Strategies for smoking cessation: what is new and what works?

While the prevalence of smoking in the USA has declined over the past half century, there still remain over 40 million current smokers, ensuring that smoking will continue to be a major factor influencing premature morbidity and mortality rates for years to come. Most people begin smoking during their teenage years and struggle to quit as adults. Nicotine dependence should be considered a chronic health condition with exacerbations and remissions. Clinicians have an important role to play in helping their patients to stop smoking. The systematic identification of all smokers is the initial step in addressing smoking cessation. Providing both pharmacotherapy and counseling support for all quit attempts helps to optimize rates of cessation. First-line pharmacotherapy to support a quit attempt include nicotine replacement (gum, patch, lozenge, nasal spray or inhaler), bupropion or varenicline. Use of these agents can increase quit rates by 1.5- to threefold. Several studies have shown that combining the nicotine patch with either gum or nasal spray can increase quit rates over single modality therapy. Recent studies have also suggested that giving smokers stop-smoking medications for several weeks in advance of their quit date may help to boost long-term quit rates. New medications are under development, including a nicotine vaccine and faster delivery nicotine medications. However, from a public health perspective, a ban on the sale of nicotine-containing combustion tobacco products may represent the most straightforward means to minimize the harm caused by tobacco use.