reference"><a href="#cite_note-mayoclinic-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup> 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<sup id="cite_ref-SmitAB_93-0" class="reference"><a href="#cite_note-SmitAB-93"><span class="cite-bracket">[</span>93<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-94" class="reference"><a href="#cite_note-94"><span class="cite-bracket">[</span>94<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-bolmana_95-0" class="reference"><a href="#cite_note-bolmana-95"><span class="cite-bracket">[</span>95<span class="cite-bracket">]</span></a></sup> 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<sup id="cite_ref-Ayers_96-0" class="reference"><a href="#cite_note-Ayers-96"><span class="cite-bracket">[</span>96<span class="cite-bracket">]</span></a></sup> and calling state quitlines.<sup id="cite_ref-97" class="reference"><a href="#cite_note-97"><span class="cite-bracket">[</span>97<span class="cite-bracket">]</span></a></sup> In Nepal, <b>smokers are not selfish,</b> a <a href="/wiki/Health_campaign" title="Health campaign">health campaign</a> of two weeks is started on the occasion of <a href="/wiki/Valentine%27s_Day" title="Valentine's Day">Valentine day</a> and <a href="/wiki/Vasant_Panchami" title="Vasant Panchami">Vasant panchami</a> to motiviate 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. <sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">[</span>98<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Self-help">Self-help</h4></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Text_messaging_used_to_provide_encouragement_to_quit_smoking.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Text_messaging_used_to_provide_encouragement_to_quit_smoking.png/220px-Text_messaging_used_to_provide_encouragement_to_quit_smoking.png" decoding="async" width="220" height="146" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Text_messaging_used_to_provide_encouragement_to_quit_smoking.png/330px-Text_messaging_used_to_provide_encouragement_to_quit_smoking.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b6/Text_messaging_used_to_provide_encouragement_to_quit_smoking.png/440px-Text_messaging_used_to_provide_encouragement_to_quit_smoking.png 2x" data-file-width="1794" data-file-height="1189" /></a><figcaption>Some health organizations manage text messaging services to help people avoid smoking.</figcaption></figure> <p>Self-help materials may produce a small increase in quit rates specially when there is no other supporting intervention form.<sup id="cite_ref-99" class="reference"><a href="#cite_note-99"><span class="cite-bracket">[</span>99<span class="cite-bracket">]</span></a></sup> "The effect of self-help was weak", and the number of types of self-help did not produce higher abstinence rates.<sup id="cite_ref-USDHHS2008_46-6" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 89–91">: 89–91 </span></sup> Nevertheless, self-help modalities for smoking cessation include: </p> <ul><li>In-person self-help groups such as <a href="/wiki/Nicotine_Anonymous" title="Nicotine Anonymous">Nicotine Anonymous</a>,<sup id="cite_ref-100" class="reference"><a href="#cite_note-100"><span class="cite-bracket">[</span>100<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-101" class="reference"><a href="#cite_note-101"><span class="cite-bracket">[</span>101<span class="cite-bracket">]</span></a></sup> or web-based cessation resources such as <a rel="nofollow" class="external text" href="https://smokefree.gov/">Smokefree.gov</a>, which offers various types of assistance including self-help materials.<sup id="cite_ref-102" class="reference"><a href="#cite_note-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup></li> <li>WebMD: a resource providing health information, tools for managing health, and support.<sup id="cite_ref-103" class="reference"><a href="#cite_note-103"><span class="cite-bracket">[</span>103<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Self-help" title="Self-help">Self-help books</a> such as <a href="/wiki/Allen_Carr" title="Allen Carr">Allen Carr</a>'s <i>Easy Way to Stop Smoking</i>.<sup id="cite_ref-Carr2004_104-0" class="reference"><a href="#cite_note-Carr2004-104"><span class="cite-bracket">[</span>104<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Spirituality" title="Spirituality">Spirituality</a>: 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.<sup id="cite_ref-105" class="reference"><a href="#cite_note-105"><span class="cite-bracket">[</span>105<span class="cite-bracket">]</span></a></sup></li> <li>A review of <a href="/wiki/Mindfulness" title="Mindfulness">mindfulness</a> training as a treatment for addiction showed reduction in craving and smoking following training.<sup id="cite_ref-106" class="reference"><a href="#cite_note-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup></li> <li>Physical activities help in the maintenance of smoking cessation even if there is no conclusive evidence of the most appropriate exercise intensity.<sup id="cite_ref-107" class="reference"><a href="#cite_note-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading4"><h4 id="Biochemical_feedback">Biochemical feedback</h4></div> <p>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.<sup id="cite_ref-Bittoun_108-0" class="reference"><a href="#cite_note-Bittoun-108"><span class="cite-bracket">[</span>108<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-109" class="reference"><a href="#cite_note-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> Evidence-wise, little is known about the effects of using biomechanical tests to determine a person's risk related to smoking cessation.<sup id="cite_ref-110" class="reference"><a href="#cite_note-110"><span class="cite-bracket">[</span>110<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Breath carbon monoxide (CO) monitoring: <a href="/wiki/Carbon_monoxide" title="Carbon monoxide">carbon monoxide</a> is a significant component of cigarette smoke, and a <a href="/wiki/Breath_carbon_monoxide_monitor" class="mw-redirect" title="Breath carbon monoxide monitor">breath carbon monoxide monitor</a> 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 <a href="/wiki/Carboxyhemoglobin" title="Carboxyhemoglobin">carboxyhemoglobin</a>. 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.<sup id="cite_ref-111" class="reference"><a href="#cite_note-111"><span class="cite-bracket">[</span>111<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Bittoun_108-1" class="reference"><a href="#cite_note-Bittoun-108"><span class="cite-bracket">[</span>108<span class="cite-bracket">]</span></a></sup></li> <li>Cotinine: <a href="/wiki/Cotinine" title="Cotinine">Cotinine</a>, a <a href="/wiki/Metabolite" title="Metabolite">metabolite</a> of nicotine, is present in smokers. Like carbon monoxide, a cotinine test can be a reliable biomarker to determine smoking status.<sup id="cite_ref-112" class="reference"><a href="#cite_note-112"><span class="cite-bracket">[</span>112<span class="cite-bracket">]</span></a></sup> 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.</li></ul> <p>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.<sup id="cite_ref-113" class="reference"><a href="#cite_note-113"><span class="cite-bracket">[</span>113<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Competitions_and_incentives">Competitions and incentives</h4></div> <p>Financial or material incentives to entice people to quit smoking improve smoking cessation while the motivation is in place.<sup id="cite_ref-Notley-2019_114-0" class="reference"><a href="#cite_note-Notley-2019-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup> Competitions that require participants to deposit their own money, "betting" that they will succeed in quitting smoking, appear to be an effective incentive.<sup id="cite_ref-Notley-2019_114-1" class="reference"><a href="#cite_note-Notley-2019-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">NRT</a> or placing them in a more typical rewards program.<sup id="cite_ref-SmokCessIncentives_115-0" class="reference"><a href="#cite_note-SmokCessIncentives-115"><span class="cite-bracket">[</span>115<span class="cite-bracket">]</span></a></sup> Evidence shows that incentive programs may be effective for pregnant mothers who smoke.<sup id="cite_ref-Notley-2019_114-2" class="reference"><a href="#cite_note-Notley-2019-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-FanshaweHartmann-Boyce2019_116-0" class="reference"><a href="#cite_note-FanshaweHartmann-Boyce2019-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading5"><h5 id="Workplace_incentives">Workplace incentives</h5></div> <p>A 2008 <a href="/wiki/Cochrane_Library" title="Cochrane Library">Cochrane</a> review of smoking cessation activities in work-places concluded that "interventions directed towards individual smokers increase the likelihood of quitting smoking".<sup id="cite_ref-117" class="reference"><a href="#cite_note-117"><span class="cite-bracket">[</span>117<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Leeks2010_118-0" class="reference"><a href="#cite_note-Leeks2010-118"><span class="cite-bracket">[</span>118<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Healthcare_systems">Healthcare systems</h3></div> <p>Interventions delivered via healthcare providers and healthcare systems have been shown to improve smoking cessation among people who visit those services. </p> <ul><li>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%.<sup id="cite_ref-USDHHS2008_46-7" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 78–79">: 78–79 </span></sup> Similarly, the Task Force on Community Preventive Services determined that provider reminders alone or with provider education effectively promote smoking cessation.<sup id="cite_ref-Hopkins2001_56-3" class="reference"><a href="#cite_note-Hopkins2001-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 33–38">: 33–38 </span></sup></li> <li>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.<sup id="cite_ref-USDHHS2008_46-8" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 82–83">: 82–83 </span></sup> Even brief advice from physicians may have "a small effect on cessation rates",<sup id="cite_ref-119" class="reference"><a href="#cite_note-119"><span class="cite-bracket">[</span>119<span class="cite-bracket">]</span></a></sup> and there is evidence that the physicians' probability of giving smoking cessation advice declines with the person who smokes age.<sup id="cite_ref-120" class="reference"><a href="#cite_note-120"><span class="cite-bracket">[</span>120<span class="cite-bracket">]</span></a></sup> There is evidence that only 81% of smokers age 50 or greater received advice on quitting from their physicians in the preceding year.<sup id="cite_ref-Ossip-Klein-2000_121-0" class="reference"><a href="#cite_note-Ossip-Klein-2000-121"><span class="cite-bracket">[</span>121<span class="cite-bracket">]</span></a></sup></li> <li>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.<sup id="cite_ref-USDHHS2008_46-9" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 83–86">: 83–86 </span></sup></li> <li>Both physicians and non-physicians increased abstinence rates compared with self-help or no clinicians.<sup id="cite_ref-USDHHS2008_46-10" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 87–88">: 87–88 </span></sup> For example, a Cochrane review of 58 studies found that nursing interventions increased the likelihood of quitting.<sup id="cite_ref-122" class="reference"><a href="#cite_note-122"><span class="cite-bracket">[</span>122<span class="cite-bracket">]</span></a></sup> Another review found some positive effects when trained community pharmacists support patients in their smoking cessation trials.<sup id="cite_ref-123" class="reference"><a href="#cite_note-123"><span class="cite-bracket">[</span>123<span class="cite-bracket">]</span></a></sup></li> <li>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.