Review reveals top three effective ways to stop smoking

A major new review of evidence by a team of scientists, including a University of Massachusetts Amherst public health researcher, has identified the three best strategies for quitting smoking:

• Varenicline—a prescription drug sold under the brand names Chantix and Champix, among others.
• Cytisine—a plant-based compound not widely available in the U.S. but sold as an over-the-counter natural health product (Cravv) in Canada and throughout Central and Eastern Europe, and available under prescription in the United Kingdom.
• Nicotine e-cigarettes.

The review, published Sept. 4 in the journal Addiction, was conducted by the non-profit Cochrane Tobacco Addiction Group (CTAG) and led by senior author Jamie Hartmann-Boyce, assistant professor of health policy and management in the UMass Amherst School of Public Health and Health Sciences, and lead author Jonathan Livingstone-Banks, a University of Oxford researcher in England.

Worldwide, smoking is the leading cause of preventable disease and death, resulting in more than seven million deaths per year.

“For people who smoke cigarettes, the single best thing they can do for their health is to quit smoking,” says Hartmann-Boyce, a Cochrane editor who conducted research at Oxford before joining UMass Amherst.

“However, many people find it difficult to do so. Fortunately, there is strong evidence to support the use of a number of different ways to quit smoking.”

The three top strategies for quitting work best when combined with behavioral support, such as counseling, the review states. Bupropion and nicotine replacement therapy (NRT) are also effective, especially NRT patches combined with fast-acting forms like gum.

“For behavioral support, evidence is strongest for counseling and for programs that reward people for stopping smoking,” Hartmann-Boyce adds.

CTAG’s new summary outlines the key findings from 14 Cochrane reviews that CTAG published between 2021 and 2023. Three Cochrane reviews included in this summary are particularly noteworthy:

• The updated Cochrane review on NRT for smoking cessation found high-certainty evidence that combining a fast-acting form of NRT (gum, lozenges, sprays) with NRT patches helped more people to quit than single-form NRT alone.
• The Cochrane review of e-cigarettes for smoking cessation is a living systematic review: review authors search for new studies monthly and update the review whenever new data emerge. The latest update concluded that there was high‐certainty evidence that e-cigarettes with nicotine increase quit rates compared with NRT, and moderate‐certainty evidence that they increase quit rates compared with e-cigarettes without nicotine.
• The 2023 Cochrane review of pharmacological and e-cigarette interventions for smoking cessation included all drugs licensed as treatments for smoking cessation anywhere in the world, as well as e-cigarettes with or without nicotine. The review included 319 studies (157,179 participants). The most effective interventions were nicotine e‐cigarettes, varenicline and cytisine, all of which had high-certainty evidence, closely followed by combination NRT.
• The updated Cochrane review on nicotine receptor partial agonists (varenicline and cytisine) for smoking cessation found that, in studies directly comparing cytisine and varenicline, there may be no difference between either medication for quitting smoking. The review included 75 trials.

“Our team will continue to review evidence on the best ways to help people quit smoking, as we know how vitally important this is to people who smoke and to public health,” Hartmann-Boyce says.