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Cited by 361Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

Treatment of Tobacco Smoking: A Review

Rigotti, Nancy A., Kruse, Gina R., Livingstone-Banks, Jonathan, Hartmann-Boyce, Jamie·2022·JAMA
DOI 10.1001/jama.2022.0395
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Abstract

IMPORTANCE: More deaths in the US are attributed to cigarette smoking each year than to any other preventable cause. Approximately 34 million people and an estimated 14% of adults in the US smoke cigarettes. If they stopped smoking, they could reduce their risk of tobacco-related morbidity and mortality and potentially gain up to 10 years of life. OBSERVATIONS: Tobacco smoking is a chronic disorder maintained by physical nicotine dependence and learned behaviors. Approximately 70% of people who smoke cigarettes want to quit smoking. However, individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence. Both behavioral counseling and pharmacotherapy while using nicotine replacement therapy (NRT) products, varenicline, or bupropion are effective treatments when used individually, but they are most effective when combined. In a meta-analysis including 19 488 people who smoked cigarettes, the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. The EAGLES trial, a randomized double-blind clinical trial of 8144 people who smoked, directly compared the efficacy and safety of varenicline, bupropion, nicotine patch, and placebo and found a significantly higher 6-month quit rate for varenicline (21.8%) than for bupropion (16.2%) and the nicotine patch (15.7%). Each therapy was more effective than placebo (9.4%). Combining a nicotine patch with other NRT products is more effective than use of a single NRT product. Combining drugs with different mechanisms of action, such as varenicline and NRT, has increased quit rates in some studies compared with use of a single product. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings. CONCLUSIONS AND RELEVANCE: Approximately 34 million people in the US smoke cigarettes and could potentially gain up to a decade of life expectancy by stopping smoking. First-line therapy should include both pharmacotherapy and behavioral support, with varenicline or combination NRT as preferred initial interventions.

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Authors
Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J.
Affiliations
  • Harvard University (US)
  • Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2022-02-08
Volume
327
Issue
6
Pages
566
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2022.0395
OpenAlex
W4210930773
Cited by
361
References
77
Citations by year
2026: 82 · 2025: 86 · 2024: 95 · 2023: 74 · 2022: 24
FWCI
9.60
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
tobacco smoking cessation, nicotine dependence, varenicline, bupropion, nicotine replacement therapy, nicotine patch, behavioral counseling, combination pharmacotherapy, quit rates, brief advice
MeSH terms
Varenicline, Tobacco Smoking, Smoking Cessation Agents, Behavior Therapy, Drug Therapy, Combination, Humans, Smoking Cessation, Bupropion, Tobacco Use Cessation Devices, Electronic Nicotine Delivery Systems

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