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JAMA Patient Page
July 6, 2021

Ways to Quit Smoking

Author Affiliations
  • 1Fishbein Fellow, JAMA
JAMA. 2021;326(1):96. doi:10.1001/jama.2021.7239

Tobacco smoking is the leading cause of preventable death, disease, and disability in the US.

Quitting smoking reduces the risk of developing lung cancer, chronic obstructive lung disease, heart disease, and many other chronic illnesses. Because of the highly addictive nature of nicotine, quit rates are very low without treatment. Although behavioral counseling and medications can both increase quit rates, combining these treatments provides the highest success rates for smoking cessation.

Recommended Behavioral Interventions

Effective behavioral techniques to help people quit smoking include advice from a doctor, nurse, or smoking cessation specialist, either individually or in a group session. Counseling can also be done by telephone or through other mobile or app-based interventions. Some resources include:

  • Telephone-based resources

    • Free quit help: 1-800-QUIT-NOW

    • In Spanish: 1-855-DÉJELO-YA

  • Web-based support (see the For More Information box)

  • Text messaging programs, such as available at smokefree.gov/tools-tips/text-programs

  • Smartphone app support, such as the National Cancer Institute’s quitSTART app

Recommended Medications for Smoking Cessation in Nonpregnant Adults

Three medications have US Food and Drug Administration (FDA) approval for treatment of smoking dependence: (1) varenicline (taken orally); (2) nicotine replacement therapy (transdermal patch, gum, lozenge, inhaler, or nasal spray); and (3) sustained-release bupropion hydrochloride (taken orally).

The standard treatment duration with smoking cessation medications is 6 to 12 weeks, but use of tobacco cessation medications for longer than 12 weeks can improve quit rates.

Choice of Initial Medication Regimen for Smoking Cessation

Choice of medication is based on patient preference, underlying medical conditions, and allergy or intolerance to medications. In the general population, varenicline appears more effective compared with nicotine replacement therapy or bupropion. Varenicline and a nicotine patch used together may increase smoking cessation. The combination of a long-acting nicotine replacement therapy (nicotine patch) with a short-acting form (gum, lozenge, inhaler, or nasal spray) is more effective than either used alone.

Potential Side Effects of Smoking Cessation Medications

Patients taking nicotine replacement therapy may experience nausea, vomiting, and insomnia. The nicotine patch may also cause local skin irritation. Side effects of varenicline may include nausea, headache, fatigue, insomnia, and abnormal dreams. Bupropion should be avoided in patients with a history of seizures.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: US Preventive Services Task Force. Interventions for tobacco smoking cessation in adults, including pregnant persons. JAMA. 2021;325(3):265-279. doi:10.1001/jama.2020.25019

Leone FT, Zhang Y, Evers-Casey S, et al. Initiating pharmacologic treatment in tobacco-dependent adults. Am J Respir Crit Care Med. 2020;202(2):e5-e31. doi:10.1164/rccm.202005-1982ST

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