|Year : 2016 | Volume
| Issue : 1 | Page : 1-8
Methods of smoking cessation
Apexa B Patel1, Advaita B Patel2, Baldev V Patel3
1 College of Dental Sciences and Research Centre, Ahmedabad, Gujarat, India
2 Department of Pharmaceutical Chemistry, Kalol Institute of Pharmacy, Kalol, Gujarat, India
3 Department of Microbiology, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
|Date of Web Publication||4-Aug-2016|
Apexa B Patel
College of Dental Sciences and Research Centre, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Smoking is the leading preventable cause of morbidity and mortality worldwide. Cessation of smoking significantly reduces the risk of dying from tobacco-related diseases such as oral cancer, heart diseases, and lung cancer. Since smoking is considered to be a major health hazard in the world, dentists and health-care workers need to consider it seriously and assist their patients in smoking cessation. This review article summarizes different smoking cessation methods, withdrawal symptoms and health benefits due to smoking cessation.
Keywords: Nicotine, nicotine replacement therapy, smoking, smoking cessation, tobacco
|How to cite this article:|
Patel AB, Patel AB, Patel BV. Methods of smoking cessation. J Nat Accred Board Hosp Healthcare Providers 2016;3:1-8
| Introduction|| |
Smoking is a practice in which a substance is burned and the resulting smoke is breathed in to be tasted and absorbed into the bloodstream. Smoking is primarily practiced as a route of administration for recreational drug use as the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. Most commonly used substance for smoking is the dried leaves of the tobacco plant which are rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Cigarettes are primarily manufactured by industry but also can be hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers, and bongs.
| Smoking Cessation|| |
The process of discontinuing tobacco smoking is called smoking cessation. Nicotine of tobacco is addictive,  which makes the process of quitting very prolonged and difficult. Seventy percent of smokers would like to quit smoking, and 50% report attempting to quit within the past year. 
| Methods of Smoking Cessation|| |
Many different methods can be used for smoking cessation which includes quitting without assistance such as cold turkey or cut down then quit, medications such as nicotine replacement therapy (NRT) or varenicline, and behavioral counseling. The majority of smokers who try to quit do so without assistance, though only 3-6% of quit attempts without assistance are successful.  the use of medications and behavioral counseling both increase the success rates, and a combination of both medication and behavioral interventions has been shown to be even more effective.  Different methods for smoking cessation are shown in [Table 1].
The most frequent unassisted methods are as follows:
- Cold turkey means an abrupt withdrawal from an addictive drug, and in this context indicates sudden and complete cessation of all nicotine use
- Gradually decreased number of cigarettes. 
Nicotine replacement therapy
Five medications approved by the US Food and Drug Administration (FDA) deliver nicotine in a form that does not involve the risks of smoking. NRT are used for a short period of time and should be tapered down to a low dose before stopping. The five NRT medications for smoking cessation are shown in [Figure 1]: 
- Transdermal nicotine patches
First-line medication for smoking cessation. It has shown in many studies to increase long-term success rates. People who take bupropion should be monitored for any unusual mood hanges. Bupropion also increases the risk of seizures, and it should not be used in people with a seizure disorder.
It has also been shown to increase smoking cessation success rates. Other antidepressants such as selective serotonin reuptake inhibitors and St. John's wort have not been consistently shown to be effective for smoking cessation. 
It decreases the urge to smoke and reduces withdrawal symptoms and is therefore considered a first-line medication for smoking cessation. 
A systematic review found that varenicline had higher success rates than bupropion.  A 2011 Cochrane review of 15 studies also found that varenicline was significantly superior to bupropion at 1 year but that varenicline and nicotine patches produced the same level of abstinence at 24 weeks.  A 2011 review of double-blind studies found that varenicline has increased the risk of serious adverse cardiovascular events compared with placebo.  Varenicline may cause neuropsychiatric side effects; for example, in 2008 the UK Medicines and Healthcare products Regulatory Agency issued a warning about possible suicidal thoughts and suicidal behavior associated with varenicline. 
It 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. ,
Studies indicate an 80% success rate from consuming psychedelic mushrooms when it is administered after careful preparation and in a therapeutic context, psilocybin can lead to deep reflection about one's life and spark motivation to change. 
Cut down to quit
Gradual reduction involves slowly reducing one's daily intake of nicotine. This can theoretically be accomplished through repeated changes to cigarettes with lower levels of nicotine by gradually reducing the number of cigarettes smoked each day or by smoking only a fraction of a cigarette on each occasion. A 2009 systematic review by researchers at the University of Birmingham found that gradual NRT could be effective in smoking cessation. , 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 6 months from the quit day, suggesting that people who want to quit can choose between these two methods. 
