New Canadian guideline provides evidence-based options for smoking cessation

Tobacco smoking remains the leading cause of preventable disease and death in Canada. It increases the risk of several types of cancer, respiratory disease, cardiovascular disease and other health conditions. In 2022, 11% of Canadians aged 15 years or older were smoking tobacco (13% of males, 9% of females) and about three-quarters were smoking daily. Cigarette smoke contains more than 7,000 chemicals; about 70 of these are carcinogens.Quitting smoking increases life expectancy and improves mental health and quality of life. To assist primary care providers in promoting smoking cessation, the Canadian Task Force on Preventive Health Care has developed a guideline document with evidence-based recommendations on options for smoking cessation in nonpregnant adults who smoke tobacco cigarettes. The guidelines stresses that as part of good clinical care, healthcare providers are expected to be knowledgeable about their patients’ smoking status. All people who smoke tobacco cigarettes should be encouraged to stop and offered one or more recommended smoking cessation interventions. Healthcare providers should engage in shared decision-making with the patient to determine the best option(s) that are accessible to the patient and fit their values and preferences.Guideline recommendations for smoking cessation are summarized below, including the estimated magnitude of benefit over usual care or no intervention, and the certainty in the estimated benefit. Strongly recommended for smoking cessation:Combination behavioural and pharmacotherapy approaches involving bupropion, cytisine, nicotine replacement therapy or varenicline. (Moderate to large benefit; Low certainty)Behavioural approachesAdvice or education—individual, healthcare provider, minimal to intensive (Moderate benefit; Low certainty)Counselling—individual, trained smoking cessation counsellor (Small benefit; Low certainty)Counselling—group, trained smoking cessation counsellor (Small benefit; Low certainty)Counselling—telephone hotline, trained smoking cessation counsellor (Small benefit; Moderate certainty)Counselling—telephone, trained smoking cessation counsellor, intensive (Moderate benefit; Low certainty)Mobile phone–based interventions, including text messages (Moderate benefit; Low certainty)Self-help materials—nontailored or tailored, but no contact (Small benefit; High certainty)PharmacotherapyBupropion (Small to moderate benefit; Low certainty)Cytisine, a Natural Health Product (Moderate benefit; Low certainty)Nicotine replacement therapy—gum, patch, inhaler; does not include e-cigarettes (Moderate benefit; Low certainty)Varenicline (Large benefit; Moderate certainty)Conditionally recommended for smoking cessationInteractive computer-based or online programs with direct behavioural support Conditionally recommended against for smoking cessationInteractive computer-based or online programs without additional support (fully automated or self-directed)E-cigarettes (with or without nicotine). E-cigarettes should not be encouraged as a smoking cessation intervention for most people because of uncertainty about nonapproved e-cigarette products, long-term harms (e.g., lung and heart health) and public health impacts. Instead, people who smoke should be directed toward interventions with proven effectiveness. E-cigarettes could be considered for specific individuals who have been unsuccessful with other interventions or express a strong preference for use, based on shared decision-making with their primary care provider. Strongly recommended against for smoking cessationS-adenosyl-L-methionineSt John’s wortHypnotherapyAcupunctureContinuous auricular stimulationLaser therapyElectrostimulation.The guidelines stress that shared decision-making should not be used to convince a person to choose a specific intervention or group of interventions, but should be used to help elicit the person’s preferences and provide information that allows them to make an informed decision. Patients who relapse should be engaged in further shared decision-making to explore options to attempt to quit again, including whether they wish to try something different, or reattempt with the same intervention.The guidelines provide a more detailed discussion of the evidence regarding the benefits and harms of the various smoking cessation options. A table summarizing Canadian and international guidelines on interventions for tobacco smoking cessation for primary care providers is also included, along with a one-page illustration that summarizes the guideline recommendations. The task force plans to update the recommendations in this guideline as new evidence becomes available.Reference:Thombs BD, Traversy G, Reynolds DL, et al; Canadian Task Force on Preventive Health Care. Recommendations on interventions for tobacco smoking cessation in adults in Canada. CMAJ 2025;197:E846-61. (accessed August 26, 2025).

New Canadian guideline provides evidence-based options for smoking cessation

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