<sup id="cite_ref-124" class="reference"><a href="#cite_note-124"><span class="cite-bracket">[</span>124<span class="cite-bracket">]</span></a></sup></li> <li>According to the 2008 Guideline, based on two studies the training of clinicians in smoking cessation methods may increase abstinence rates;<sup id="cite_ref-USDHHS2008_46-11" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 130">: 130 </span></sup> however, a Cochrane review found and measured that such training decreased smoking in patients.<sup id="cite_ref-125" class="reference"><a href="#cite_note-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup></li> <li>Reducing or eliminating the costs of cessation therapies for smokers increased quit rates in three meta-analyses.<sup id="cite_ref-USDHHS2008_46-12" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 139–140">: 139–140 </span></sup><sup id="cite_ref-Hopkins2001_56-4" class="reference"><a href="#cite_note-Hopkins2001-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 38–40">: 38–40 </span></sup><sup id="cite_ref-126" class="reference"><a href="#cite_note-126"><span class="cite-bracket">[</span>126<span class="cite-bracket">]</span></a></sup></li> <li>In one systematic review and meta-analysis, multi-component interventions increased quit rates in <a href="/wiki/Primary_care" title="Primary care">primary care</a> settings.<sup id="cite_ref-127" class="reference"><a href="#cite_note-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> "Multi-component" interventions were defined as those that combined two or more of the following strategies known as the "5 A's":<sup id="cite_ref-USDHHS2008_46-13" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 38–43">: 38–43 </span></sup> <ul><li>Ask — Systematically identify all tobacco users at every visit</li> <li>Advise — Strongly urge all tobacco users to quit<figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Breath_CO_Monitor.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/Breath_CO_Monitor.jpg/140px-Breath_CO_Monitor.jpg" decoding="async" width="140" height="214" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c5/Breath_CO_Monitor.jpg/210px-Breath_CO_Monitor.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c5/Breath_CO_Monitor.jpg/280px-Breath_CO_Monitor.jpg 2x" data-file-width="1086" data-file-height="1659" /></a><figcaption>Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with its corresponding percent concentration of carboxyhemoglobin</figcaption></figure></li> <li>Assess — Determine willingness to make a quit attempt</li> <li>Assist — Aid the patient in quitting (provide counselling-style support and medication)</li> <li>Arrange — Ensure follow-up contact</li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Substitutes_for_cigarettes">Substitutes for cigarettes</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">Nicotine replacement therapy</a> and <a href="/wiki/Electronic_cigarette#Smoking_cessation" title="Electronic cigarette">Electronic cigarette § Smoking cessation</a></div> <ul><li><a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">Nicotine replacement therapy</a> (NRT) is the general term for using products that contain nicotine but not tobacco to aid smoking cessation. These include nicotine lozenges, <a href="/wiki/Nicotine_gum" title="Nicotine gum">nicotine gum</a> and inhalers, <a href="/wiki/Nicotine_patch" title="Nicotine patch">nicotine patches</a>, 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.<sup id="cite_ref-128" class="reference"><a href="#cite_note-128"><span class="cite-bracket">[</span>128<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Electronic_cigarette" title="Electronic cigarette">Electronic cigarettes (ECs)</a>: 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.<sup id="cite_ref-129" class="reference"><a href="#cite_note-129"><span class="cite-bracket">[</span>129<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers"><span title="Updated version https://www.ncbi.nlm.nih.gov/pubmed/38189560 (February 2024)">needs update</span></a></i>]</sup> Little is known regarding the long-term harms related to vaping.<sup id="cite_ref-FormanekSalisbury-Afshar2018_130-0" class="reference"><a href="#cite_note-FormanekSalisbury-Afshar2018-130"><span class="cite-bracket">[</span>130<span class="cite-bracket">]</span></a></sup> A 2016 UK <a href="/wiki/Royal_College_of_Physicians" title="Royal College of Physicians">Royal College of Physicians</a> report supports using e-cigarettes as a smoking cessation tool.<sup id="cite_ref-131" class="reference"><a href="#cite_note-131"><span class="cite-bracket">[</span>131<span class="cite-bracket">]</span></a></sup> A 2015 <a href="/wiki/Public_Health_England" title="Public Health England">Public Health England</a> 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."<sup id="cite_ref-McNeill2015_132-0" class="reference"><a href="#cite_note-McNeill2015-132"><span class="cite-bracket">[</span>132<span class="cite-bracket">]</span></a></sup> However, since little is known about long term effects, other regulated options such as nicotine replacement therapy, varenicline or bupropion should be discussed primarily.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Alternative_approaches">Alternative approaches</h3></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:PEZ_PEZ.Die.s%C3%BC%C3%9Fe.Freude_Braun_5way_DE.AT-01.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/62/PEZ_PEZ.Die.s%C3%BC%C3%9Fe.Freude_Braun_5way_DE.AT-01.png/150px-PEZ_PEZ.Die.s%C3%BC%C3%9Fe.Freude_Braun_5way_DE.AT-01.png" decoding="async" width="150" height="409" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/6/62/PEZ_PEZ.Die.s%C3%BC%C3%9Fe.Freude_Braun_5way_DE.AT-01.png 1.5x" data-file-width="220" data-file-height="600" /></a><figcaption>A <a href="/wiki/Pez" title="Pez">Pez</a> vending machine. Pez was invented in 1927 as a smoking cessation aid, serving as an alternative to tobacco.<sup id="cite_ref-133" class="reference"><a href="#cite_note-133"><span class="cite-bracket">[</span>133<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>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. </p> <ul><li><a href="/wiki/Acupuncture" title="Acupuncture">Acupuncture</a>: Acupuncture has been explored as an adjunct treatment method for smoking cessation.<sup id="cite_ref-He_134-0" class="reference"><a href="#cite_note-He-134"><span class="cite-bracket">[</span>134<span class="cite-bracket">]</span></a></sup> A 2014 Cochrane review was unable to make conclusions regarding acupuncture as the evidence is poor.<sup id="cite_ref-135" class="reference"><a href="#cite_note-135"><span class="cite-bracket">[</span>135<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-USDHHS2008_46-14" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 99">: 99 </span></sup></li> <li><a href="/wiki/Hypnosis" title="Hypnosis">Hypnosis</a>: Hypnosis often involves the hypnotherapist suggesting the unpleasant outcomes of smoking to the patient.<sup id="cite_ref-136" class="reference"><a href="#cite_note-136"><span class="cite-bracket">[</span>136<span class="cite-bracket">]</span></a></sup> Clinical trials studying hypnosis and <a href="/wiki/Hypnotherapy" title="Hypnotherapy">hypnotherapy</a> as a method for smoking cessation have been inconclusive.<sup id="cite_ref-USDHHS2008_46-15" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 100">: 100 </span></sup><sup id="cite_ref-Barnes)2019_137-0" class="reference"><a href="#cite_note-Barnes)2019-137"><span class="cite-bracket">[</span>137<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Johnson_138-0" class="reference"><a href="#cite_note-Johnson-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Law_139-0" class="reference"><a href="#cite_note-Law-139"><span class="cite-bracket">[</span>139<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Barnes)2019_137-1" class="reference"><a href="#cite_note-Barnes)2019-137"><span class="cite-bracket">[</span>137<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-140" class="reference"><a href="#cite_note-140"><span class="cite-bracket">[</span>140<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Herbal_medicine" title="Herbal medicine">Herbal medicine</a>: Many herbs have been studied as a method for smoking cessation, including <a href="/wiki/Lobelia" title="Lobelia">lobelia</a> and <a href="/wiki/Hypericum_perforatum" title="Hypericum perforatum">St John's wort</a>.<sup id="cite_ref-141" class="reference"><a href="#cite_note-141"><span class="cite-bracket">[</span>141<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-142" class="reference"><a href="#cite_note-142"><span class="cite-bracket">[</span>142<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Asthma" title="Asthma">asthma</a> and bronchitis, and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">FDA</a>'s Poisonous Plant Database.<sup id="cite_ref-143" class="reference"><a href="#cite_note-143"><span class="cite-bracket">[</span>143<span class="cite-bracket">]</span></a></sup> 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.</li> <li><a href="/wiki/Smokeless_tobacco" title="Smokeless tobacco">Smokeless tobacco</a>: There is little smoking in Sweden, which is reflected in the very low cancer rates for Swedish men. Use of <a href="/wiki/Snus" title="Snus">snus</a> (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.<sup id="cite_ref-144" class="reference"><a href="#cite_note-144"><span class="cite-bracket">[</span>144<span class="cite-bracket">]</span></a></sup> However, the report by the <a href="/wiki/Scientific_Committee_on_Emerging_and_Newly_Identified_Health_Risks" title="Scientific Committee on Emerging and Newly Identified Health Risks">Scientific Committee on Emerging and Newly Identified Health Risks</a> (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."<sup id="cite_ref-145" class="reference"><a href="#cite_note-145"><span class="cite-bracket">[</span>145<span class="cite-bracket">]</span></a></sup> A recent national study on the use of alternative tobacco products, including snus, did not show that these products promote cessation.<sup id="cite_ref-146" class="reference"><a href="#cite_note-146"><span class="cite-bracket">[</span>146<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Aversion_therapy" title="Aversion therapy">Aversion therapy</a>: 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.<sup id="cite_ref-147" class="reference"><a href="#cite_note-147"><span class="cite-bracket">[</span>147<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Nicotine_vaccine" title="Nicotine vaccine">Nicotine vaccines</a>: Nicotine vaccines (e.g., <a href="/wiki/NicVAX" title="NicVAX">NicVAX</a> and <a href="/wiki/TA-NIC" title="TA-NIC">TA-NIC</a>) 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.<sup id="cite_ref-148" class="reference"><a href="#cite_note-148"><span class="cite-bracket">[</span>148<span class="cite-bracket">]</span></a></sup></li> <li>Technology and machine learning: Research studies using machine learning or <a href="/wiki/Artificial_intelligence" title="Artificial intelligence">artificial intelligence</a> tools to provide feedback and communication with those who are trying to quit smoking are increasing, yet the findings are so far inconclusive.<sup id="cite_ref-149" class="reference"><a href="#cite_note-149"><span class="cite-bracket">[</span>149<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-150" class="reference"><a href="#cite_note-150"><span class="cite-bracket">[</span>150<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-151" class="reference"><a href="#cite_note-151"><span class="cite-bracket">[</span>151<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Psilocybin" title="Psilocybin">Psilocybin</a> has been being investigated as a potential smoking cessation aid for several years. In 2021, <a href="/wiki/Johns_Hopkins_School_of_Medicine" title="Johns Hopkins School of Medicine">Johns Hopkins Medicine</a> has been awarded a grant from the National Institutes of Health to explore the potential impacts of psilocybin and talk therapy on tobacco addiction.