Tobacco Cessation

Tobacco Cessation, or quitting tobacco is a process. Many people quit tobacco without help, but interventions exist that can support quit attempts, and promote successful outcomes.

Youth Tobacco Cessation

According to the the USDHHS Clinical Guidelines for treating tobacco dependence, behavioral approaches to youth tobacco cessation should not be simple modifications of adult interventions. Interventions should focus on issues and topics that are developmentally relevant and youth friendly. Peer health education has been found to be effective in prompting quit attempts. Refusal skills training, the social manipulation of tobacco advertising, and the roles of parents, family members, and peers should be considered. Some evidence suggests that youth cessation outcomes improve with more intensity (group setting, more than 5 sessions), although quit lines are also effective, easily accessable and provide confidential cessation support. Reducing youth access to tobacco products, adopting comprehensive tobacco-free policies, and tobacco counter-marketing encourage youth tobacco cessation. Tobacco cessation medications are currently not recommended for individuals under the age of 18.

Adolescent Smoking Cessation: Promising Strategies and Evidence-based Recommendations
(Adolescent Medicine, 2011)

A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers. 
(Tobacco Control, 2011)

Effectiveness of a School Nurse-Delivered Smoking-Cessation Intervention for Adolescents
(Pediatrics, 2011)

Effects of sixty six adolescent tobacco use cessation trails and seventeen prospective studies of self-initiated quitting
(Tobacco Induced Diseases, 2002)

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in Adolescent Smoking Cessation Trial
(Journal of Adolescent Health, 2011)

Preventing Adolescent Tobacco Use and Assisting Young People to Quit: Population-, Community-, and Individually Focused Evidence Based Interventions
(Nursing Clinics of North America, 2011)

Targeted Smoking Cessation Messages for Adolescents
(Society for Adolescent Health and Medicine, 2011)

Youth Tobacco Cessation: A Guide for Making Informed Decisions
(Centers for Disease Control and Prevention)

Young Adult Tobacco Cessation

Although young adults may understand that tobacco use is harmful to health, they often significantly underestimate their own risks, and do not fully understand the risks of short term exposure to tobacco. Young adults may be skeptical of or disinterested in tobacco cessation interventions, so approaches to cessation in this population should be both effective and appealing. Cessation interventions should be accessible, affordable, convenient, and flexible. Interventions should address multiple forms of tobacco and nicotine products, as well as daily/non daily use behaviors. Cessation attempts should also be supported by environmental changes such as tobacco free policies.

Adolescent and young adult tobacco prevention and cessation: current status and future directions
(Tobacco Control, 2003)

Adolescent Psychological and Social Predictors of Young Adult Smoking Acquisition and Cessation: A 10-Year Longitudinal Study
(Health Psychology, 2011)

College Smokers’ Estimates of Their Probabilities of Remaining a Smoker in the Near Future
(Journal of Health Psychology, 2009)

Helping Young Adult Smokers Quit: The Time is Now
(American Journal of Public Health, 2007)

Quit Attempts and Intention to Quit Cigarette Smoking Smoking Young Adults in the United States
(Research and Practice, 2007)

Quitting Smoking Among Adults — United States, 2001–2010
(CDC MMWR, 2011)

Smoking Cessation Among Neglected Populations: Employed and Unemployed Young Adults (18-24 yrs)
(Canadian Tobacco Control Research Initiative, 2006)

Smoking Cessation in Young Adults
(American Journal of Public Helath, 2007)

The impact of stage-of-change on willingness to affiliate with smokers
(Addictive Behaviors, 2005)

Tobacco Industry Research on Smoking Cessation. Recapturing young adults and other recent quitters
(University of California Postprints, 2004)

Use of Cessation Methods Among Smokers Aged 16-24 Years – United States, 2003
(Centers for Disease Control and Prevention MMWR, 2006)

Use of Tobacco Cessation Treatments Among Young Adult Smokers: 2005 National Health Interview Survey
(Research and Practice, 2007)

Young Adult former ever smokers: The role of the type of smoker, quit attempts, quit aids, attitudes/beliefs, and demographics
(Preventive Medicine, 2013)

Tobacco Cessation Interventions

Best practices for tobacco cessation can be found in Treating Tobacco Use and Dependence, a publication from the US Department of Health and Human Services (2008). Recommendations include a combination of counseling (in-person or telephone) and medications for tobacco cessation. A Screening and Brief Intervention model can help identify tobacco users and initiate a conversation on cessation. Motivational Interviewing can be a helpful counseling technique for individuals who are ambivalent about or resistant to quitting. Quit and Win contests, Peer Health Educator programs, outreach events can all support a college tobacco cessation program grounded in best practices. The studies below offer information on various cessation interventions and their efficacy.

