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  1. Tim Lancaster, clinical reader (tim.lancaster@dphpc.ox.ac.uk)a,
  2. Lindsay Stead, review group coordinatora,
  3. Chris Silagy, directorb,
  4. Amanda Sowden, senior research fellowc

    for the Cochrane Tobacco Addiction Review Group.

  1. a Imperial Cancer Research Fund General Practice Research Group, Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF
  2. b Monash Institute of Public Health, Monash Medical Centre, Locked Bag 29, Clayton, 3168 Victoria, Australia
  3. c NHS Centre for Reviews and Dissemination, University of York, York YO10 5DD
  1. Correspondence to: T Lancaster

    Peto estimates that current cigarette smoking will cause about 450 million deaths worldwide in the next 50 years. Reducing current smoking by 50% would avoid 20–30 million premature deaths in the first quarter of the century and about 150 million in the second quarter.1 Preventing young people from starting smoking would cut the number of deaths related to tobacco, but not until after 2050. Quitting by current smokers is therefore the only way in which tobacco related mortality can be reduced in the medium term. There is evidence that some form of treatment aids an increasing number of successful attempts to quit.2 This review aims to summarise evidence for the effectiveness of the available interventions.

    Summary points

    Advice from doctors, structured interventions from nurses, and individual and group counselling are effective interventions

    Generic self help materials are no better than brief advice but more effective than doing nothing; personalised materials are more effective than standard materials

    All forms of nicotine replacement therapy are effective

    The antidepressants bupropion and nortriptyline increased quit rates in a small number of trials; the usefulness of the antihypertensive drug clonidine is limited by side effects

    Anxiolytics and lobeline are ineffective

    The effectiveness of aversion therapy, mecamylamine, acupuncture, hypnotherapy, and exercise is uncertain

    Methods

    The Cochrane Tobacco Addiction Review group identifies and summarises the evidence for interventions to reduce and prevent tobacco use; it produces and maintains systematic reviews to inform policymakers, clinicians, and individuals wishing to stop smoking. Twenty systematic reviews are available in the Cochrane Library and have contributed to the evidence base for smoking cessation guidelines.3

    Details of the methods and results of each review are available in the Cochrane Library (abstracts at www.update-software.com/ccweb/cochrane/revabstr/g160index.htm). The reviews summarise results from randomised controlled trials with at least six …

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