Smoking cessation: WHO recommends combining behavioural interventions with pharmacological treatments

The World Health Organization (WHO) has published a guide presenting the different validated methods of support for stopping smoking for adults; it recommends behavioral support for smokers by health professionals, associated with pharmacological treatments, and with possible additional recourse to interventions in digital form (online programs, applications)[1].

This guide is primarily intended for health professionals working in clinical and community settings where smokers may present and be treated. WHO encourages these professionals, decision-makers and stakeholders to adopt and implement these recommendations in order to promote smoking cessation and improve the health of millions of people worldwide who need it. Helping smokers to quit is a key element of a comprehensive approach to tobacco control highlighted in the WHO treaty, the Framework Convention on Tobacco Control (FCTC), whose Article 14 dedicated to this topic is accompanied by implementation guidelines adopted in 2010. This new WHO guide is part of the aim of disseminating validated management modalities.

WHO estimates that there are 1.25 billion tobacco users. Approximately 60,000,000 of these, or 750 million smokers, want to quit. However, approximately 70,000,000 of smokers who would like to quit do not have access to smoking cessation services, particularly in low- and middle-income countries.

Effective behavioral interventions in smoking cessation

WHO recommends that health professionals provide behavioural interventions, ranging from brief counselling, or ‘quit counselling’ (30 seconds to 3 minutes, in the health care setting, regardless of the reason) to more intensive behavioural support (individual, group or telephone) for motivated smokers. Digital interventions, such as written messages, smartphone applications and online programmes, can be used as complements to these behavioural interventions, or as self-management tools.

WHO recommends that the smoking status of all patients should be systematically included in their medical records, and that all health professionals should be trained in the practical implementation of these behavioural interventions, the effectiveness of which is based on evidence.

Combining behavioral interventions with pharmacological treatments

Combining behavioural interventions with pharmacotherapies significantly increases smoking cessation success rates. WHO therefore recommends that countries provide these treatments free of charge or at a reduced cost to improve their accessibility, particularly in low- and middle-income countries.

The pharmacological treatments recognized as effective and recommended by the WHO are nicotine replacement therapy [NS – cutaneous forms (patches), buccal forms (gums, lozenges, inhalers, sprays), nasal forms (sprays)], varenicline, bupropion and cytisine. NS, varenicline, and bupropion are recommended as first-line treatment; the combination of two NS (one cutaneous form and one buccal form) is recommended. The combination of a NS or varenicline with bupropion can be proposed in the absence of discontinuation in response to well-conducted first-line treatment.

Alternative methods are not recommended

WHO reminds that there is no evidence to suggest the effectiveness of alternative methods such as: traditional therapies, mindfulness, acupuncture, hypnosis, yoga. These should not divert smokers, wishing to quit smoking, from a global approach including behavioral support associated with effective pharmacotherapy.

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[1] WHO clinical treatment guideline for tobacco cessation in adults. Geneva: World Health Organization; 2024. License: CC BY-NC-SA 3.0 IGO.