Scoping review finds effective tools for embedding smoking cessation in primary care

A systematic scoping review of 30 empirical studies found that primary care can support smoking cessation most effectively when behavioural counselling and medication are combined with practical systems for identifying, contacting and treating tobacco users. Electronic health record prompts, cost-free pharmacotherapy, financial incentives and immediate cessation support after lung-function testing also produced favourable results in several studies. The evidence for vaping cessation was far thinner: only two included studies involved people who used e-cigarettes, and neither provided enough vaping-specific outcome data to establish which approaches work best.

The review, which searched PubMed and EMBASE for studies published from 19 September 2020 through 19 September 2024, focused on interventions and implementation strategies used in primary care in Australia, Canada, the European Union, the United Kingdom and the United States. Primary care was defined as the first point of contact for non-emergency patients, including consultations with general practitioners, nurses, allied health professionals and pharmacists. Two reviewers independently screened records, extracted study characteristics and assessed reported abstinence outcomes, verification methods and intervention components. Because the designs, populations and outcomes varied substantially, the researchers used narrative synthesis rather than formal meta-analysis.

Of 2,166 records screened, 30 peer-reviewed studies met the inclusion criteria. Thirteen were conducted in the United States and 13 in the European Union, while evidence from the United Kingdom, Australia and Canada was comparatively limited. Twenty-two were randomised or non-randomised controlled trials, and eight used other quasi-experimental designs. Most evaluated smoking cessation rather than vaping cessation. Point-prevalence and prolonged abstinence were commonly reported, and nine studies also used biochemical validation, such as carbon monoxide testing, to support their findings. This breadth makes the review useful for mapping real-world approaches, although the absence of a formal quality assessment and the marked heterogeneity limit the strength of any overall estimate.

Counselling was the most frequently studied cessation component, appearing in 26 studies; 18 reported statistically significant improvements in smoking abstinence. Twelve used behavioural-cognitive approaches intended to strengthen problem-solving, coping and self-efficacy, while nine incorporated motivational interviewing. The level of support varied considerably, from brief advice during lung-cancer screening or after spirometry to repeated sessions with follow-up. Six behavioural-cognitive studies reported significant cessation improvements. A pharmacist-led programme that combined motivational and behavioural support produced 12-month abstinence of 20.7%, with better outcomes among participants who received pharmacotherapy and engaged with more pharmacist consultations or telephone sessions. In another study, motivational coaching, financial support and nicotine replacement therapy increased six-month abstinence to 17%, compared with 9% in the comparison group.

Alternative delivery channels also showed promise. Six of eight studies examining telephone, text and other remote counselling methods reported positive or partly positive results. A cognitive-behavioural therapy app combined self-monitoring, feedback and medication support, yielding seven-day abstinence of 44.5% at four weeks after the quit date, compared with 28.7% after very brief advice; the reported relative risk was 1.55, with a 95% confidence interval of 1.23 to 1.96. A chatbot intervention produced long-term nicotine abstinence of 26.0%, compared with 18.8% in standard primary care, although the confidence interval for the odds ratio included the null value. These findings suggest that digital tools can extend primary care capacity, but they do not mean that every app or chatbot is equally effective. The studies differed in content, support, comparison conditions and outcome definitions.

Pharmacotherapy was assessed in 18 studies, of which 13 reported effectiveness in promoting abstinence. Five examined bupropion or varenicline, and three of these found significantly higher abstinence rates with varenicline than with placebo, nicotine replacement therapy or cytisine. Multi-component care was especially common: 16 of the 18 pharmacotherapy studies combined medication with behavioural support, and 11 found combination therapy more effective than a single component or usual care. In one pharmacist-led or coordinated programme, 12-month cessation reached 54.3% in the intervention group, compared with 37.1% in controls. The pattern is consistent across much of the review: medication appeared most useful when it was not delivered as an isolated offer but embedded in a service that included advice, follow-up or structured opportunities to try quitting.

