Scientists Identify Top 3 Effective Strategies to Quit Smoking

A team of scientists, including a University of Massachusetts Amherst public health researcher, has conducted a major review of evidence and identified the three most effective strategies for quitting smoking: varenicline, cytisine, and nicotine e-cigarettes. The review, published in the journal Addiction on September 4, was led by the non-profit Cochrane Tobacco Addiction Group (CTAG) and authored by senior author Jamie Hartmann-Boyce, assistant professor of health policy and management at the UMass Amherst School of Public Health and Health Sciences, and lead author Jonathan Livingstone-Banks, a University of Oxford researcher in England.

Smoking: The Leading Cause of Preventable Disease and Death

Smoking remains the leading cause of preventable disease and death worldwide, resulting in more than seven million deaths annually. Hartmann-Boyce emphasizes that quitting smoking is the single best thing smokers can do for their health, but many find it challenging. Fortunately, strong evidence supports the use of various strategies to quit smoking.

Top Three Strategies for Quitting Smoking

Varenicline: A prescription drug sold under the brand names Chantix and Champix, among others.
Cytisine: A plant-based compound available as an over-the-counter natural health product (Cravv®) in Canada and throughout Central and Eastern Europe, and under prescription in the United Kingdom.
Nicotine e-cigarettes.

The review states that these strategies work best when combined with behavioral support, such as counseling. Bupropion and nicotine replacement therapy (NRT) are also effective, especially when NRT patches are combined with fast-acting forms like gum. Hartmann-Boyce notes that evidence is strongest for counseling and programs that reward people for stopping smoking.

Notable Cochrane Reviews

CTAG’s summary outlines key findings from 14 Cochrane reviews published between 2021 and 2023. Three reviews are particularly noteworthy:

The updated Cochrane review on NRT for smoking cessation found high-certainty evidence that combining a fast-acting form of NRT with NRT patches helped more people quit than single-form NRT alone.
The living systematic review of e-cigarettes for smoking cessation 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 found that the most effective interventions were nicotine e‐cigarettes, varenicline, and cytisine, 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.

Hartmann-Boyce and her team remain committed to reviewing evidence on the best ways to help people quit smoking, recognizing the vital importance of this research to smokers and public health.

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