<sup id="cite_ref-152" class="reference"><a href="#cite_note-152"><span class="cite-bracket">[</span>152<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Special_populations">Special populations</h2></div> <div class="mw-heading mw-heading3"><h3 id="Children_and_adolescents">Children and adolescents</h3></div> <p>Methods used with children and adolescents include: </p> <ul><li>Motivational enhancement<sup id="cite_ref-Fanshawe-2017_153-0" class="reference"><a href="#cite_note-Fanshawe-2017-153"><span class="cite-bracket">[</span>153<span class="cite-bracket">]</span></a></sup></li> <li>Psychological support<sup id="cite_ref-Fanshawe-2017_153-1" class="reference"><a href="#cite_note-Fanshawe-2017-153"><span class="cite-bracket">[</span>153<span class="cite-bracket">]</span></a></sup></li> <li>Youth anti-tobacco activities, including participation in sports</li> <li>School-based curricula, like <a href="/wiki/Life_skills" title="Life skills">life-skills</a> training</li> <li><a href="/wiki/School_nursing" title="School nursing">School-based nurse</a> counseling sessions<sup id="cite_ref-154" class="reference"><a href="#cite_note-154"><span class="cite-bracket">[</span>154<span class="cite-bracket">]</span></a></sup></li> <li>Access reduction to tobacco</li> <li>Anti-tobacco media<sup id="cite_ref-155" class="reference"><a href="#cite_note-155"><span class="cite-bracket">[</span>155<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-156" class="reference"><a href="#cite_note-156"><span class="cite-bracket">[</span>156<span class="cite-bracket">]</span></a></sup></li> <li>Family communication</li></ul> <p>Cochrane reviews, mainly of studies combining motivational enhancement and psychological support, concluded that "complex approaches" for smoking cessation among young people show promise.<sup id="cite_ref-Fanshawe-2017_153-2" class="reference"><a href="#cite_note-Fanshawe-2017-153"><span class="cite-bracket">[</span>153<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-157" class="reference"><a href="#cite_note-157"><span class="cite-bracket">[</span>157<span class="cite-bracket">]</span></a></sup> The 2008 US Guideline recommends counselling-style support for adolescent smokers on the basis of a meta-analysis of seven studies.<sup id="cite_ref-USDHHS2008_46-16" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 159–161">: 159–161 </span></sup> Neither the Cochrane review nor the 2008 Guideline recommend medications for adolescents who smoke. </p> <div class="mw-heading mw-heading3"><h3 id="Pregnant_women">Pregnant women</h3></div> <p><a href="/wiki/Smoking_and_pregnancy" title="Smoking and pregnancy">Smoking during pregnancy</a> 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.<sup id="cite_ref-USDHHS2008_46-17" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 165–167">: 165–167 </span></sup> Mothers who smoke during pregnancy have a greater tendency towards <a href="/wiki/Preterm_birth" title="Preterm birth">premature births</a>. 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.<sup id="cite_ref-158" class="reference"><a href="#cite_note-158"><span class="cite-bracket">[</span>158<span class="cite-bracket">]</span></a></sup> Additionally, a study published by <a href="/wiki/American_Academy_of_Pediatrics" title="American Academy of Pediatrics">American Academy of Pediatrics</a> shows that smoking during pregnancy increases the chance of <a href="/wiki/SIDS" title="SIDS">sudden unexpected infant death</a> ((SUID) or (SIDS)).<sup id="cite_ref-159" class="reference"><a href="#cite_note-159"><span class="cite-bracket">[</span>159<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-160" class="reference"><a href="#cite_note-160"><span class="cite-bracket">[</span>160<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-161" class="reference"><a href="#cite_note-161"><span class="cite-bracket">[</span>161<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-162" class="reference"><a href="#cite_note-162"><span class="cite-bracket">[</span>162<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-163" class="reference"><a href="#cite_note-163"><span class="cite-bracket">[</span>163<span class="cite-bracket">]</span></a></sup> However, life style modification are the preferred method for pregnant women, and they should discuss smoking cessation techniques with a healthcare professional. </p> <div class="mw-heading mw-heading3"><h3 id="Schizophrenia">Schizophrenia</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Schizophrenia_and_tobacco_smoking" title="Schizophrenia and tobacco smoking">Schizophrenia and tobacco smoking</a></div> <p>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.<sup id="cite_ref-164" class="reference"><a href="#cite_note-164"><span class="cite-bracket">[</span>164<span class="cite-bracket">]</span></a></sup> For example, in the United States, 80% or more of people with schizophrenia smoke, compared to 20% of the general population in 2006.<sup id="cite_ref-165" class="reference"><a href="#cite_note-165"><span class="cite-bracket">[</span>165<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hospitalized_smokers">Hospitalized smokers</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smoking_cessation-West%26Shiffman.png" class="mw-file-description"><img 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." src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Smoking_cessation-West%26Shiffman.png/220px-Smoking_cessation-West%26Shiffman.png" decoding="async" width="220" height="153" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Smoking_cessation-West%26Shiffman.png/330px-Smoking_cessation-West%26Shiffman.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a0/Smoking_cessation-West%26Shiffman.png/440px-Smoking_cessation-West%26Shiffman.png 2x" data-file-width="730" data-file-height="507" /></a><figcaption>Percent increase of success for six months over unaided attempts for each type of quitting (chart from West & Shiffman based on Cochrane review data<sup id="cite_ref-WestShiffman2007_166-0" class="reference"><a href="#cite_note-WestShiffman2007-166"><span class="cite-bracket">[</span>166<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 59">: 59 </span></sup>)</figcaption></figure> <p>Smokers who are hospitalised may be particularly motivated to quit.<sup id="cite_ref-USDHHS2008_46-18" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 149–150">: 149–150 </span></sup> 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.<sup id="cite_ref-167" class="reference"><a href="#cite_note-167"><span class="cite-bracket">[</span>167<span class="cite-bracket">]</span></a></sup> </p><p>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 <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">nicotine replacement therapy</a>.<sup id="cite_ref-preop._168-0" class="reference"><a href="#cite_note-preop.-168"><span class="cite-bracket">[</span>168<span class="cite-bracket">]</span></a></sup> It is found to reduce the complications and the number of postoperative morbidity.<sup id="cite_ref-preop._168-1" class="reference"><a href="#cite_note-preop.-168"><span class="cite-bracket">[</span>168<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mood_disorders">Mood disorders</h3></div> <p>People with <a href="/wiki/Mood_disorder" title="Mood disorder">mood disorders</a> or <a href="/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorders</a> have a greater chance to begin smoking and a lower chance of quitting smoking.<sup id="cite_ref-Moylan-2013_169-0" class="reference"><a href="#cite_note-Moylan-2013-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> A higher correlation with smoking has also been seen in people diagnosed with the <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a> 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.<sup id="cite_ref-Baggett-2013_170-0" class="reference"><a href="#cite_note-Baggett-2013-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a> in the future.<sup id="cite_ref-Moylan-2013_169-1" class="reference"><a href="#cite_note-Moylan-2013-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Homeless_and_poverty">Homeless and poverty</h3></div> <p>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.<sup id="cite_ref-Baggett-2013_170-1" class="reference"><a href="#cite_note-Baggett-2013-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-smokingcessationleadership.ucsf.edu-2015_171-0" class="reference"><a href="#cite_note-smokingcessationleadership.ucsf.edu-2015-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> </p><p>In the United States, 60–80% of homeless adults are smokers. This is a considerably higher rate than the general adult population of 19%.<sup id="cite_ref-Baggett-2013_170-2" class="reference"><a href="#cite_note-Baggett-2013-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> Many current smokers who are homeless report smoking as a means of coping with "all the pressure of being homeless."<sup id="cite_ref-Baggett-2013_170-3" class="reference"><a href="#cite_note-Baggett-2013-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> The perception that homeless people smoking being "socially acceptable" can reinforce these trends.<sup id="cite_ref-Baggett-2013_170-4" class="reference"><a href="#cite_note-Baggett-2013-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> </p><p>Americans under the poverty line have higher rates of smoking and lower rates of quitting than those over the poverty line.<sup id="cite_ref-smokingcessationleadership.ucsf.edu-2015_171-1" class="reference"><a href="#cite_note-smokingcessationleadership.ucsf.edu-2015-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-www.nationalhomeless.org_172-0" class="reference"><a href="#cite_note-www.nationalhomeless.org-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-173" class="reference"><a href="#cite_note-173"><span class="cite-bracket">[</span>173<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-www.nationalhomeless.org_172-1" class="reference"><a href="#cite_note-www.nationalhomeless.org-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-www.nationalhomeless.org_172-2" class="reference"><a href="#cite_note-www.nationalhomeless.org-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-174" class="reference"><a href="#cite_note-174"><span class="cite-bracket">[</span>174<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Concurrent_substance_use_disorders">Concurrent substance use disorders</h3></div> <p>Over three-quarters of people in treatment or recovery from substance misuse issues are current smokers.<sup id="cite_ref-:5_175-0" class="reference"><a href="#cite_note-:5-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-176" class="reference"><a href="#cite_note-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-:5_175-1" class="reference"><a href="#cite_note-:5-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-177" class="reference"><a href="#cite_note-177"><span class="cite-bracket">[</span>177<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-178" class="reference"><a href="#cite_note-178"><span class="cite-bracket">[</span>178<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-179" class="reference"><a href="#cite_note-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Comparison_of_success_rates">Comparison of success rates</h2></div> <p>Comparison of success rates across interventions can be difficult because of different definitions of "success" across studies.<sup id="cite_ref-ReferenceB_180-0" class="reference"><a href="#cite_note-ReferenceB-180"><span class="cite-bracket">[</span>180<span class="cite-bracket">]</span></a></sup> Robert West and Saul Shiffman, authorities in this field recognized by government health departments in a number of countries,<sup id="cite_ref-WestShiffman2007_166-1" class="reference"><a href="#cite_note-WestShiffman2007-166"><span class="cite-bracket">[</span>166<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 73, 76, 80">: 73, 76, 80 </span></sup> have concluded that, used together, "behavioral support" and "medication" can quadruple the chances that a quit attempt will be successful. </p><p>A 2008 systematic review in the <i><a href="/wiki/European_Journal_of_Cancer_Prevention" title="European Journal of Cancer Prevention">European Journal of Cancer Prevention</a></i> found that group behavioural therapy was the most effective intervention strategy for smoking cessation, followed by <a href="/wiki/Bupropion" title="Bupropion">bupropion</a>, intensive physician advice, nicotine replacement therapy, individual counselling, telephone counselling, nursing interventions, and tailored self-help interventions; the study did not discuss <a href="/wiki/Varenicline" title="Varenicline">varenicline</a>.