effective than no psychosocial counseling or therapy, but it is not a recommended treatment (Fiore et al., 2008). A Cochrane review on aversive smoking suggested that although it may be effective, more research was needed (Hajek and Stead, 2001). Self-help materials, such as brochures and videos, as either the only interventions or in combination with other interventions, do not significantly increase abstinence rates (Fiore et al., 2008). Acupuncture has also been assessed in both the guideline and a Cochrane review; the Cochran review found a slight positive effect (White et al., 2006), but the guideline did not.

Neither the 2008 PHS guideline nor the Cochrane review found sufficient studies to assess the use of hypnosis for tobacco-use cessation. One study in veterans found that hypnosis increased abstinence at the 6-month and 12-month follow-ups (Carmody et al., 2008).

The use of financial incentives for tobacco-use cessation has also been explored. A Cochrane review found that the use of financial incentives increased the rate of participation in smoking-cessation programs but did not increase long-term abstinence rates (Cahill and Perera, 2008). Volpp et al. (2006) studied the use of financial incentives in a group of veterans attending a VA medical center, paying some smokers to attend smoking-cessation classes and for remaining abstinent for 30 days. The financial incentives were useful for enrolling veterans in the program, but the 6-month quit rates between the incentive and no-incentive groups were not significantly different (p > 0.2). However, in a later study of employees at a large company, financial incentives for enrolling in and completing the smoking-cessation program and for maintaining abstinence for up to 12 months resulted in significantly higher abstinence rates compared with employees who did not receive such incentives (p < 0.001) (Volpp et al., 2009).

Other interventions that have been studied include telling smokers about their decreased lung function, or lung “age,” as a result of smoking; the effectiveness of this intervention is uncertain (Kotz et al., 2008; Parkes et al., 2008; Wilt et al., 2007).

Finding: Behavioral therapies are effective in increasing long-term tobacco cessation. Cognitive strategies and problem-solving are particularly effective when offered in a multisession format. Available over-the-counter and prescription medications, when used appropriately, also improve the likelihood of long-term tobacco cessation. A combination of the tobacco-cessation pharmacotherapies and behavioral therapies described above is most effective in achieving long-term tobacco cessation. Other

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