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Am Fam Physician. 2022;105(2):133-135

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Which behavioral interventions help people quit smoking, and what factors influence how successful they are?

Evidence-Based Answer

A variety of behavioral interventions are effective for smoking cessation. Providing individual or group counseling (odds ratio [OR] = 1.44; 95% credibility interval [CrI], 1.22 to 1.70; number needed to treat [NNT] = 40), guaranteed financial incentives (OR = 1.46; 95% CrI, 1.15 to 1.85; NNT = 29), and text message–based counseling (OR = 1.45; 95% CrI, 1.17 to 1.80; NNT = 33) provide the greatest benefit. Population characteristics do not consistently affect the success of these interventions. All of the interventions provide additional benefit even when smoking cessation pharmacotherapy is prescribed. There are no apparent harms of behavioral interventions.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

InterventionProbable outcome with interventionProbable outcome without interventionNNT (95% CI)Participants (studies)Evidence quality
Guaranteed financial incentives106 per 1,000 (95% CI, 91 to 123)71 per 1,00029 (19 to 50)20,097 (30 RCTs)High
Text message–based counseling90 per 1,000 (95% CI, 70 to 110)60 per 1,00033 (20 to 100)14,133 (13 RCTs)Moderate
Individual counseling110 per 1,000 (95% CI, 100 to 120)70 per 1,00025 (20 to 33)11,100 (27 RCTs)High
Group counseling90 per 1,000 (95% CI, 80 to 120)50 per 1,00025 (14 to 33)4,395 (13 RCTs)Moderate
Printed self-help materials60 per 1,000 (95% CI, 52 to 69)50 per 1,000NA13,241 (11 RCTs)Moderate
Internet-based interventions148 per 1,000 (95% CI, 130 to 167)129 per 1,000NA6,786 (8 RCTs)Low
Telephone counseling100 per 1,000 (95% CI, 85 to 116)72 per 1,00036 (23 to 77)32,484 (14 RCTs)Moderate
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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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