Cochrane for Clinicians

Putting Evidence into Practice

Individual Behavioral Counseling for Smoking Cessation


Am Fam Physician. 2018 Jul 1;98(1):21-22.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does individual behavioral counseling provided by a trained therapist impact the rate of smoking cessation?

Evidence-Based Answer

Individual behavioral counseling conducted by a trained therapist provides some benefit when compared with brief counseling and support; however, this benefit is less pronounced in the context of pharmacotherapy. If seven out of 100 smokers are able to quit smoking for at least six months with brief counseling (i.e., brief advice, educational self-help materials, or usual care), adding individual behavioral counseling delivered by a trained therapist would increase this number to 10 to 12 out of 100 smokers. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.) If 11 out of 100 smokers are able to quit smoking with pharmacotherapy, adding individual behavioral counseling by a trained therapist might increase this number to as many as 16 out of 100 smokers.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Cigarette smoking is the single greatest modifiable health risk factor in the United States, with current smokers dying on average at least 10 years earlier than those who have never smoked.2 Family physicians are encouraged to screen for tobacco use, offer smoking cessation counseling, and provide pharmacotherapy when appropriate.3 This analysis measured whether individual behavioral counseling provided by a therapist trained in smoking cessation adds additional benefit compared with brief counseling intervention or no counseling intervention. The analysis specifically excluded studies in which counseling was delivered by physicians or nurses as part of routine clinical care.

This Cochrane review included 49 randomized or quasirandomized controlled trials in which at least one treatment arm consisted of an unconfounded intervention from a therapist, with 19,000 total adult participants.1 The trials took place in a variety

Author disclosure: No relevant financial affiliations.


show all references

1. Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2017;(3):CD001292....

2. Jha P, Ramasundarahettige M, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368(4):341–350.

3. Larzelere MM, Williams DE. Promoting smoking cessation. Am Fam Physician. 2012;85(6):591–598.

4. Ahluwalia JS, Okuyemi K, Nollen N, et al. The effects of nicotine gum and counseling among African American light smokers: a 2 × 2 factorial design. Addiction. 2006;101(6):883–891.

5. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical practice guideline. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service; 2008.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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