Background Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. Objectives To determine the long-term effect of incentives and contingency management programmes for smoking cessation. Search methods For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. Selection criteria We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinicor institution-based), and also studies in pregnant smokers. Data collection and analysis We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. Main results Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I 2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those Incentives for smoking cessation (Review)

Analysis 2.4. Comparison 2 Comparison of theoretical basis of behavioural interventions, Outcome 4 Complex theoretical model with stage of change, motivational interviewing, cognitive behavioural therapy and/or social cognitive theory vs control.

Analysis 2.2. Comparison 2 Bupropion plus nicotine replacement therapy (NRT) versus NRT alone, Outcome 2 Adverse events.... Analysis 2.3. Comparison 2 Bupropion plus nicotine replacement therapy (NRT) versus NRT alone, Outcome 3 Serious adverse events.

ore than an estimated 8 million smoking-attributed deaths occur globally each year, and approximately 34 million people in the US (14% of adults) currently smoke cigarettes. 1,2 One-third to one-half of people who regularly smoke cigarettes die of a tobacco-related disease, typically approximately 10 years earlier than people who do not smoke cigarettes. 3 Most smoking-attributed deaths are due to cancer (34%), cardiovascular diseases (32%), or respiratory disease (21%). 3 Smoking is associated with cancers of the lung, oropharynx, larynx, esophagus, stomach, liver, pancreas, kidney, bladder, uterine cervix, and colon or rectum, as well as acute myeloid leukemia. 3 Nearly 90% of lung cancers are attributed to cigarette smoking. 3 Smoking is responsible for approximately 80% of chronic obstructive pulmonary disease deaths. 3 The health risk from cigarette smoking is primarily due to chemicals produced by the burning of tobacco and not to nicotine. 3 More than 80% of tobacco users in the US use combustible products, primarily cigarettes but also cigars, pipes, and waterpipes (hookah). 2 In 2019, 19% of US tobacco users reported using multiple tobacco products. 2 Disproportionately high rates of smoking occur among adults with lower education, lower incomes, nontobacco substance use disorders, psychiatric conditions, people living with HIV, American Indian or Alaska Native individuals, and members of the lesbian, gay, bisexual, transgender (LGBT+) community. 2,4 Black individuals experience higher rates of tobacco-related disease and death than any other race. Black men have the highest lung cancer death rate of any racial or ethnic group at 60.4 per 100 000, despite having similar smoking rates as White individuals. 2,5 Worldwide, an estimated 1.3 billion individuals use tobacco products, and more than 80% of them live in low-and middle-income countries. 1 In the US, nearly 90% of adult daily smokers started IMPORTANCE More deaths in the US are attributed to cigarette smoking each year than to any other preventable cause. Approximately 34 million people and an estimated 14% of adults in the US smoke cigarettes. If they stopped smoking, they could reduce their risk of tobacco-related morbidity and mortality and potentially gain up to 10 years of life.OBSERVATIONS Tobacco smoking is a chronic disorder maintained by physical nicotine dependence and learned behaviors. Approximately 70% of people who smoke cigarettes want to quit smoking. However, individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence. Both behavioral counseling and pharmacotherapy while using nicotine replacement therapy (NRT) products, varenicline, or bupropion are effective treatments when used individually, but they are most effective when combined. In a meta-analysis including 19 488 people who smoked cigarettes, the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or u...

Cochrane Database of Systematic Reviews Main results Eighty-three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, we judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. We pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (RR 1.15, 95% CI 1.08 to 1.22, I = 8%, 65 studies, n = 23,331) for abstinence at longest follow-up, and this e ect was not di erent when we compared subgroups by type of pharmacotherapy or intensity of contact. This e ect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that di ered in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant e ect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378).