<sup id="cite_ref-181" class="reference"><a href="#cite_note-181"><span class="cite-bracket">[</span>181<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Factors_affecting_success">Factors affecting success</h2></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smoking_insula.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Smoking_insula.jpg/220px-Smoking_insula.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Smoking_insula.jpg/330px-Smoking_insula.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Smoking_insula.jpg/440px-Smoking_insula.jpg 2x" data-file-width="600" data-file-height="450" /></a><figcaption>Individuals who sustained damage to the <a href="/wiki/Insular_cortex" title="Insular cortex">insula</a> were able to more easily abstain from smoking.<sup id="cite_ref-182" class="reference"><a href="#cite_note-182"><span class="cite-bracket">[</span>182<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Quitting can be harder for individuals with darkly pigmented skin than individuals with pale skin since nicotine has an affinity for <a href="/wiki/Melanin" title="Melanin">melanin</a>-containing tissues. Studies suggest this can cause the phenomenon of increased <a href="/wiki/Nicotine#Dependence" title="Nicotine">nicotine dependence</a> and lower smoking cessation rate in darker-pigmented individuals.<sup id="cite_ref-183" class="reference"><a href="#cite_note-183"><span class="cite-bracket">[</span>183<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-autogenerated1_184-0" class="reference"><a href="#cite_note-autogenerated1-184"><span class="cite-bracket">[</span>184<span class="cite-bracket">]</span></a></sup> 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%.<sup id="cite_ref-autogenerated1_184-1" class="reference"><a href="#cite_note-autogenerated1-184"><span class="cite-bracket">[</span>184<span class="cite-bracket">]</span></a></sup> Nevertheless, a <a href="/wiki/Cochrane_(organization)" class="mw-redirect" title="Cochrane (organization)">Cochrane</a> review determined that interventions to increase social support for a smoker's cessation attempt did not improve long-term quit rates.<sup id="cite_ref-185" class="reference"><a href="#cite_note-185"><span class="cite-bracket">[</span>185<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-Hitchman-2014_186-0" class="reference"><a href="#cite_note-Hitchman-2014-186"><span class="cite-bracket">[</span>186<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-Hitchman-2014_186-1" class="reference"><a href="#cite_note-Hitchman-2014-186"><span class="cite-bracket">[</span>186<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-187" class="reference"><a href="#cite_note-187"><span class="cite-bracket">[</span>187<span class="cite-bracket">]</span></a></sup> </p><p>Smokers with <a href="/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a> may be less successful at quitting smoking than non-depressed smokers.<sup id="cite_ref-USDHHS2008_46-19" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 81">: 81 </span></sup><sup id="cite_ref-Glassman1990_188-0" class="reference"><a href="#cite_note-Glassman1990-188"><span class="cite-bracket">[</span>188<span class="cite-bracket">]</span></a></sup> </p><p>Relapse (resuming smoking after quitting) has been related to psychological issues such as low <a href="/wiki/Self-efficacy" title="Self-efficacy">self-efficacy</a>,<sup id="cite_ref-189" class="reference"><a href="#cite_note-189"><span class="cite-bracket">[</span>189<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-190" class="reference"><a href="#cite_note-190"><span class="cite-bracket">[</span>190<span class="cite-bracket">]</span></a></sup> or non-optimal coping responses;<sup id="cite_ref-191" class="reference"><a href="#cite_note-191"><span class="cite-bracket">[</span>191<span class="cite-bracket">]</span></a></sup> however, psychological approaches to prevent relapse have not been proven to be successful.<sup id="cite_ref-Livingstone-Banks-2019_192-0" class="reference"><a href="#cite_note-Livingstone-Banks-2019-192"><span class="cite-bracket">[</span>192<span class="cite-bracket">]</span></a></sup> In contrast, <a href="/wiki/Varenicline" title="Varenicline">varenicline</a> is suggested to have some effects and <a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">nicotine replacement therapy</a> may help the unassisted abstainers.<sup id="cite_ref-Livingstone-Banks-2019_192-1" class="reference"><a href="#cite_note-Livingstone-Banks-2019-192"><span class="cite-bracket">[</span>192<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-193" class="reference"><a href="#cite_note-193"><span class="cite-bracket">[</span>193<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Side_effects">Side effects</h2></div> <table class="wikitable" align="right"> <caption>Duration of nicotine withdrawal symptoms </caption> <tbody><tr> <td>Craving for tobacco </td> <td>3 to 8 weeks<sup id="cite_ref-Kaiser_194-0" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Dizziness </td> <td>Few days<sup id="cite_ref-Kaiser_194-1" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Insomnia </td> <td>1 to 2 weeks<sup id="cite_ref-Kaiser_194-2" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Headaches </td> <td>1 to 2 weeks<sup id="cite_ref-Kaiser_194-3" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Chest discomfort </td> <td>1 to 2 weeks<sup id="cite_ref-Kaiser_194-4" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Constipation </td> <td>1 to 2 weeks<sup id="cite_ref-Kaiser_194-5" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Irritability </td> <td>2 to 4 weeks<sup id="cite_ref-Kaiser_194-6" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Fatigue </td> <td>2 to 4 weeks<sup id="cite_ref-Kaiser_194-7" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Cough or nasal drip </td> <td>Few weeks<sup id="cite_ref-Kaiser_194-8" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Lack of concentration </td> <td>Few weeks<sup id="cite_ref-Kaiser_194-9" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td>Hunger </td> <td>Up to several weeks<sup id="cite_ref-Kaiser_194-10" class="reference"><a href="#cite_note-Kaiser-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup> </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Withdrawal_symptoms">Withdrawal symptoms</h3></div> <p>The <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> 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."<sup id="cite_ref-195" class="reference"><a href="#cite_note-195"><span class="cite-bracket">[</span>195<span class="cite-bracket">]</span></a></sup> Studies have shown that the use of pharmacotherapies, such as <a href="/wiki/Varenicline" title="Varenicline">varenicline</a><sup id="cite_ref-196" class="reference"><a href="#cite_note-196"><span class="cite-bracket">[</span>196<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-197" class="reference"><a href="#cite_note-197"><span class="cite-bracket">[</span>197<span class="cite-bracket">]</span></a></sup> can be useful in reducing withdrawal symptoms during the quitting process. </p> <div class="mw-heading mw-heading3"><h3 id="Weight_gain">Weight gain</h3></div> <p>Giving up smoking is associated with an average weight gain of 4–5 kilograms (8.8–11.0 lb) after 12 months, most of which occurs within the first three months of quitting.<sup id="cite_ref-198" class="reference"><a href="#cite_note-198"><span class="cite-bracket">[</span>198<span class="cite-bracket">]</span></a></sup> </p><p>The possible causes of the weight gain include: </p> <ul><li>Smoking over-expresses the gene <a href="/wiki/AZGP1" title="AZGP1">AZGP1</a> which stimulates <a href="/wiki/Lipolysis" title="Lipolysis">lipolysis</a>, so smoking cessation may decrease lipolysis.<sup id="cite_ref-Vanni2009_199-0" class="reference"><a href="#cite_note-Vanni2009-199"><span class="cite-bracket">[</span>199<span class="cite-bracket">]</span></a></sup></li> <li>Smoking suppresses appetite, which may be caused by nicotine's effect on central <a href="/wiki/Autonomic_nervous_system" title="Autonomic nervous system">autonomic</a> neurons (e.g., via regulation of <a href="/wiki/Melanin_concentrating_hormone" class="mw-redirect" title="Melanin concentrating hormone">melanin concentrating hormone</a> neurons in the <a href="/wiki/Hypothalamus" title="Hypothalamus">hypothalamus</a>).<sup id="cite_ref-Jo2002_200-0" class="reference"><a href="#cite_note-Jo2002-200"><span class="cite-bracket">[</span>200<span class="cite-bracket">]</span></a></sup> Smoking cessation will increase the persons appetite once again, especially as taste buds can return to its normal function.</li> <li>Heavy smokers are reported to burn 200 calories per day more than non-smokers eating the same diet.<sup id="cite_ref-201" class="reference"><a href="#cite_note-201"><span class="cite-bracket">[</span>201<span class="cite-bracket">]</span></a></sup> Possible reasons for this phenomenon include nicotine's ability to increase energy metabolism or nicotine's effect on <a href="/wiki/Peripheral_nervous_system" title="Peripheral nervous system">peripheral neurons</a>.<sup id="cite_ref-Jo2002_200-1" class="reference"><a href="#cite_note-Jo2002-200"><span class="cite-bracket">[</span>200<span class="cite-bracket">]</span></a></sup></li></ul> <p>The <a href="/wiki/United_States_Department_of_Health_and_Human_Services" title="United States Department of Health and Human Services">U.S. Department of Health and Human Services</a> guideline suggests that sustained-release bupropion, nicotine gum, and nicotine lozenge be used "to delay weight gain after quitting."<sup id="cite_ref-202" class="reference"><a href="#cite_note-202"><span class="cite-bracket">[</span>202<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-203" class="reference"><a href="#cite_note-203"><span class="cite-bracket">[</span>203<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-204" class="reference"><a href="#cite_note-204"><span class="cite-bracket">[</span>204<span class="cite-bracket">]</span></a></sup> 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 <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a> in those who have quit smoking.<sup id="cite_ref-205" class="reference"><a href="#cite_note-205"><span class="cite-bracket">[</span>205<span class="cite-bracket">]</span></a></sup> The risks of rebound weight gain is significantly less than the risks of continued smoking. </p> <div class="mw-heading mw-heading3"><h3 id="Mental_health">Mental health</h3></div> <p>Like other physically addictive drugs, nicotine addiction causes a down-regulation of the production of <a href="/wiki/Dopamine" title="Dopamine">dopamine</a> 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,<sup id="cite_ref-Glassman1990_188-1" class="reference"><a href="#cite_note-Glassman1990-188"><span class="cite-bracket">[</span>188<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-206" class="reference"><a href="#cite_note-206"><span class="cite-bracket">[</span>206<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-207" class="reference"><a href="#cite_note-207"><span class="cite-bracket">[</span>207<span class="cite-bracket">]</span></a></sup> A 2021 review found that quitting smoking lessens anxiety and depression.