Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force

Ann Intern Med. 2015 Oct 20;163(8):608-21. doi: 10.7326/M15-0171. Epub 2015 Sep 22.


Background: Tobacco use is the leading cause of preventable death in the United States.

Purpose: To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation.

Data sources: 5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic reviews, and PubMed was searched through 1 March 2015 for trials on electronic nicotine delivery systems.

Study selection: Two reviewers examined 114 articles to identify English-language reviews that reported health, cessation, or adverse outcomes.

Data extraction: One reviewer abstracted data from good- and fair-quality reviews, and a second checked for accuracy.

Data synthesis: 54 reviews were included. Behavioral interventions increased smoking cessation at 6 months or more (physician advice had a pooled risk ratio [RR] of 1.76 [95% CI, 1.58 to 1.96]). Nicotine replacement therapy (RR, 1.60 [CI, 1.53 to 1.68]), bupropion (RR, 1.62 [CI, 1.49 to 1.76]), and varenicline (RR, 2.27 [CI, 2.02 to 2.55]) were also effective for smoking cessation. Combined behavioral and pharmacotherapy interventions increased cessation by 82% compared with minimal intervention or usual care (RR, 1.82 [CI, 1.66 to 2.00]). None of the drugs were associated with major cardiovascular adverse events. Only 2 trials addressed efficacy of electronic cigarettes for smoking cessation and found no benefit. Among pregnant women, behavioral interventions benefited cessation and perinatal health; effects of nicotine replacement therapy were not significant.

Limitation: Evidence published after each review's last search date was not included.

Conclusion: Behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited.

Primary funding source: Agency for Healthcare Research and Quality.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adult
  • Behavior Therapy*
  • Bupropion / adverse effects
  • Bupropion / therapeutic use
  • Counseling*
  • Electronic Nicotine Delivery Systems / adverse effects
  • Female
  • Humans
  • Nicotinic Agonists / adverse effects
  • Nicotinic Agonists / therapeutic use
  • Pregnancy
  • Smoking Cessation / methods*
  • Smoking Prevention*
  • Tobacco Use Cessation Devices* / adverse effects
  • United States
  • Varenicline / adverse effects
  • Varenicline / therapeutic use


  • Nicotinic Agonists
  • Bupropion
  • Varenicline