Financial measures were also among the more promising approaches. Six studies examined monetary support, including three that eliminated the cost of medication. In one low-dose computed tomography screening programme, four face-to-face counselling sessions, educational materials and cost-free nicotine replacement therapy were associated with a one-year quit rate of 15.5% and significant improvements in smoking-related behaviours. Another digital intervention supplied nicotine gum or patches free of charge and reported seven-day point-prevalence abstinence of 44.5%, compared with 28.7% after very brief advice. Contingency-management studies also reported higher abstinence: varenicline plus counselling with attendance-based payments produced week-26 abstinence of 15.7%, versus 6.5% with placebo, while a programme for Medicaid-enrolled pregnant women increased biochemically confirmed abstinence at six months postpartum from 9.2% to 14.7%. Financial coaching that linked quitting with budgeting and benefits referrals produced self-reported six-month abstinence of 17%, versus 9% with usual care.

Embedding cessation support into existing clinical moments produced mixed but generally encouraging results. Seven studies examined integration with low-dose computed tomography screening or post-spirometry feedback. Only one of the screening studies reported a significant short-term improvement, with a one-year abstinence rate of 15.5%. By contrast, four of five studies involving immediate, personalised support after spirometry found significantly higher smoking cessation than standard advice alone. The difference may reflect how cessation care was delivered: feedback alone was not the intervention under evaluation, whereas immediate support created a direct route into treatment. Two studies tested opt-out models, in which patients were automatically enrolled or offered cessation support unless they declined. One formed part of a successful screening programme, but the other increased quit attempts and use of cessation aids without changing self-reported abstinence at six months.

Electronic health records produced consistently positive process or outcome signals across all five studies that examined them. These systems could record tobacco use systematically, prompt clinicians to follow evidence-based steps, display best-practice alerts, refer patients automatically to quitlines or e-health programmes, and support proactive outreach by care managers. One EHR-embedded Ask, Advise and Connect programme found six-month abstinence of 7.6% among patients receiving treatment in Spanish-speaking settings, compared with 3.7% in English-speaking settings. A paediatric implementation that transferred tablet-based screening data into the electronic record and prompted counselling and referral was followed by more than a two-fold reduction in population-level tobacco use. Another registry-based system increased treatment reach, with odds ratios of 2.0 to 3.0, and smoking cessation rates, with reported odds ratios ranging from 2.2 to 10.5. The review supports EHR integration as an implementation strategy, but it does not isolate the contribution of every technical feature.

Provider education alone was the least convincing strategy. All five studies evaluated some combination of training and process improvement, and two reported better delivery of the Ask, Advise, Assess, Assist and Arrange framework. One recorded a rise in the proportion of participants reducing smoking from 5.5% before training to 41.8% afterwards. Another found more quit attempts and a 12-month cessation rate of 46%, compared with 20%, although no effect was evident at six months. The remaining studies did not significantly improve six-month prolonged abstinence, and offering smoking cessation as the default through an encounter decision aid did not affect self-reported abstinence at six months. The distinction between process and clinical outcomes matters: training can make clinicians more likely to follow cessation protocols without necessarily producing a durable increase in successful quits. More intensive behavioural, pharmacological and system-level strategies were generally associated with better outcomes than education by itself.

The clearest finding is therefore not a single winning technology, but a pattern of coordinated care. Primary care appears most effective when it systematically identifies tobacco use, offers counselling, supplies or facilitates medication, reduces financial barriers and creates an active referral or follow-up pathway. The review offers a detailed map of the components with the most support, but it cannot establish that all packages will work in every health system. The search excluded lower-middle-income settings, included diverse study designs, did not conduct formal meta-analysis and provided no quality assessment. Most importantly, its smoking evidence cannot simply be assumed to apply to vaping cessation. With only two studies involving e-cigarette users and limited reporting of vaping-specific abstinence, dedicated behavioural, educational and implementation research remains necessary.

Subject of Research: A 2026 scoping review of smoking and vaping cessation interventions and implementation strategies in primary care

Article Title: Evidence for Embedding Smoking and Vaping Cessation Support in Primary Care: A Scoping Review

Article References: Wang, S., Rojas, I., Dean, E., Hoek, A. C., & Pettigrew, S. (2026). Evidence for Embedding Smoking and Vaping Cessation Support in Primary Care: A Scoping Review. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10835-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10835-3

Keywords: smoking cessation, vaping cessation, primary care, systematic scoping review, behavioural counselling, pharmacotherapy, electronic health records, financial incentives, opt-out care, spirometry feedback, Evidence, Embedding