Smoking cessation
Also known as: nicotine replacement · tobacco cessation · varenicline
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Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions
U.S. Preventive Services Task Force (USPSTF) · 2021 · Final recommendation statement, 19 January 2021
The USPSTF's current recommendation on helping adults stop smoking, covering both non-pregnant adults and pregnant people. It grades behavioural support and, for non-pregnant adults, FDA-approved pharmacotherapy as high-benefit, and finds evidence insufficient for some other scenarios.
- Grade A for behavioural interventions plus FDA-approved pharmacotherapy in non-pregnant adults, and Grade A for behavioural interventions in pregnant persons. source
- Evidence graded I (insufficient) for pharmacotherapy in pregnancy and for e-cigarettes as a cessation aid in adults. source
- Replaces the USPSTF's 2015 recommendation statement on tobacco smoking cessation in adults. source
Tobacco: preventing uptake, promoting quitting and treating dependence
National Institute for Health and Care Excellence (NICE), UK · 2021 · NG209, last updated 4 February 2025
NICE guideline NG209 is the consolidated UK guidance on tobacco, covering prevention of uptake in young people, support to quit, harm reduction for those not ready to stop, and treatment of tobacco dependence across health and care settings. It applies from age 12 upwards.
US vs EU key differences
- E-cigarettes are the sharpest divergence: the USPSTF issues an I statement, judging evidence insufficient to support e-cigarettes for cessation in adults including pregnancy, whereas NICE tells clinicians to give adults interested in nicotine-containing e-cigarettes clear, current information and to pair them with behavioural support. source
- NICE frames the harm hierarchy explicitly for patients, advising that a nicotine-containing e-cigarette is at least as effective as nicotine replacement therapy and safer than continued smoking but less safe than NRT itself. source
- In pregnancy the US position is split: an A grade for asking, advising and offering behavioural interventions, but an I statement on cessation pharmacotherapy because the benefit-harm balance is unsettled. source
- Scope differs substantially: the USPSTF statement is a clinician-facing screening-and-treatment recommendation for adults, while NICE NG209 covers everyone aged 12 and over and also sets population-level measures such as mass-media campaigns, school-based programmes and curbing illegal tobacco sales. source
- The UK guidance has also been kept alive as a living document, with the stop-smoking intervention section updated to take account of newer evidence on cytisinicline (cytisine), a drug not part of the 2021 US recommendation. source
What changed recently
- EUPH5, PH14, PH23, PH26, PH39, PH45, PH48 and NG92 → NG2092021-11-30
NG209 consolidated eight separate NICE tobacco publications into one guideline covering prevention of uptake, quitting and treatment of dependence in everyone aged 12 and over, with reworked recommendations on harm reduction, smoking in pregnancy, school-based prevention and retailer compliance. The February 2025 revision added cytisinicline (cytisine) as a stop-smoking pharmacotherapy option.
- US2015 → 20212021-01-19
The 2021 statement replaces the 2015 USPSTF recommendation and keeps the A grades for behavioural counselling and pharmacotherapy in non-pregnant adults and for behavioural interventions in pregnancy, but newly issues an I statement on electronic cigarettes as a cessation aid because the evidence on their effectiveness and harms was judged insufficient.
See the full update feed for changes across every system.