Abstinence and Relapse Rates Following a College Campus-Based Quit & Win Contest
(Journal of American College Health, 2010)

A Case-Based Clinician Training Program for Treating Tobacco Use in College Students
(Public Health Reports, 2006)

Adaption of a Lay Health Advisor Model as a Recruitment and Retention Strategy in a Clinical Trial of College Student Smokers
(Health Promotion Practice, 2008)

A group-randomized tobacco trial among 30 Pacific Northwest colleges: Results from the Campus Health Action on Tobacco study
(Nicotine & Tobacco Research, 2010)

A Smokeless Tobacco Cessation Program for Postsecondary Students
(Health Values, 1995)

Beliefs, Knowledge, and Self-Efficacy of Nursing Students Regarding Tobacco Cessation
(American Journal of Preventive Medicine, 2008)

Case Study: Tobacco Cessation and Policy in the Workforce Development Setting
(Health Education Council)

Evidence-Based Smoking Cessation for College Students
(Nursing Clinics of North America, 2011)

Helping Smokers Quit in the Real World
(Mayo Clinic Proceedings, 2014)

Individual behavioural counseling for smoking cessation (Review)
(Cochrane Collaboration, 2008)

Motivational Interviewing for smoking cessation (Review)
(Cochrane Collaboration, 2010)

Promoting tobacco cessation via the workplace: opportunities for improvement
(Tobacco Control, 2011)

Research Report: Tobacco Addiction
(National Institute on Drug Abuse, 2006)

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses
(Journal of American College Health, 2011) 

Secondary Smoking Prevention in a University Setting: A Randomized Comparison of an Experimental, Theory-Based Intervention and a Standardized Didactic Intervention for Increasing Cessation Motivation
(Health Psychology, 2007)

Smoking Cessation and Relapse Prevention Among Undergraduate Students: A Pilot Demonstration Project
(Journal of American College Health, 2004)

Smoking, smoking cessation and smoking relapse patterns: a web-based survey of current and former smokers in the US
(The International Journal of Clinical Practice, 2011)

Stage-Based Interventions for Smoking Cessation: A Review Synopsis
(Public Health Nursing, 2011)

Styles of Physician Advice About Smoking Cessation in College Students
(Journal of American College Health, 2009) 

The Ask-Advise-Connect Approach for Smokers in a Safety Net Healthcare System
(American Journal of Preventive Medicine, 2013)

The Impact of the Georgia Health Sciences University Nursing Faculty Practice in Tobacco Cessation Rates
(Nursing Clinics of North America, 2012)

Use of and Interest in Smoking Cessation Strategies Among Daily and Nondaily College Student Smokers
(Journal of American College Health, 2012)

Use of Cessation Methods Among Smokers Aged 16-24 Years – United States, 2003
(Centers for Disease Control and Prevention, 2006)

Phone and Internet-Based Tobacco Cessation Interventions

An alternative to in-person counseling for tobacco cessation is to offer cessation support over the phone or through live chat. The California Smokers’ Helpline,  Quit Tobacco: Make Everyone Proud, and the National Cancer Institute offer evidence-based tobacco cessation counseling over the phone or with live chat on the web. Several apps including NCI QuitPal, QuitGuide, and QuitSTART have been developed by credible tobacco cessation organizations as well. These apps may be useful to support other counseling efforts. It is important to consider the source of tobacco cessation information online, as the internet is full of misinformation and quackery products which have not been shown to be successful in helping people quit tobacco.

A Content Analysis of Popular Smartphone Apps for Smoking Cessation 
(American Journal of Preventive Medicine, 2013)

An Investigation of Smoking Cessation Video Content on YouTube
(Substance Use & Misuse, 2011)

A Review of the Evidence on Technology-Based Interventions for the Treatment of Tobacco in College Health
(Worldviews on Evidence Based Nursing, 2013)

A Systematic Review of Randomized Controlled Trials: Web-Based Interventions for Smoking Cessation Among Adolescents, College Students, and Adults
(Nicotine and Tobacco Research, 2011)

A Theory-Based Video Messaging Mobile Phone Intervention for Smoking Cessation: Randomized Controlled Trial
(Journal of Medical Internet Research, 2011)

Efficacy of an Experimental, Dissonance-Based Smoking Intervention for College Students Delivered via the Internet
(Journal of Consulting and Clinical Psychology, 2013)

Evidence of Real-World Effectiveness of a Telephone Quitline for Smokers
(New England Journal of Medicine, 2002)

Internet and Mobile Phone Text Messaging Intervention for College Smokers
(Journal of American College Health, 2008)

