theoretical models of the determinants of tobacco use and cessation, the interventions typically have five key components: (1) self-monitoring, including systematic observation and recording of behavior; (2) cognitive restructuring, which involves identifying and altering thoughts and beliefs that may undermine quit efforts; (3) goal-setting focused on specific, quantifiable, and reasonable short-term (such as 1–2 weeks) and long-term (such as 6 months) goals; (4) problem-solving to identify and cope with high-risk situations that may lead to relapse; and (5) social support, seeking support from others and informing them of the types of support desired (NRC, 2003). Those interventions can be offered in different formats (such as face to face, over the telephone, and by computer) with different numbers and lengths of contact. Meta-analyses show that even a behavioral intervention contact as brief as 3 minutes improves the odds of quitting by as much as 40% compared with no treatment. Abstinence rates increase as the length of counseling sessions increases from minimal (under 3 minutes) to longer than 10 minutes, as the number of sessions increases, and as the total contact time increases from 1–3 minutes to 91–300 minutes; however, contact time in excess of 300 minutes does not appear to increase abstinence rates (Fiore et al., 2008).

Tobacco-Cessation Medications

Seven medications have been approved by FDA for smoking cessation and are recommended by the 2008 PHS guideline alone or in combination as first-line medications (Fiore et al., 2008). The first-line medications include several forms of NRTs—gum, lozenges, and patches are available over the counter, and nasal sprays and inhalers are available by prescription—and bupropion sustained-release (SR) and varenicline, which are available by prescription. Each of these medications has been shown to increase the likelihood of smoking cessation significantly (Fiore et al., 2008). Nicotine gum, patches, and lozenges should be used for 6–14 weeks for both highly dependent and regular smokers. In addition to recommending the use of the nicotine patch as a single medication, the guideline recommends several medications in combination with it, including nicotine gum or spray, bupropion SR, and inhaled nicotine. Kornitzer et al. (1995) found a significant increase in abstinence rates in those who added gum use to patch use. In an effort to assess the comparative effectiveness of the FDA-approved medications, various cessation medications were compared to the nicotine patch—the most commonly used cessation medication. The meta-analysis identified two medication regiments that were more effective than the nicotine patch: varenicline used alone and the combination of a long-term



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