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Behavioral approaches to smoking cessation

Elyse R Park, PhD, MPH
Section Editors
Mark D Aronson, MD
James K Stoller, MD, MS
Deputy Editor
Judith A Melin, MA, MD, FACP


Each year, approximately two out of every three smokers make an attempt to quit [1]. Health care clinicians miss many opportunities to provide counseling for smoking cessation despite patient interest and the demonstrated efficacy of brief counseling in office practice [2]. An analysis of 2001 to 2004 National Ambulatory Medical Care Survey (NAMCS) data showed that approximately 80 percent of smokers did not receive physician counseling to quit during an office visit [2,3]. The low rates of counseling are unfortunate, as one study based at several primary care practices found that one in five smokers attending a routine primary care appointment were willing to make a serious quit attempt with the help of treatment that incorporated evidence-based counseling and some form of pharmacologic aide [4].

Meta-analysis and systematic reviews of clinical trials have found that a combination of behavioral counseling and pharmacotherapy produce the best results for smoking cessation [5-7]. In the United States, insurance plans are required to cover tobacco-cessation interventions, including behavioral counseling and medications approved by the US Food and Drug Administration (FDA) [8].

The behavioral approach to smoking cessation will be discussed in this topic. An overview of smoking cessation, including the 5 A's approach (table 1 and table 2), and pharmacologic therapy for smoking cessation, are discussed separately. (See "Overview of smoking cessation management in adults" and "Pharmacotherapy for smoking cessation in adults".)


For every patient at every clinic visit, we suggest using a clinician intervention model called the "5 A's" (table 1). This model encourages clinicians to ask patients about smoking, advise all smokers to quit, assess their readiness to quit, assist them with their smoking cessation effort (table 2), and arrange for follow-up visits or contact. (See "Overview of smoking cessation management in adults".)


All smokers who are ready to quit should be offered assistance in quitting that includes referral to the most intensive smoking cessation counseling program that is available and acceptable to the smoker. All smokers making a quit attempt should receive behavioral counseling. Behavioral counseling strategies that are elements of successful smoking cessation treatment include practical counseling (problem solving/skills training) and intratreatment supportive intervention (social support delivered as part of treatment) [9]. Ideally, these elements should be included in a treatment plan.

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Literature review current through: Nov 2017. | This topic last updated: Apr 25, 2016.
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