Counseling and Social Support for Quitting Tobacco

Approximately two-thirds of people who smoke cigarettes say they would like to quit. The most effective method for quitting is to receive counseling and to use cessation medications. Individuals receiving counseling get support in developing a quit plan, deciding on a quit date, learning effective behavioral strategies to limit cravings (e.g., removing ashtrays and other triggers, deep breathing, exercise), seeking social support, and using cessation medications.¹ Together these strategies significantly increase the chances of quitting smoking compared to quitting without these aids. Counseling for quitting can be obtained from several sources other than in-person cessation clinics (which provide support individually or in a group setting). One option is the free 1-800-QUIT-NOW quit line which is funded by states’ health departments, connects individuals with a live counselor, and sometimes provides cessation medications (e.g., NRT) (Map 4.3.4). Telephone counseling quitlines for cessation are generally underused,² however, with many individuals and health care professionals not aware of their availability and/or efficacy.³ Insurance coverage for counseling and cessation medications increases their use and chances of quitting by socioeconomically disadvantaged individuals.⁴ This free benefit is available to Medicaid enrollees but there is wide variation among states in the comprehensiveness of coverage (Map 4.3.5).

A popular approach for cessation support for quitting is smartphone apps, some of which have been downloaded hundreds of thousands of times.⁵ There is wide variability in their quality, however, with many lacking even the most basic information such as medications available for cessation and how to access them.⁵ An additional barrier is users’ abandoning app-based programs after a short period of use. Attempts to increase their adherence or efficacy have included tailoring content to specific populations such as cancer survivors,⁶ women, or teens, or the addition of features to improve adherence (e.g., gamification).^7,8 Apps that include important information and proven techniques for quitting, or that have been evaluated in scientific research, will likely be more helpful for individuals attempting to quit smoking (Figure 4.3.1).