<sup id="cite_ref-208" class="reference"><a href="#cite_note-208"><span class="cite-bracket">[</span>208<span class="cite-bracket">]</span></a></sup> </p><p>A 2013 study by <i><a href="/wiki/The_British_Journal_of_Psychiatry" class="mw-redirect" title="The British Journal of Psychiatry">The British Journal of Psychiatry</a></i> has found that smokers who successfully quit feel less anxious afterward, with the effect being greater among those who had <a href="/wiki/Mood_disorder" title="Mood disorder">mood</a> and <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a> than those who smoked for pleasure.<sup id="cite_ref-bjp_209-0" class="reference"><a href="#cite_note-bjp-209"><span class="cite-bracket">[</span>209<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Health_benefits">Health benefits</h2></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:British_doctors_study_35.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b3/British_doctors_study_35.svg/300px-British_doctors_study_35.svg.png" decoding="async" width="300" height="237" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b3/British_doctors_study_35.svg/450px-British_doctors_study_35.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b3/British_doctors_study_35.svg/600px-British_doctors_study_35.svg.png 2x" data-file-width="404" data-file-height="319" /></a><figcaption>Survival from age 35 of non-smokers, cigarette smokers and ex-smokers who stopped smoking between 25 and 34 years old.<sup id="cite_ref-Doll2004_210-0" class="reference"><a href="#cite_note-Doll2004-210"><span class="cite-bracket">[</span>210<span class="cite-bracket">]</span></a></sup> The ex-smokers line follows closely the non-smokers line.</figcaption></figure> <p>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:<sup id="cite_ref-www.cancer.org_211-0" class="reference"><a href="#cite_note-www.cancer.org-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Within 20 minutes after quitting, <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a> and <a href="/wiki/Heart_rate" title="Heart rate">heart rate</a> decrease</li> <li>Within a few days, <a href="/wiki/Carbon_monoxide" title="Carbon monoxide">carbon monoxide</a> levels in the blood decrease to normal</li> <li>Within 48 hours, nerve endings and sense of smell and taste both start recovering</li> <li>Within 3 months, <a href="/wiki/Circulatory_system" title="Circulatory system">circulation</a> and <a href="/wiki/Spirometry" title="Spirometry">lung function</a> improve</li> <li>Within 1 year, there are decreases in cough and shortness of breath</li> <li>Within 1–2 years, the risk of <a href="/wiki/Coronary_disease" class="mw-redirect" title="Coronary disease">coronary heart disease</a> is cut in half</li> <li>Within 5–10 years, the risk of <a href="/wiki/Stroke" title="Stroke">stroke</a> falls to the same as a non-smoker, and the risks of many cancers (mouth, throat, esophagus, bladder, cervix) decrease significantly</li> <li>Within 10 years, the risk of dying from <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a> is cut in half, and the risks of larynx and pancreas cancers decrease</li> <li>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)<sup id="cite_ref-www.cancer.org_211-1" class="reference"><a href="#cite_note-www.cancer.org-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup></li></ul> <p>The <a href="/wiki/British_Doctors_Study" title="British Doctors Study">British Doctors Study</a> showed that those who stopped smoking before they reached 30 years old lived almost as long as those who never smoked.<sup id="cite_ref-Doll2004_210-1" class="reference"><a href="#cite_note-Doll2004-210"><span class="cite-bracket">[</span>210<span class="cite-bracket">]</span></a></sup> Stopping in one's sixties can still add three years of healthy life.<sup id="cite_ref-Doll2004_210-2" class="reference"><a href="#cite_note-Doll2004-210"><span class="cite-bracket">[</span>210<span class="cite-bracket">]</span></a></sup> Randomized U.S. and Canadian trials showed that a ten-week smoking cessation program decreased mortality from all causes over 14 years later.<sup id="cite_ref-212" class="reference"><a href="#cite_note-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> 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."<sup id="cite_ref-213" class="reference"><a href="#cite_note-213"><span class="cite-bracket">[</span>213<span class="cite-bracket">]</span></a></sup> </p><p>The significant increase in the risk of all-cause mortality that is present in people who smoke is decreased with long-term smoking cessation.<sup id="cite_ref-214" class="reference"><a href="#cite_note-214"><span class="cite-bracket">[</span>214<span class="cite-bracket">]</span></a></sup> Smoking cessation can improve health status and quality of life at any age.<sup id="cite_ref-Smoking_cessation_215-0" class="reference"><a href="#cite_note-Smoking_cessation-215"><span class="cite-bracket">[</span>215<span class="cite-bracket">]</span></a></sup> Evidence shows that cessation of smoking reduces risk of <a href="/wiki/Lung_cancer" title="Lung cancer">lung</a>, <a href="/wiki/Laryngeal_cancer" title="Laryngeal cancer">laryngeal</a>, <a href="/wiki/Oral_cancer" title="Oral cancer">oral cavity and pharynx</a>, <a href="/wiki/Esophageal_cancer" title="Esophageal cancer">esophageal</a>, <a href="/wiki/Pancreatic_cancer" title="Pancreatic cancer">pancreatic</a>, <a href="/wiki/Bladder_cancer" title="Bladder cancer">bladder</a>, <a href="/wiki/Stomach_cancer" title="Stomach cancer">stomach</a>, <a href="/wiki/Colorectal_cancer" title="Colorectal cancer">colorectal</a>, <a href="/wiki/Cervical_cancer" title="Cervical cancer">cervical</a>, and <a href="/wiki/Kidney_cancer" title="Kidney cancer">kidney</a> cancer, in addition to reducing the risk of <a href="/wiki/Acute_myeloid_leukemia" title="Acute myeloid leukemia">acute myeloid leukemia</a>.<sup id="cite_ref-Smoking_cessation_215-1" class="reference"><a href="#cite_note-Smoking_cessation-215"><span class="cite-bracket">[</span>215<span class="cite-bracket">]</span></a></sup> </p><p>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.<sup id="cite_ref-216" class="reference"><a href="#cite_note-216"><span class="cite-bracket">[</span>216<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cost-effectiveness">Cost-effectiveness</h2></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smokers-as-a-percentage-of-adult-pop.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Smokers-as-a-percentage-of-adult-pop.jpg/300px-Smokers-as-a-percentage-of-adult-pop.jpg" decoding="async" width="300" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Smokers-as-a-percentage-of-adult-pop.jpg/450px-Smokers-as-a-percentage-of-adult-pop.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Smokers-as-a-percentage-of-adult-pop.jpg/600px-Smokers-as-a-percentage-of-adult-pop.jpg 2x" data-file-width="693" data-file-height="461" /></a><figcaption>Smokers as a percentage of the population for the United States, the Netherlands, Norway, Japan, and Finland</figcaption></figure> <p><a href="/wiki/Cost-effectiveness_analysis" title="Cost-effectiveness analysis">Cost-effectiveness analyses</a> of smoking cessation activities have shown that they increase <a href="/wiki/Quality-adjusted_life_year" title="Quality-adjusted life year">quality-adjusted life years</a> (QALYs) at costs comparable with other types of interventions to treat and prevent disease.<sup id="cite_ref-USDHHS2008_46-20" class="reference"><a href="#cite_note-USDHHS2008-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 134–137">: 134–137 </span></sup> Studies of the cost-effectiveness of smoking cessation include: </p> <ul><li>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.<sup id="cite_ref-217" class="reference"><a href="#cite_note-217"><span class="cite-bracket">[</span>217<span class="cite-bracket">]</span></a></sup></li> <li>A study from <a href="/wiki/Erasmus_University_Rotterdam" title="Erasmus University Rotterdam">Erasmus University Rotterdam</a> limited to people with <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">chronic obstructive pulmonary disease</a> 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.<sup id="cite_ref-218" class="reference"><a href="#cite_note-218"><span class="cite-bracket">[</span>218<span class="cite-bracket">]</span></a></sup></li> <li>Among <a href="/wiki/National_Health_Service" title="National Health Service">National Health Service</a> smoking cessation clients in <a href="/wiki/Glasgow" title="Glasgow">Glasgow</a>, pharmacy one-to-one counselling cost £2,600 per QALY gained and group support cost £4,800 per QALY gained.<sup id="cite_ref-219" class="reference"><a href="#cite_note-219"><span class="cite-bracket">[</span>219<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Statistical_trends">Statistical trends</h2></div> <p>The frequency of smoking cessation among smokers varies across countries. Smoking cessation increased in Spain between 1965 and 2000,<sup id="cite_ref-220" class="reference"><a href="#cite_note-220"><span class="cite-bracket">[</span>220<span class="cite-bracket">]</span></a></sup> in Scotland between 1998 and 2007,<sup id="cite_ref-221" class="reference"><a href="#cite_note-221"><span class="cite-bracket">[</span>221<span class="cite-bracket">]</span></a></sup> and in Italy after 2000.<sup id="cite_ref-222" class="reference"><a href="#cite_note-222"><span class="cite-bracket">[</span>222<span class="cite-bracket">]</span></a></sup> In contrast, in the U.S. the cessation rate was "stable (or varied little)" between 1998 and 2008,<sup id="cite_ref-223" class="reference"><a href="#cite_note-223"><span class="cite-bracket">[</span>223<span class="cite-bracket">]</span></a></sup> and in China smoking cessation rates declined between 1998 and 2003.<sup id="cite_ref-224" class="reference"><a href="#cite_note-224"><span class="cite-bracket">[</span>224<span class="cite-bracket">]</span></a></sup> </p><p>Nevertheless, in a growing number of countries there are now more ex-smokers than smokers.<sup id="cite_ref-Chapman-MacKenzie_31-1" class="reference"><a href="#cite_note-Chapman-MacKenzie-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> 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.<sup id="cite_ref-225" class="reference"><a href="#cite_note-225"><span class="cite-bracket">[</span>225<span class="cite-bracket">]</span></a></sup> As of 2020, the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> reports that the number of adults who smoke in the U.S. has fallen to 30.8 million.<sup id="cite_ref-226" class="reference"><a href="#cite_note-226"><span class="cite-bracket">[</span>226<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2></div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 22em;"> <ul><li><a href="/wiki/Breath_carbon_monoxide_monitor" class="mw-redirect" title="Breath carbon monoxide monitor">Breath carbon monoxide monitor</a></li> <li><a href="/wiki/Bupropion" title="Bupropion">Bupropion</a></li> <li><a href="/wiki/Coerced_abstinence" title="Coerced abstinence">Coerced abstinence</a></li> <li><a href="/wiki/Health_effects_of_tobacco" title="Health effects of tobacco">Health effects of tobacco</a></li> <li><a href="/wiki/Health_promotion" title="Health promotion">Health promotion</a></li> <li><a href="/wiki/Massachusetts_Tobacco_Cessation_and_Prevention_Program" title="Massachusetts Tobacco Cessation and Prevention Program">Massachusetts Tobacco Cessation and Prevention Program</a></li> <li><a href="/wiki/Nicotine_Anonymous" title="Nicotine Anonymous">Nicotine Anonymous</a></li> <li><a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">Nicotine replacement therapy</a></li> <li><a href="/wiki/Smoking_cessation_programs_in_Canada" class="mw-redirect" title="Smoking cessation programs in Canada">Smoking cessation programs in Canada</a></li> <li><a href="/wiki/Tobacco_cessation_clinics_in_India" title="Tobacco cessation clinics in India">Tobacco cessation clinics in India</a></li> <li><a href="/wiki/Tobacco_control" title="Tobacco control">Tobacco control</a></li> <li><a href="/wiki/Tobacco_Control_(journal)" title="Tobacco Control (journal)"><i>Tobacco Control</i></a> (journal)</li> <li><a href="/wiki/Truth_Initiative" title="Truth Initiative">Truth Initiative</a> (formerly American Legacy Foundation)</li> <li><a href="/wiki/U.S._government_and_smoking_cessation" title="U.S. government and smoking cessation">U.S. government and smoking cessation</a></li> <li><a href="/wiki/Vaping_cessation" title="Vaping cessation">Vaping cessation</a></li> <li><a href="/wiki/Varenicline" title="Varenicline">Varenicline</a></li> <li><a href="/wiki/Youth_Tobacco_Cessation_Collaborative" title="Youth Tobacco Cessation Collaborative">Youth Tobacco Cessation Collaborative</a></li> <li><a href="/wiki/World_No_Tobacco_Day" title="World No Tobacco Day">World No Tobacco Day</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="Bibliography">Bibliography</h2></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-nhs-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-nhs_1-0">^</a></b></span> <span 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no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output 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font-style: italic;"><a href="https://commons.wikimedia.org/wiki/Category:Smoking_cessation" class="extiw" title="commons:Category:Smoking cessation">Smoking cessation</a></span>.