Set a quit plan and quit date
Most smoking cessation resources such as the CDC  and Mayo Clinic  encourage smokers to create a quit plan, including setting a quit date, which helps them in planning ahead for challenges from smoking cessation. A quit plan can improve a smoker's chance of a successful quit ,, as can as 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  and calling state quitlines. 
A Cochrane review found evidence that community interventions using "multiple channels to provide reinforcement, support, and norms for not smoking" had an effect on smoking cessation outcomes among adults.  Specific methods used in the community to encourage smoking cessation among adults include:
- Policies making workplaces and public places smoke-free. It is estimated that "comprehensive clean indoor laws" can increase smoking cessation rates by 12-38%.  In 2008, the New York State of Alcoholism and Substance Abuse Services banned smoking by patients, staff, and volunteers at 1300 addiction treatment centers 
- Voluntary rules making homes smoke-free, which will help in promoting smoking cessation 
- Initiatives to educate the people regarding the health effects of second-hand smoke
- Increasing the price of tobacco products, for example, by taxation. The US Task Force on Community Preventive Services found "strong scientific evidence" that it is effective in increasing tobacco use cessation.  It is estimated that an increase in price of 10% will increase smoking cessation rates by 3-5% 
- Mass media campaigns. The US Task Force on Community Preventive Services declared that "strong scientific evidence" existed for these when "combined with other interventions"  but a Cochrane review concluded that it was "difficult to establish their independent role and value." 
- Great American Smokeout is an annual event that invites smokers to quit for 1 day, hoping they will be able to extend this forever
- The World Health Organization's World No Tobacco Day is held on May 31 each year
- Smoking-cessation support is often offered over the internet, over the telephone quitlines , (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 counseling or self-help and that telephone cessation support with medication is more effective than medication alone 
- Group or individual psychological support can help people who want to quit. This form of counseling can be effective alone; combining it with medication is more effective, and the number of sessions of support with medication correlates with effectiveness. , The counseling styles that have been effective in smoking cessation activities include motivational interviewing, ,, cognitive behavioral therapy,  and acceptance and commitment therapy 
- 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 a part of a group 
- The transtheoretical model including "stages of change" has been used in tailoring smoking cessation methods to individuals. ,,, However, a 2010 Cochrane review concluded that "stage-based self-help interventions and individual counseling were neither more nor less effective than their nonstage-based equivalents." 
Self-help modalities for smoking cessation include the following:
- In-person self-help groups such as nicotine anonymous ,, or electronic self-help groups such as stomp it out 
- Newsgroups: The Usenet group alt.support.stop-smoking has been used by people quitting smoking as a place to go to for support from others 
- Interactive web-based and stand-alone computer programs and online communities which assist participants in quitting. For example, "quit meters" keep track of statistics such as how long a person has remained abstinent.  In the 2008 US Guideline, there was no meta-analysis of computerized interventions, but they were described as "highly promising. " A meta-analysis published in 2009,  a Cochrane review published in 2010,  and a 2011 systematic review  found the evidence base for such interventions weak
- Mobile phone-based interventions: A 2016 Cochrane review stated that cumulative scientific evidence indicates "a beneficial impact of mobile phone-based smoking cessation interventions on 6-month cessation outcomes… in high-income countries with good tobacco control policies" 
- Interactive web-based programs combined with mobile phone: Two randomized control trials documented long-term treatment effects of such interventions ,
- Self-help books such as Allen Carr's easy way to stop smoking 
- Spirituality: 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. 
Various methods exist which 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 the use of monitoring throughout an effort to quit can increase motivation to quit. ,
- Breath carbon monoxide monitoring: because carbon monoxide (CO) is a significant component of cigarette smoke, a breath CO monitor can be used to detect recent cigarette use. CO concentration in breath has been shown to be directly correlated with the CO concentration in blood known as percent carboxyhemoglobin. The value of demonstrating blood CO concentration to a smoker through a noninvasive breath sample is that it links the smoking habit with the physiological harm associated with smoking.  Within hours of quitting, CO concentrations show a noticeable decrease, and this can be encouraging for someone working to quit. Breath CO monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback, similar to the way in which other diagnostic tools such as the stethoscope, the blood pressure cuff, and the cholesterol test have been used by treatment professionals in medicine 
- Cotinine: A metabolite of nicotine, cotinine is present in smokers. Like CO a cotinine test can serve as a reliable biomarker to determine smoking status.  Cotinine levels can be tested through urine, saliva, blood, or hair samples, with one of the main concerns of cotinine testing being the invasiveness of typical sampling methods.