Pilot RCT Results of Stop My Smoking USA: A Messaging-Based Smoking Cessation Program for Young Adults
(Nicotine & Tobacco Research, 2012)

Reaching Young Adult Smokers Through Quitlines
(American Journal of Public Health, 2007)

Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomized trial
(The Lancet, 2011)

Telephone Counseling Increases Cessation Rates Among Young Adult Smokers
(Health Psychology, 2004)

The Rose of Peer-Email Support As Part of a College Smoking Cessation Website
(American Journal of Preventive Medicine, 2008)

Twitter=quitter? An analysis of Twitter quit smoking social networks
(Tobacco Control, 2011)

YouTube as a source of quitting smoking information
(Tobacco Control, 2010)

Pharmacotherapy for Tobacco Cessation

Seven first-line medications have been approved for tobacco cessation. Use of these medications to support cessation attempts should be recommended for individuals quitting tobacco, except when contraindicated. Medical providers and tobacco cessation counselors can help educate people who use these medications to ensure the products are used correctly and consistently. The following studies explore topics related to safety, efficacy, and use to pharmacotherapy for tobacco cessation.

Adherence to Varenicline in the COMPASS Smoking Cessation Intervention Trial
(Nicotine & Tobacco Research, 2011) 

A Single 4 mg Dose of Nicotine Decreases Heart Rate Variability in Healthy Nonsmokers: Implications for Smoking Cessation Programs
(Nicotine & Tobacco Research, 2011) 

Nicotine Replacement Therapy for Smoking Cessation
(Cochrane Summary, 2007)

Novel Delivery Systems for Nicotine Replacement Therapy as an Aid to Smoking Cessation and for Harm Reducation: Rationale, and Evidence for Advantages over Existing Systems
(CNS Drugs, 2013)

Over-the-counter nicotine replacement therapy for everyone: Is it the best solution? 
(Medical Hypotheses, 2011)

Cessation in Special Populations

People vary in the type of tobacco they use and the way they use it. Consequently, tobacco cessation efforts may need to vary to meet the unique cessation needs of different groups. For example, non-dialy tobacco users my not believe that their smoking hurts their own health, but they may respond to messaging about how their second-hand smoke effects others. They also may have a difficult time quitting even though they may smoke less than daily smokers. Other groups such as smokeless tobacco users, and people with varying educational and socioeconomic backgrounds vary on cessation needs as well. The following articles examine some of these groups and their cessation needs.

Counseling Nondaily Smokers about Secondhand Smoke as a Cessation Message: A Pilot Randomized Trial
(Nicotine & Tobacco Research, 2012)

Encouraging smoking cessation among disadvantaged groups: A qualitative study of the financial aspects of cessation
(Drug and Alcohol Review, 2010)

Interventions for smokeless tobacco use cessation (Review)
(Cochrane Collaboration, 2011)

Smoking and Cessation Behaviors Among Young Adults of Various Educational Backgrounds
(American Journal of Public Health, 2007)

Smoking Cessation Behavior Among Intermittent Smokers vs. Daily Smokers
(American Journal of Public Health, 2011)

Cessation and Other Health Topics

Quitting tobacco impacts many aspects of health. Additionally, certain health factors may impact the outcome of a person’s quit attempt. The following articles explore cessation in relation to other health topics.

Association between smoking cessation and sexual health in men
(BJU International, 2011) 

Barriers to quitting smoking among medically ill smokers
(Journal of Behavioral Medicine, 2011)

Cessation Treatment and E-Cigarettes
(North American Quitline Consortium, 2014)

Does remission from alcohol and drug use disorders increase the likelihood of smoking cessation among nicotine dependent young adults? 
(Social Psychiatry and Psychiatric Epidemiology, 2008)

Effective of Expressive Writing as a Treatment Adjunct for Reducing Smoking Cessation Related Weight Gain in Young Adult Smokers
(Substance Use & Misuse, 2008)

Effects of Omega-3 Fatty Acids on Tobacco Craving in Cigarette Smokers: A Double-Blind, Randomized, Placebo-Controlled Pilot Study
(Journal of Psychopharmacology, 2014)  

Integrated Smoking Cessation and Binge Drinking Intervention for Young Adults: a Pilot Investigation
(Annals of Behavioral Medicine, 2010)

Mobile Contingency Management as an Adjunctive Smoking Cessation Treatment for Smokers With Posttraumatic Stress Disorder
(Nicotine & Tobacco Research, 2013)

Targeting Body Image Schema for Smoking Cessation Among College Females: Rationale, Program Description, and Pilot Study Results
(Behavior Modification, 2011)