</div></div> </div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHenningfieldFantBuchhalterStitzer2005" class="citation journal cs1">Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML (2005). <a rel="nofollow" class="external text" href="https://doi.org/10.3322%2Fcanjclin.55.5.281">"Pharmacotherapy for nicotine dependence"</a>. <i>CA</i>. <b>55</b> (5): 281–99, quiz 322–3, 325. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.3322%2Fcanjclin.55.5.281">10.3322/canjclin.55.5.281</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16166074">16166074</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:25668093">25668093</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CA&rft.atitle=Pharmacotherapy+for+nicotine+dependence&rft.volume=55&rft.issue=5&rft.pages=281-99%2C+quiz+322-3%2C+325&rft.date=2005&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A25668093%23id-name%3DS2CID&rft_id=info%3Apmid%2F16166074&rft_id=info%3Adoi%2F10.3322%2Fcanjclin.55.5.281&rft.aulast=Henningfield&rft.aufirst=JE&rft.au=Fant%2C+RV&rft.au=Buchhalter%2C+AR&rft.au=Stitzer%2C+ML&rft_id=https%3A%2F%2Fdoi.org%2F10.3322%252Fcanjclin.55.5.281&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmoking+cessation" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHughesKeelyNaud2004" class="citation journal cs1">Hughes JR, Keely J, Naud S (January 2004). 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Englewood Cliffs, NJ: Prentice-Hall. Archived from the original on 2015-02-13.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=How+to+stop+smoking+in+five+days&rft.place=Englewood+Cliffs%2C+NJ&rft.pub=Prentice-Hall&rft.date=1964&rft.aulast=McFarland&rft.aufirst=JW&rft.au=Folkenberg%2C+EJ&rft_id=http%3A%2F%2Fwww.uhs.wisc.edu%2Fhealth-topics%2Ftobacco%2Fdocuments%2FFive_Day_Plan.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmoking+cessation" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: CS1 maint: unfit URL (<a href="/wiki/Category:CS1_maint:_unfit_URL" title="Category:CS1 maint: unfit URL">link</a>)</span></li></ul> </div> <p><br /> </p> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output 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.mw-parser-output .navbox{display:none!important}}</style></div><div role="navigation" class="navbox" aria-labelledby="Public_health" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Public_health" title="Template:Public health"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Public_health" title="Template talk:Public health"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Public_health" title="Special:EditPage/Template:Public health"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Public_health" style="font-size:114%;margin:0 4em"><a href="/wiki/Public_health" title="Public health">Public health</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">General</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Auxology" title="Auxology">Auxology</a></li> <li><a href="/wiki/Biological_hazard" title="Biological hazard">Biological hazard</a></li> <li><a href="/wiki/Chief_Medical_Officer" class="mw-redirect" title="Chief Medical Officer">Chief Medical Officer</a></li> <li><a href="/wiki/Cultural_competence_in_health_care" class="mw-redirect" title="Cultural competence in health care">Cultural competence</a></li> <li><a href="/wiki/Deviance_(sociology)" title="Deviance (sociology)">Deviance</a></li> <li><a href="/wiki/Environmental_health" title="Environmental health">Environmental health</a></li> <li><a href="/wiki/Eugenics" title="Eugenics">Eugenics</a> <ul><li><a href="/wiki/History_of_eugenics" title="History of eugenics">History of</a></li> <li><a href="/wiki/New_eugenics" title="New eugenics">Liberal</a></li></ul></li> <li><a href="/wiki/Euthenics" title="Euthenics">Euthenics</a></li> <li><a href="/wiki/Public_health_genomics" title="Public health genomics">Genomics</a></li> <li><a href="/wiki/Globalization_and_disease" title="Globalization and disease">Globalization and disease</a></li> <li><a href="/wiki/Harm_reduction" title="Harm reduction">Harm reduction</a></li> <li><a href="/wiki/Health_economics" title="Health economics">Health economics</a></li> <li><a href="/wiki/Health_literacy" title="Health literacy">Health literacy</a></li> <li><a href="/wiki/Health_policy" title="Health policy">Health policy</a> <ul><li><a href="/wiki/Health_system" title="Health system">Health system</a></li> <li><a href="/wiki/Health_care_reform" title="Health care reform">Health care reform</a></li></ul></li> <li><a href="/wiki/Housing_First" title="Housing First">Housing First</a></li> <li><a href="/wiki/Human_right_to_water_and_sanitation" title="Human right to water and sanitation">Human right to water and sanitation</a></li> <li><a href="/wiki/Management_of_depression" title="Management of depression">Management of depression</a> <ul><li><a href="/wiki/Public_health_law" title="Public health law">Public health law</a></li> <li><a href="/wiki/National_public_health_institutes" class="mw-redirect" title="National public health institutes">National public health institute</a></li></ul></li> <li><a href="/wiki/Health_politics" title="Health politics">Health politics</a></li> <li><a href="/wiki/Labor_rights" title="Labor rights">Labor rights</a></li> <li><a href="/wiki/Maternal_health" title="Maternal health">Maternal health</a></li> <li><a href="/wiki/Medical_anthropology" title="Medical anthropology">Medical anthropology</a></li> <li><a href="/wiki/Medical_sociology" title="Medical sociology">Medical sociology</a></li> <li><a href="/wiki/Mental_health" title="Mental health">Mental health</a> (<a href="/wiki/Minister_of_Mental_Health" title="Minister of Mental Health">Ministers</a>)</li> <li><a href="/wiki/Occupational_safety_and_health" title="Occupational safety and health">Occupational safety and health</a></li> <li><a href="/wiki/Pharmaceutical_policy" title="Pharmaceutical policy">Pharmaceutical policy</a></li> <li><a href="/wiki/Pollution" title="Pollution">Pollution</a> <ul><li><a href="/wiki/Air_pollution" title="Air pollution">Air</a></li> <li><a href="/wiki/Water_pollution" title="Water pollution">Water</a></li> <li><a href="/wiki/Soil_pollution" class="mw-redirect" title="Soil pollution">Soil</a></li> <li><a href="/wiki/Radioactive_contamination" title="Radioactive contamination">Radiation</a></li> <li><a href="/wiki/Light_pollution" title="Light pollution">Light</a></li></ul></li> <li><a href="/wiki/Prisoners%27_rights" title="Prisoners' rights">Prisoners' rights</a></li> <li><a href="/wiki/Public_health_intervention" title="Public health intervention">Public health intervention</a></li> <li><a href="/wiki/Public_health_laboratory" title="Public health laboratory">Public health laboratory</a></li> <li><a href="/wiki/Right_to_food" title="Right to food">Right to food</a></li> <li><a href="/wiki/Right_to_health" title="Right to health">Right to health</a></li> <li><a href="/wiki/Right_to_housing" title="Right to housing">Right to housing</a></li> <li><a href="/wiki/Right_to_rest_and_leisure" title="Right to rest and leisure">Right to rest and leisure</a></li> <li><a href="/wiki/Right_to_sit" title="Right to sit">Right to sit</a></li> <li><a href="/wiki/Security_of_person" title="Security of person">Security of person</a></li> <li><a href="/wiki/Sexual_and_reproductive_health" title="Sexual and reproductive health">Sexual and reproductive health</a></li> <li><a href="/wiki/Social_psychology" title="Social psychology">Social psychology</a></li> <li><a href="/wiki/Sociology_of_health_and_illness" title="Sociology of health and illness">Sociology of health and illness</a></li> <li><a href="/wiki/Unisex_changing_rooms" title="Unisex changing rooms">Unisex changing rooms</a></li> <li><a href="/wiki/Unisex_public_toilets" class="mw-redirect" title="Unisex public toilets">Unisex public toilets</a></li> <li><a href="/wiki/Workers%27_right_to_access_the_toilet" title="Workers' right to access the toilet">Workers' right to access the toilet</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Preventive_healthcare" title="Preventive healthcare">Preventive healthcare</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Behavior_change_(public_health)" title="Behavior change (public health)">Behavior change</a> <ul><li><a href="/wiki/Behavioural_change_theories" title="Behavioural change theories">Theories</a></li></ul></li> <li><a href="/wiki/Family_planning" title="Family planning">Family planning</a></li> <li><a href="/wiki/Health_promotion" title="Health promotion">Health promotion</a></li> <li><a href="/wiki/Human_nutrition" title="Human nutrition">Human nutrition</a> <ul><li><a href="/wiki/Healthy_diet" title="Healthy diet">Healthy diet</a></li> <li><a href="/wiki/Preventive_nutrition" title="Preventive nutrition">Preventive nutrition</a></li></ul></li> <li><a href="/wiki/Hygiene" title="Hygiene">Hygiene</a> <ul><li><a href="/wiki/Food_safety" title="Food safety">Food safety</a></li> <li><a href="/wiki/Hand_washing" title="Hand washing">Hand washing</a></li> <li><a href="/wiki/Infection_control" class="mw-redirect" title="Infection control">Infection control</a></li> <li><a href="/wiki/Oral_hygiene" title="Oral hygiene">Oral hygiene</a></li></ul></li> <li><a href="/wiki/Occupational_safety_and_health" title="Occupational safety and health">Occupational safety and health</a> <ul><li><a href="/wiki/Human_factors_and_ergonomics" class="mw-redirect" title="Human factors and ergonomics">Human factors and ergonomics</a></li> <li><a href="/wiki/Occupational_hygiene" title="Occupational hygiene">Hygiene</a></li> <li><a href="/wiki/Drug_policy" title="Drug policy">Controlled Drugs</a></li> <li><a href="/wiki/Injury_prevention" title="Injury prevention">Injury prevention</a></li> <li><a href="/wiki/Occupational_medicine" title="Occupational medicine">Medicine</a></li> <li><a href="/wiki/Occupational_health_nursing" title="Occupational health nursing">Nursing</a></li></ul></li> <li><a href="/wiki/Patient_safety" title="Patient safety">Patient safety</a> <ul><li><a href="/wiki/Patient_safety_organization" title="Patient safety organization">Organization</a></li></ul></li> <li><a href="/wiki/Pharmacovigilance" title="Pharmacovigilance">Pharmacovigilance</a></li> <li><a href="/wiki/Safe_sex" title="Safe sex">Safe sex</a></li> <li><a href="/wiki/Sanitation" title="Sanitation">Sanitation</a> <ul><li><a href="/wiki/Emergency_sanitation" title="Emergency sanitation">Emergency</a></li> <li><a href="/wiki/Fecal%E2%80%93oral_route" title="Fecal–oral route">Fecal–oral transmission</a></li> <li><a href="/wiki/Open_defecation" title="Open defecation">Open defecation</a></li> <li><a href="/wiki/Sanitary_sewer" title="Sanitary sewer">Sanitary sewer</a></li> <li><a href="/wiki/Waterborne_diseases" class="mw-redirect" title="Waterborne diseases">Waterborne diseases</a></li> <li><a href="/wiki/Sanitation_worker" title="Sanitation