Cigarette smoking is the leading preventable cause of mortality. Smokers who stop smoking reduce their risk of developing and dying from tobacco-related diseases [1,2]. Approximately 70 percent of smokers say in surveys that they want to quit, and over 40 percent of smokers report that they tried to quit in the past year and intentionally did not smoke for at least one day . However, the long-term success rate of any one unaided quit attempt is low, with only 3 to 7 percent of smokers who make an attempt still abstinent one year later. With optimal treatment, one-year abstinence rates after a single quit attempt can exceed 30 percent, yet only 25 percent of smokers who try to quit seek help and even fewer use the most effective treatments [3,4].
Meta-analyses of clinical trials have found that behavioral counseling and pharmacotherapy (with nicotine replacement, bupropion, or varenicline) each has strong evidence of efficacy for smoking cessation, and that the combination of the two methods produces the best results [5,6].
This topic provides an overview of smoking cessation management in adults, including the choice of therapy and how to implement treatment. Management of smoking cessation in adolescents and pregnant women is discussed separately. (See "Management of smoking cessation in adolescents" and "Cigarette smoking and pregnancy", section on 'Smoking cessation'.)
The patterns of tobacco use and behavioral and pharmacologic treatments for smoking cessation are presented in detail separately. (See "Patterns of tobacco use" and "Smoking cessation counseling strategies in primary care" and "Pharmacotherapy for smoking cessation in adults".)
ASSESSMENT OF USE AND EXPOSURE
The United States Preventive Health Services guidelines recommend that tobacco use status of every patient treated in a healthcare setting be assessed and documented at every visit . This practice has been shown to increase the likelihood of smoking-related discussions between patients and physicians and to increase smoking cessation rates [8-10].