While both measures offer high sensitivity and specificity, they differ in usage method and cost. As an example, breath CO monitoring is noninvasive, while cotinine testing relies on a bodily fluid. These two methods can be used either alone or together, for example, in a situation where abstinence verification needs additional confirmation. 
Competitions and incentives
One 2008 Cochrane review concluded that "incentives and competitions have not been shown to enhance long-term cessation rates." A different 2008 Cochrane review found that one type of competition, "Quit and Win," did increase quit rates among participants. 
Interventions delivered via health-care providers and health-care systems have been shown to help in smoking cessation among people who visit those providers.
- "Multicomponent interventions were defined as those that combined two or more of the following strategies known as the '5 As':" ,,,,,
- Ask - Systematically identify all tobacco users at every visit
- Advise - Strongly urge all tobacco users to quit
- Assess - Determine willingness to make a quit attempt
- Assist - Aid the patient in quitting (provide counseling-style support and medication)
- Arrange - Ensure follow-up contact [Figure 2].
Substitutes for cigarettes
NRT includes products that contain nicotine but not a tobacco to aid cessation of smoking. These include nicotine lozenges that are sucked, nicotine gum and inhalers, nicotine patches, as well as electronic cigarette. In 2014 The Royal College of Physicians in London published an article advocating the use of electronic cigarettes as a smoking cessation tool.  Chewing cinnamon sticks or gum has been recommended when trying to quit the use of tobacco [Figure 2]. 
Acupuncture has been explored as an adjunct treatment method for smoking cessation. 
A 2006 book reviewing the scientific literature on aromatherapy identified only one study on smoking cessation and aromatherapy; the study found that "inhalation of vapor from black pepper extract reduces smoking withdrawal symptoms." 
Hypnosis involves the hypnotherapist suggesting to the patient the unpleasant outcomes of smoking.  Clinical trials studying hypnosis and hypnotherapy as a method for smoking cessation have been inconclusive; ,, 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. 
Many herbs have been studied as a method for smoking cessation, including lobelia and St John's wort.  The results are inconclusive, but St. John's wort shows few adverse events. Lobelia has been used to treat respiratory diseases like asthma and bronchitis and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the FDAs Poisonous Plant Database.  Lobelia can still be found in many products sold for smoking cessation and should be used with caution.
There is little smoking in Sweden, which is reflected in the very low cancer rates for Swedish men. The use of snus (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. 
| Methods of Smoking Cessation in Children and Adolescents|| |
Methods used with children and adolescents include the following:
- Motivational enhancement 
- Psychological support 
- Youth anti-tobacco activities, such as sport involvement
- School-based curricula, such as life-skills training
- School-based nurse counseling sessions 
- Access reduction to tobacco
- Anti-tobacco media
- Family communication.
| Pregnant Women|| |
Smoking during pregnancy can cause adverse health effects in both the woman and the fetus. The 2008 US Guideline determined that "person-to-person psychosocial interventions" increased abstinence rates in pregnant women who smoke to 13.3%, compared with 7.6% in usual care. Mothers who smoke during pregnancy have a greater tendency toward premature births. Their babies are often underdeveloped, have smaller organs, and weigh much less compared with the normal baby. In addition, these babies have worse immune systems, making them more susceptible to many diseases in early childhood, such as middle ear inflammations and asthmatic bronchitis which can bring about a lot of agony and suffering. As well, there is a high chance that they will become smokers themselves when grown up. It is a widely spread myth that a female smoker can cause harm to her fetus by quitting immediately upon discovering that she is with child. Though this idea does seem to follow logic, it is not based on any medical study or fact. 
| Withdrawal Symptoms Due to Smoking Cessation|| |
Because nicotine is addictive, quitting smoking leads to symptoms of nicotine withdrawal such as craving, anxiety and irritability, depression, and weight gain.  Professional smoking cessation support methods generally endeavor to address both nicotine addiction and nicotine withdrawal symptoms [Figure 3].