worker">Worker</a></li></ul></li> <li><a href="/wiki/School_hygiene" title="School hygiene">School hygiene</a></li> <li><a class="mw-selflink selflink">Smoking cessation</a></li> <li><a href="/wiki/Vaccination" title="Vaccination">Vaccination</a></li> <li><a href="/wiki/Vector_control" title="Vector control">Vector control</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Population_health" title="Population health">Population health</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Biostatistics" title="Biostatistics">Biostatistics</a></li> <li><a href="/wiki/Child_mortality" title="Child mortality">Child mortality</a></li> <li><a href="/wiki/Community_health" title="Community health">Community health</a></li> <li><a href="/wiki/Epidemiology" title="Epidemiology">Epidemiology</a></li> <li><a href="/wiki/Global_health" title="Global health">Global health</a></li> <li><a href="/wiki/Health_impact_assessment" title="Health impact assessment">Health impact assessment</a></li> <li><a href="/wiki/Health_system" title="Health system">Health system</a></li> <li><a href="/wiki/Infant_mortality" title="Infant mortality">Infant mortality</a></li> <li><a href="/wiki/List_of_open-source_health_software" title="List of open-source health software">Open-source healthcare software</a></li> <li><a href="/wiki/Multimorbidity" title="Multimorbidity">Multimorbidity</a></li> <li><a href="/wiki/Public_health_informatics" title="Public health informatics">Public health informatics</a></li> <li><a href="/wiki/Social_determinants_of_health" title="Social determinants of health">Social determinants of health</a> <ul><li><a href="/wiki/Commercial_determinants_of_health" title="Commercial determinants of health">Commercial determinants of health</a></li> <li><a href="/wiki/Health_equity" title="Health equity">Health equity</a></li> <li><a href="/wiki/Race_and_health" title="Race and health">Race and health</a></li></ul></li> <li><a href="/wiki/Social_medicine" title="Social medicine">Social medicine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Biological and<br />epidemiological statistics</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Case%E2%80%93control_study" title="Case–control study">Case–control study</a></li> <li><a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">Randomized controlled trial</a></li> <li><a href="/wiki/Relative_risk" title="Relative risk">Relative risk</a></li> <li><a href="/wiki/Statistical_hypothesis_testing" class="mw-redirect" title="Statistical hypothesis testing">Statistical hypothesis testing</a> <ul><li><a href="/wiki/Analysis_of_variance" title="Analysis of variance">Analysis of variance (ANOVA)</a></li> <li><a href="/wiki/Regression_analysis" title="Regression analysis">Regression analysis</a></li> <li><a href="/wiki/ROC_curve" class="mw-redirect" title="ROC curve">ROC curve</a></li> <li><a href="/wiki/Student%27s_t-test" title="Student's t-test">Student's <i>t</i>-test</a></li> <li><a href="/wiki/Z-test" title="Z-test"><i>Z</i>-test</a></li></ul></li> <li><a href="/wiki/List_of_statistical_packages" class="mw-redirect" title="List of statistical packages">Statistical software</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Infectious and epidemic<br />disease prevention</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Asymptomatic_carrier" title="Asymptomatic carrier">Asymptomatic carrier</a></li> <li><a href="/wiki/Epidemic" title="Epidemic">Epidemics</a> <ul><li><a href="/wiki/List_of_epidemics_and_pandemics" title="List of epidemics and pandemics">List</a></li></ul></li> <li><a href="/wiki/Notifiable_disease" title="Notifiable disease">Notifiable diseases</a> <ul><li><a href="/wiki/List_of_notifiable_diseases" title="List of notifiable diseases">List</a></li></ul></li> <li><a href="/wiki/Public_health_surveillance" title="Public health surveillance">Public health surveillance</a> <ul><li><a href="/wiki/Disease_surveillance" title="Disease surveillance">Disease surveillance</a></li></ul></li> <li><a href="/wiki/Quarantine" title="Quarantine">Quarantine</a></li> <li><a href="/wiki/Sexually_transmitted_infection" title="Sexually transmitted infection">Sexually transmitted infection</a></li> <li><a href="/wiki/Social_distancing" title="Social distancing">Social distancing</a></li> <li><a href="/wiki/Tropical_disease" title="Tropical disease">Tropical disease</a></li> <li><a href="/wiki/Vaccine_trial" title="Vaccine trial">Vaccine trial</a></li> <li><a href="/wiki/WASH" title="WASH">WASH</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Food hygiene and<br />safety management</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Food <ul><li><a href="/wiki/Food_additive" title="Food additive">Additive</a></li> <li><a href="/wiki/Food_chemistry" title="Food chemistry">Chemistry</a></li> <li><a href="/wiki/Food_engineering" title="Food engineering">Engineering</a></li> <li><a href="/wiki/Food_microbiology" title="Food microbiology">Microbiology</a></li> <li><a href="/wiki/Food_processing" title="Food processing">Processing</a></li> <li><a href="/wiki/Food_safety" title="Food safety">Safety</a></li> <li><a href="/wiki/Category:Food_safety_scandals" title="Category:Food safety scandals">Safety scandals</a></li></ul></li> <li><a href="/wiki/Good_agricultural_practice" title="Good agricultural practice">Good agricultural practice</a></li> <li><a href="/wiki/Good_manufacturing_practice" title="Good manufacturing practice">Good manufacturing practice</a> <ul><li><a href="/wiki/HACCP" class="mw-redirect" title="HACCP">HACCP</a></li> <li><a href="/wiki/ISO_22000" title="ISO 22000">ISO 22000</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Health behavioral<br />sciences</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Diffusion_of_innovations" title="Diffusion of innovations">Diffusion of innovations</a></li> <li><a href="/wiki/Health_belief_model" title="Health belief model">Health belief model</a></li> <li><a href="/wiki/Health_communication" title="Health communication">Health communication</a></li> <li><a href="/wiki/Health_psychology" title="Health psychology">Health psychology</a></li> <li><a href="/wiki/Positive_deviance" title="Positive deviance">Positive deviance</a></li> <li><a href="/wiki/PRECEDE%E2%80%93PROCEED_model" title="PRECEDE–PROCEED model">PRECEDE–PROCEED model</a></li> <li><a href="/wiki/Social_cognitive_theory" title="Social cognitive theory">Social cognitive theory</a></li> <li><a href="/wiki/Social_norms_approach" title="Social norms approach">Social norms approach</a></li> <li><a href="/wiki/Theory_of_planned_behavior" title="Theory of planned behavior">Theory of planned behavior</a></li> <li><a href="/wiki/Transtheoretical_model" title="Transtheoretical model">Transtheoretical model</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations,<br />education<br />and history</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Caribbean <ul><li><a href="/wiki/Caribbean_Public_Health_Agency" title="Caribbean Public Health Agency">Caribbean Public Health Agency</a></li></ul></li> <li>China <ul><li><a href="/wiki/Chinese_Center_for_Disease_Control_and_Prevention" title="Chinese Center for Disease Control and Prevention">Center for Disease Control and Prevention</a></li></ul></li> <li>Europe <ul><li><a href="/wiki/European_Centre_for_Disease_Prevention_and_Control" title="European Centre for Disease Prevention and Control">Centre for Disease Prevention and Control</a></li> <li><a href="/wiki/European_Parliament_Committee_on_the_Environment,_Public_Health_and_Food_Safety" title="European Parliament Committee on the Environment, Public Health and Food Safety">Committee on the Environment, Public Health and Food Safety</a></li></ul></li> <li>India <ul><li><a href="/wiki/Ministry_of_Health_and_Family_Welfare" title="Ministry of Health and Family Welfare">Ministry of Health and Family Welfare</a></li></ul></li> <li>Canada <ul><li><a href="/wiki/Health_Canada" title="Health Canada">Health Canada</a></li> <li><a href="/wiki/Public_Health_Agency_of_Canada" title="Public Health Agency of Canada">Public Health Agency</a></li></ul></li> <li>U.S. <ul><li><a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a></li> <li><a href="/wiki/Health_departments_in_the_United_States" title="Health departments in the United States">Health departments in the United States</a></li> <li><a href="/wiki/Council_on_Education_for_Public_Health" title="Council on Education for Public Health">Council on Education for Public Health</a></li> <li><a href="/wiki/United_States_Public_Health_Service" title="United States Public Health Service">Public Health Service</a></li></ul></li> <li><a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a></li> <li><a href="/wiki/World_Toilet_Organization" title="World Toilet Organization">World Toilet Organization</a></li> <li>(<a href="/wiki/List_of_national_public_health_agencies" title="List of national public health agencies">Full list</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Education</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Health_education" title="Health education">Health education</a></li> <li>Higher education <ul><li><a href="/wiki/Bachelor_of_Science_in_Public_Health" title="Bachelor of Science in Public Health">Bachelor of Science in Public Health</a></li> <li><a href="/wiki/Doctor_of_Public_Health" title="Doctor of Public Health">Doctor of Public Health</a></li> <li><a href="/wiki/Professional_degrees_of_public_health" title="Professional degrees of public health">Professional degrees of public health</a></li> <li><a href="/wiki/Category:Schools_of_public_health" title="Category:Schools of public health">Schools of public health</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sara_Josephine_Baker" title="Sara Josephine Baker">Sara Josephine Baker</a></li> <li><a href="/wiki/Samuel_Jay_Crumbine" title="Samuel Jay Crumbine">Samuel Jay Crumbine</a></li> <li><a href="/wiki/Carl_Rogers_Darnall" title="Carl Rogers Darnall">Carl Rogers Darnall</a></li> <li><a href="/wiki/Joseph_Lister" title="Joseph Lister">Joseph Lister</a></li> <li><a href="/wiki/Margaret_Sanger" title="Margaret Sanger">Margaret Sanger</a></li> <li><a href="/wiki/John_Snow_(physician)" class="mw-redirect" title="John Snow (physician)">John Snow</a></li> <li><a href="/wiki/Mary_Mallon" title="Mary Mallon">Typhoid Mary</a></li> <li><a href="/wiki/Radium_Girls" title="Radium Girls">Radium Girls</a></li> <li><a href="/wiki/Germ_theory_of_disease" title="Germ theory of disease">Germ theory of disease</a></li> <li><a href="/wiki/Social_hygiene_movement" title="Social hygiene movement">Social hygiene movement</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <b><a href="/wiki/Category:Public_health" title="Category:Public health">Category</a></b></li> <li><span class="noviewer" typeof="mw:File"><span title="Commons page"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/12px-Commons-logo.svg.png" decoding="async" width="12" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/18px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/24px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /></span></span> <b><a href="https://commons.wikimedia.org/wiki/Category:Public_health" class="extiw" title="commons:Category:Public health">Commons</a></b></li> <li><span class="noviewer" typeof="mw:File"><span title="WikiProject"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/16px-People_icon.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/24px-People_icon.