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We’ve known for decades that smoking leads to serious health problems including cancer, lung and heart disease, stroke, and diabetes. Despite the health risks, quitting smoking is a significant challenge for most people because the nicotine in cigarettes is incredibly addictive.

A new systematic review published in the journal BMC Medicine takes a careful look at non-pharmacological interventions to help people quit smoking.

The review combined the results of 145 studies conducted from 1996 to 2022. The studies evaluated 20 different types of interventions designed to help smokers quit that don’t involve taking medicines. Among the interventions evaluated were cognitive behavioral therapy, professional counseling advice, and non-nicotine e-cigarettes.

Overall, more than 50 percent of studies in the review concluded that a specific intervention was effective.

Of the interventions in the paper, cognitive behavioral education, professional counseling, and motivational interviews all helped to raise awareness among smokers on the connection between smoking and illness.

Cognitive behavioral therapy also provided participants with better skills to cope with cravings and negative emotions in order to maintain abstinence, compared to other interventions. In fact, 88 percent of the studies on cognitive behavioral education found it to be “effective” or “likely effective” in addressing withdrawal symptoms.

Studies also found that professional counseling and motivational interviews—where medical professionals provided information about smoking—were effective, especially for those who have low motivation to quit.

The review also included evidence on online-based smoking cessation programs and found most programs helped some participants quit smoking. Active telephone counseling had the most evidence supporting its use, while programs that used text messaging also proved to be effective for some. However, researchers have only studied the effects of these programs over periods of up to six months; there isn’t evidence if participants relapse to smoking in the long run.

Non-nicotine e-cigarette interventions helped some people reduce their use of paper cigarettes, but there’s not clear evidence that they led people to quit smoking altogether. There is separate evidence that people who smoke fewer cigarettes are more likely to quit smoking in the future; therefore, non-nicotine e-cigarette interventions may provide a benefit over the long term.

While the review authors found evidence that non-pharmaceutical interventions help people quit, they found the quality of the studies was generally low. In addition, many didn’t account for participants who relapsed into smoking after the study ended.

The take-home message: There is clear evidence that interventions to help people quit smoking work. Additional research would help public health officials better understand which types of interventions work best for different people, and find ways to prevent participants from returning to smoking.