| Health Benefits from Smoking Cessation|| |
Tobacco's detrimental health effects can be reduced or largely removed through smoking cessation. The health benefits over time of stopping smoking include [Figure 3]: 
- Within 20 min after quitting, blood pressure and heart rate decrease
- Within 12 h, CO levels in the blood decrease to normal
- Within 48 h, nerve endings and sense of smell and taste both start recovering
- Within 3 months, circulation and lung function improve
- Within 9 months, there are decreases in cough and shortness of breath
- Within 1 year, the risk of coronary heart disease is cut in half
- Within 5 years, the risk of stroke falls to the same as a nonsmoker and the risks of many cancers such as mouth, throat, esophagus, bladder, and cervix decrease significantly
- Within 10 years, the risk of dying from lung cancer is cut in half,  and the risks of larynx and pancreas cancers decrease
- Within 15 years, the risk of coronary heart disease drops to the level of a nonsmoker
- Lowered risk for developing chronic obstructive pulmonary disease.
| Conclusion|| |
Smoking cessation is always beneficial for health. The common notion among the people who smoke is that they might feel more miserable when they discontinue the smoking, but the current evidence clearly suggests that smoking cessation will result in a healthier mental and physical health. With the appropriate use of pharmacotherapy such as NRT, there is a huge chance of successfully quitting. However, evidence suggests that a combination of psychotherapy and medication will have a higher chance of success than either of them taken alone.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guide To Quitting Smoking. American Cancer Society; 31 January, 2011. Last retrieved on 2016 May 05].
Centers for Disease Control and Prevention (CDC). Quitting smoking among adults - United States, 2001-2010. MMWR Morb Mortal Wkly Rep 2011;60:1513-9.
Rigotti NA. Strategies to help a smoker who is struggling to quit. JAMA 2012;308:1573-80.
Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2012;10:CD008286.
Fiore MC, Novotny TE, Pierce JP, Giovino GA, Hatziandreu EJ, Newcomb PA, et al
. Methods used to quit smoking in the United States. Do cessation programs help? JAMA 1990;263:2760-5.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2008;1:CD000146.
Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014;1:CD000031.
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2011;2:CD006103.
Singh S, Loke YK, Spangler JG, Furberg CD. Risk of serious adverse cardiovascular events associated with varenicline: A systematic review and meta-analysis. CMAJ 2011;183:1359-66.
Gourlay SG, Stead LF, Benowitz NL. Clonidine for smoking cessation. Cochrane Database Syst Rev 2004;3:CD000058.
Fiore MC, Jaén CR, Baker TB, Bailey WC, Goldstein MG, Heyman RB. Clinical practice guideline: Treating tobacco use and dependence: 2008 update (PDF). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2008. Available from: http://bphc.hrsa.gov/buckets/treatingtobacco.pdf
. [Last retrieved on 2016 Feb 16].
Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: Systematic review and meta-analysis. BMJ 2009;338:b1024.
Lindson-Hawley N, Aveyard P, Hughes JR. Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database Syst Rev 2012;11:CD008033.
Smit ES, Hoving C, Schelleman-Offermans K, West R, de Vries H. Predictors of successful and unsuccessful quit attempts among smokers motivated to quit. Addict Behav 2014;39:1318-24.
de Vries H, Eggers SM, Bolman C. The role of action planning and plan enactment for smoking cessation. BMC Public Health 2013;13:393.
Bolman C, Eggers SM, van Osch L, Te Poel F, Candel M, de Vries H. Is Action planning helpful for smoking cessation? Assessing the Effects of action planning in a web-based computer-tailored intervention. Subst Use Misuse 2015;50:1249-60.
Ayers JW, Althouse BM, Johnson M, Cohen JE. Circaseptan (weekly) rhythms in smoking cessation considerations. JAMA Intern Med 2014;174:146-8.
Erbas B, Bui Q, Huggins R, Harper T, White V. Investigating the relation between placement of Quit antismoking advertisements and number of telephone calls to Quitline: A semiparametric modelling approach. J Epidemiol Community Health 2006;60:180-2.
Secker-Walker RH, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database Syst Rev 2002;3:CD001745.
Lemmens V, Oenema A, Knut IK, Brug J. Effectiveness of smoking cessation interventions among adults: A systematic review of reviews. Eur J Cancer Prev 2008;17:535-44.
Centers for Disease Control and Prevention (CDC). State-specific prevalence of smoke-free home rules - United States, 1992-2003. MMWR Morb Mortal Wkly Rep 2007;56:501-4.
Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, et al
. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001;20 2 Suppl: 16-66.
Bala MM, Strzeszynski L, Topor-Madry R, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev 2013;6:CD004704.
Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, et al.
Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med 2002;347:1087-93.
Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H. Factors related to abstinence in a telephone helpline for smoking cessation. Eur J Public Health 2004;14:306-10.
Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev 2006;3:CD002850.
Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev 2005;2:CD001007.
Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2005;2:CD001292.
Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010;1:CD006936.
Hettema JE, Hendricks PS. Motivational interviewing for smoking cessation: A meta-analytic review. J Consult Clin Psychol 2010;78:868-84.
Heckman CJ, Egleston BL, Hofmann MT. Efficacy of motivational interviewing for smoking cessation: A systematic review and meta-analysis. Tob Control 2010;19:410-6.
Perkins KA, Conklin CA, Levine MD. Cognitive-behavioral Therapy for Smoking Cessation: A Practical Guidebook to the Most Effective Treatment. New York: Routledge; 2008.
Ruiz FJ. A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther 2010;10:125-62.
Prochaska JO, Velicer WF, DiClemente CC, Fava J. Measuring processes of change: Applications to the cessation of smoking. J Consult Clin Psychol 1988;56:520-8.
DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol 1991;59:295-304.
Velicer WF, Prochaska JO, Rossi JS, Snow MG. Assessing outcome in smoking cessation studies. Psychol Bull 1992;111:23-41.
Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol 1993;12:399-405.
Cahill K, Lancaster T, Green N. Stage-based interventions for smoking cessation. Cochrane Database Syst Rev 2010;11:CD004492.
Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev 2005;3:CD001118.
Glasser I. Nicotine anonymous may benefit nicotine-dependent individuals. Am J Public Health 2010;100:196.
Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: Meta-analysis of randomized controlled trials. Arch Intern Med 2009;169:929-37.
Civljak M, Sheikh A, Stead LF, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2010;9:CD007078.
Hutton HE, Wilson LM, Apelberg BJ, Avila Tang E, Odelola O, Bass EB, et al
. A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine Tob Res 2011;13:227-38.
Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev 2016;4:CD006611.
Brendryen H, Kraft P. Happy ending: A randomized controlled trial of a digital multi-media smoking cessation intervention. Addiction 2008;103:478-84.
Brendryen H, Drozd F, Kraft P. A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): Randomized controlled trial. J Med Internet Res 2008;10:555.
Carr A. The Easy Way to Stop Smoking. New York: Sterling; 2004.
Gonzales D, Redtomahawk D, Pizacani B, Bjornson WG, Spradley J, Allen E, et al
. Support for spirituality in smoking cessation: Results of pilot survey. Nicotine Tob Res 2007;9:299-303.
Bittoun R. Carbon monoxide meter: The essential clinical tool- the "stethoscope"- of smoking cessation. J Smok Cessat 2008;3:69-70.
Jamrozik K, Vessey M, Fowler G, Nicholas W, Parker G, van Vunakis H. Controlled trial of three different anti-smoking interventions in general practice. Br Med J 1984;288;1499-503.
Irving JM, Clark EC, Crombie IK, Smith WC. Evaluation of a portable measure of expired-air carbon monoxide. Prev Med 1988;17:109-15.
Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G. Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: Focus on developmental toxicology. Ther Drug Monit 2009;31:14-30.
McClure JB. Are biomarkers useful treatment aids for promoting health behavior change? An empirical review. Am J Prev Med 2002;22:200-7.
Cahill K, Perera R. Competitions and incentives for smoking cessation. Cochrane Database Syst Rev 2008;3:CD004307.
Cahill K, Perera R. Quit and Win contests for smoking cessation. Cochrane Database Syst Rev 2008;4:CD004986.
He D, Berg JE, Høstmark AT. Effects of acupuncture on smoking cessation or reduction for motivated smokers. Prev Med 1997;26:208-14.
White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev 2014;1:CD000009.
Barnes J, Dong CY, McRobbie H, Walker N, Mehta M, Stead LF. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev 2010;10:CD001008.
Johnson DL, Karkut RT. Performance by gender in a stop-smoking program combining hypnosis and aversion. Psychol Rep 1994;75:851-7.
Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med 1995;155:1933-41.
Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, et al.
Smoking, smoking cessation, and major depression. JAMA 1990;264:1546-9.
Carmody TP, Duncan C, Simon JA, Solkowitz S, Huggins J, Lee S, et al.
Hypnosis for smoking cessation: A randomized trial. Nicotine Tob Res 2008;10:811-8.
SCENIHR. Health Effects of Smokeless Tobacco Products (PDF) (Report); 2008. p. 103.
Grimshaw GM, Stanton A. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2006;4:CD003289.
Benowitz NL. Nicotine addiction. N Engl J Med 2010;362:2295-303.
Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ 2000;321:323-9.
[Figure 1], [Figure 2], [Figure 3]