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/37/People_icon.svg/32px-People_icon.svg.png 2x" data-file-width="100" data-file-height="100" /></span></span> <b><a href="/wiki/Wikipedia:WikiProject_Nursing" title="Wikipedia:WikiProject Nursing">WikiProject</a></b></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Tobacco_smoking" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Smoking_nav" title="Template:Smoking nav"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Smoking_nav" title="Template talk:Smoking nav"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Smoking_nav" title="Special:EditPage/Template:Smoking nav"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Tobacco_smoking" style="font-size:114%;margin:0 4em"><a href="/wiki/Tobacco_smoking" title="Tobacco smoking">Tobacco smoking</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Country<br />and region</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Africa</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Smoking_in_Egypt" title="Smoking in Egypt">Egypt</a></li> <li><a href="/wiki/Smoking_in_Nigeria" title="Smoking in Nigeria">Nigeria</a></li> <li><a href="/wiki/Smoking_in_South_Africa" title="Smoking in South Africa">South Africa</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Asia</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Smoking_in_Afghanistan" class="mw-redirect" title="Smoking in Afghanistan">Afghanistan</a></li> <li><a href="/wiki/Smoking_in_China" title="Smoking in China">China</a></li> <li><a href="/wiki/Smoking_in_East_Timor" title="Smoking in East Timor">East Timor</a></li> <li><a href="/wiki/Smoking_in_Hong_Kong" title="Smoking in Hong Kong">Hong Kong</a></li> <li><a href="/wiki/Tobacco_in_India" class="mw-redirect" title="Tobacco in India">India</a></li> <li><a href="/wiki/Smoking_in_Indonesia" title="Smoking in Indonesia">Indonesia</a></li> <li><a href="/wiki/Smoking_in_Iran" title="Smoking in Iran">Iran</a></li> <li><a href="/wiki/Smoking_in_Iraq" title="Smoking in Iraq">Iraq</a></li> <li><a href="/wiki/Smoking_in_Japan" title="Smoking in Japan">Japan</a></li> <li><a href="/wiki/Smoking_in_North_Korea" title="Smoking in North Korea">North Korea</a></li> <li><a href="/wiki/Smoking_in_South_Korea" title="Smoking in South Korea">South Korea</a></li> <li><a href="/wiki/Smoking_in_Macau" title="Smoking in Macau">Macau</a></li> <li><a href="/wiki/Smoking_in_Malaysia" title="Smoking in Malaysia">Malaysia</a></li> <li><a href="/wiki/Smoking_in_Pakistan" title="Smoking in Pakistan">Pakistan</a></li> <li><a href="/wiki/Smoking_in_the_Philippines" title="Smoking in the Philippines">Philippines</a></li> <li><a href="/wiki/Smoking_in_Saudi_Arabia" title="Smoking in Saudi Arabia">Saudi Arabia</a></li> <li><a href="/wiki/Smoking_in_Singapore" title="Smoking in Singapore">Singapore</a></li> <li><a href="/wiki/Smoking_in_Syria" title="Smoking in Syria">Syria</a></li> <li><a href="/wiki/Smoking_in_Taiwan" title="Smoking in Taiwan">Taiwan</a></li> <li><a href="/wiki/Smoking_in_Turkey" title="Smoking in Turkey">Turkey</a></li> <li><a href="/wiki/Smoking_in_Vietnam" title="Smoking in Vietnam">Vietnam</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Oceania</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Smoking_in_Australia" title="Smoking in Australia">Australia</a></li> <li><a href="/wiki/Smoking_in_New_Zealand" title="Smoking in New Zealand">New Zealand</a></li> <li class="mw-empty-elt"></li> <li><a href="/wiki/Smoking_in_Tokelau" title="Smoking in Tokelau">Tokelau</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Europe</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Smoking_in_Albania" title="Smoking in Albania">Albania</a></li> <li><a href="/wiki/Tobacco_policy_in_Armenia" title="Tobacco policy in Armenia">Armenia</a></li> <li><a href="/wiki/Smoking_in_Croatia" title="Smoking in Croatia">Croatia</a></li> <li><a href="/wiki/Smoking_in_Finland" title="Smoking in Finland">Finland</a></li> <li><a href="/wiki/Tobacco_in_France" class="mw-redirect" title="Tobacco in France">France</a></li> <li><a href="/wiki/Tobacco_in_Germany" class="mw-redirect" title="Tobacco in Germany">Germany</a></li> <li><a href="/wiki/Tobacco_in_Greece" class="mw-redirect" title="Tobacco in Greece">Greece</a></li> <li><a href="/wiki/Smoking_in_Hungary" title="Smoking in Hungary">Hungary</a></li> <li><a href="/wiki/Tobacco_in_Iceland" class="mw-redirect" title="Tobacco in Iceland">Iceland</a></li> <li><a href="/wiki/Smoking_in_Ireland" title="Smoking in Ireland">Ireland</a></li> <li><a href="/wiki/Smoking_in_Italy" title="Smoking in Italy">Italy</a></li> <li><a href="/wiki/Smoking_in_Latvia" title="Smoking in Latvia">Latvia</a></li> <li><a href="/wiki/Smoking_in_Norway" title="Smoking in Norway">Norway</a></li> <li><a href="/wiki/Tobacco_in_Russia" class="mw-redirect" title="Tobacco in Russia">Russia</a></li> <li><a href="/wiki/Smoking_in_Sweden" title="Smoking in Sweden">Sweden</a></li> <li><a href="/wiki/Smoking_in_Turkey" title="Smoking in Turkey">Turkey</a></li> <li><a href="/wiki/Tobacco_in_the_United_Kingdom" class="mw-redirect" title="Tobacco in the United Kingdom">United Kingdom</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">South America</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tobacco_in_Argentina" class="mw-redirect" title="Tobacco in Argentina">Argentina</a></li> <li><a href="/wiki/Tobacco_in_Brazil" class="mw-redirect" title="Tobacco in Brazil">Brazil</a></li> <li><a href="/wiki/Smoking_in_Colombia" title="Smoking in Colombia">Colombia</a></li> <li><a href="/wiki/Smoking_in_Ecuador" title="Smoking in Ecuador">Ecuador</a></li> <li><a href="/wiki/Smoking_in_Uruguay" title="Smoking in Uruguay">Uruguay</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">North America</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tobacco_in_Canada" class="mw-redirect" title="Tobacco in Canada">Canada</a></li> <li><a href="/wiki/Tobacco_in_Cuba" class="mw-redirect" title="Tobacco in Cuba">Cuba</a></li> <li><a href="/wiki/Tobacco_in_the_United_States" title="Tobacco in the United States">United States</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Religious_views_on_smoking" title="Religious views on smoking">Religion</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Smoking_in_Jewish_law" title="Smoking in Jewish law">Smoking in Jewish law</a></li> <li><a href="/wiki/Islamic_views_on_tobacco" title="Islamic views on tobacco">Islamic views on tobacco</a></li> <li><a href="/wiki/Tobacco_fatwa" class="mw-redirect" title="Tobacco fatwa">Tobacco fatwa</a></li> <li><a href="/wiki/Ceremonial_pipe" title="Ceremonial pipe">Ceremonial pipe</a></li> <li><a href="/wiki/Chanunpa" title="Chanunpa">Chanunpa</a></li> <li><a href="/wiki/Kinnikinnick" title="Kinnikinnick">Kinnikinnick</a></li> <li><a href="/wiki/Pipe_bag" title="Pipe bag">Pipe bag</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Health</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Health_effects_of_tobacco" title="Health effects of tobacco">Health effects of tobacco</a> (<a href="/wiki/Nicotine_poisoning" title="Nicotine poisoning">Nicotine poisoning</a></li> <li><a href="/wiki/Nicotine_withdrawal" title="Nicotine withdrawal">Nicotine withdrawal</a>)</li> <li><a href="/wiki/Passive_smoking" title="Passive smoking">Passive smoking</a></li> <li><a href="/wiki/Third-hand_smoke" title="Third-hand smoke">Third-hand smoke</a></li> <li><a href="/wiki/Prevalence_of_tobacco_use" title="Prevalence of tobacco use">Prevalence of tobacco use</a></li> <li><a href="/wiki/Schizophrenia_and_tobacco_smoking" title="Schizophrenia and tobacco smoking">Schizophrenia and smoking</a></li> <li><a href="/wiki/Sidestream_smoke" title="Sidestream smoke">Sidestream smoke</a></li> <li><a href="/wiki/Smokeless_tobacco_keratosis" title="Smokeless tobacco keratosis">Smokeless tobacco keratosis</a></li> <li><a href="/wiki/Smoker%27s_face" title="Smoker's face">Smoker's face</a></li> <li><a href="/wiki/Smoker%27s_melanosis" title="Smoker's melanosis">Smoker's melanosis</a></li> <li><a href="/wiki/Stomatitis_nicotina" title="Stomatitis nicotina">Stomatitis nicotina</a></li> <li><a href="/wiki/Smoking_age" class="mw-redirect" title="Smoking age">Smoking age</a></li> <li><a href="/wiki/Smoking_and_male_infertility" class="mw-redirect" title="Smoking and male infertility">Smoking and male infertility</a></li> <li><a class="mw-selflink selflink">Smoking cessation</a></li> <li><a href="/wiki/Tobacco-free_pharmacies" class="mw-redirect" title="Tobacco-free pharmacies">Tobacco-free pharmacies</a></li> <li><a href="/wiki/Tobacco_packaging_warning_messages" title="Tobacco packaging warning messages">Tobacco packaging warning messages</a></li> <li><a href="/wiki/WHO_Framework_Convention_on_Tobacco_Control" title="WHO Framework Convention on Tobacco Control">WHO Framework Convention on Tobacco Control</a> <ul><li><a href="/wiki/MPOWER_tobacco_control" title="MPOWER tobacco control">MPOWER</a></li> <li><a href="/wiki/Protocol_to_Eliminate_Illicit_Trade_in_Tobacco_Products" title="Protocol to Eliminate Illicit Trade in Tobacco Products">Protocol to Eliminate Illicit Trade in Tobacco Products</a></li></ul></li> <li><a href="/wiki/World_No_Tobacco_Day" title="World No Tobacco Day">World No Tobacco Day</a></li> <li><a href="/wiki/Youth_smoking" title="Youth smoking">Youth smoking</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Women_and_smoking" title="Women and smoking">Women and smoking</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Breastfeeding_difficulties#Tobacco_smoking" title="Breastfeeding difficulties">Breastfeeding difficulties</a></li> <li><a href="/wiki/Risk_factors_for_breast_cancer#Tobacco" title="Risk factors for breast cancer">Breast cancer</a></li> <li><a href="/wiki/Cervical_cancer#Causes" title="Cervical cancer">Cervical cancer</a></li> <li><a href="/wiki/Menopause#Additional_factors" title="Menopause">Menopause</a></li> <li><a href="/wiki/Ptosis_(breasts)#Causes" title="Ptosis (breasts)">Ptosis of the breast</a></li> <li><a href="/wiki/Smoking_and_female_infertility" class="mw-redirect" title="Smoking and female infertility">Smoking and female infertility</a></li> <li><a href="/wiki/Smoking_and_pregnancy" title="Smoking and pregnancy">Smoking and pregnancy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Smoking_ban" title="Smoking ban">Smoking ban</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Inflight_smoking" title="Inflight smoking">Inflight smoking</a></li> <li><a href="/wiki/List_of_smoking_bans" title="List of smoking bans">List of smoking bans</a></li> <li><a href="/wiki/Smoking_bans_in_private_vehicles" title="Smoking bans in private vehicles">Smoking bans in private vehicles</a></li> <li><a href="/wiki/Tobacco-free_college_campuses" title="Tobacco-free college campuses">Tobacco-free college campuses</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/List_of_smoking_bans#Smoking_bans_by_country" title="List of smoking bans">Country and region</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_smoking_bans_in_Australia" title="List of smoking bans in Australia">Australia</a></li> <li><a href="/wiki/Smoking_ban_in_England" class="mw-redirect" title="Smoking ban in England">England</a></li> <li><a href="/wiki/Loi_%C3%89vin" title="Loi Évin">France</a></li> <li><a href="/wiki/List_of_smoking_bans_in_the_United_States" title="List of smoking bans in the United States">United States</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chain_smoking" title="Chain smoking">Chain smoking</a></li> <li><a href="/wiki/Tobacco_consumption_by_country" class="mw-redirect" title="Tobacco consumption by country">Tobacco consumption by country</a></li> <li><a href="/wiki/History_of_smoking" title="History of smoking">History of smoking</a></li> <li><a href="/wiki/Smoking_cap" title="Smoking cap">Smoking cap</a></li> <li><a href="/wiki/Smokeasy" title="Smokeasy">Smokeasy</a></li> <li><a href="/wiki/Smoking_fetishism" title="Smoking fetishism">Smoking fetishism</a></li> <li><a href="/wiki/Smoking_in_association_football" title="Smoking in association football">Smoking in association football</a></li> <li><a href="/wiki/Smoking_jacket" title="Smoking jacket">Smoking jacket</a></li> <li><a href="/wiki/Tobacco_pipe" title="Tobacco pipe">Tobacco pipe</a></li> <li><a href="/wiki/Smoking_room" title="Smoking room">Smoking room</a></li> <li><a href="/wiki/Nicotine_marketing" title="Nicotine marketing">Nicotine marketing</a></li> <li><a href="/wiki/Tobacco_industry" title="Tobacco industry">Tobacco industry</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span 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