interactive web-based and stand-alone computer programs and online communities assist participants in quitting. for example, "quit meters" keep track of statistics such as how long a person has remained abstinent. computerised and interactive tailored interventions may be promising,: 93–94 ; however, the evidence base for such interventions is weak. a mobile phone-based intervention where automated, supportive text messages are sent alongside other forms of support helps more people quit smoking: "the current evidence supports a beneficial impact of mobile phone-based cessation interventions on six-month cessation outcomes. a 2011 randomized trial of mobile phone-based smoking cessation support in the uk found that a txt2stop cessation program significantly improved cessation rates at six months. a 2013 meta-analysis also noted "modest benefits" of mobile health interventions. interactive web-based programs combined with a mobile phone: two rcts documented long-term treatment effects (abstinence rate: 20-22 %) of such interventions. psychosocial approaches the great american smokeout is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever. the world health organization's world no tobacco day is held on may 31 each year. smoking-cessation support is often offered over the telephone quitlines (e.g., the us toll-free number 1-800-quit-now), or in person. three meta-analyses have concluded that telephone cessation support is effective when compared with minimal or no counselling or self-help and that telephone cessation support with medication is more effective than medication alone,: 91–92 : 40–42 and that intensive individual counselling is more effective than the brief personal counselling intervention. a slight tendency towards better results for more intensive counselling was also observed in another meta-analysis. this analysis distinguished between reactive (smokers calling quitlines) and proactive (smokers receiving calls) interventions. for people who called the quitline themselves, additional calls helped to quit smoking for six months or longer. when proactively initiating contact with a smoker, telephone counselling increased the chances of smoking cessation by 2–4% compared with people who received no calls. there is about 10% to 25% increase in the chance of smoking cessation success with more behavioral support provided in person or via telephone when used as an adjunct to pharmacotherapy. online social cessation networks attempt to emulate offline group cessation models using purpose built web applications. they are designed to promote online social support and encouragement for smokers when (usually automatically calculated) milestones are reached. early studies have shown social cessation to be especially effective with smokers aged 19–29. group or individual psychological support can help people who want to quit. recently, group therapy has been more helpful than self-help and some other individual intervention. the psychological support form of counselling can be effective alone; combining it with medication is more effective, and the number of support sessions with medication correlates with effectiveness.: 89–90, 101–103 the counselling styles that have been effective in smoking cessation activities include motivational interviewing, cognitive behavioral therapy and acceptance and commitment therapy, methods based on cognitive behavioral therapy. the freedom from smoking group clinic includes eight sessions and features a step-by-step plan for quitting smoking. each session is designed to help smokers gain control over their behavior. the clinic format encourages participants to work on the process and problems of quitting both individually and as part of a group. multiple formats of psychosocial interventions increase quit rates: 10.8% for no intervention, 15.1% for one format, 18.5% for 2 formats, and 23.2% for three or four formats.: 91 the transtheoretical model, including "stages of change", has been used in tailoring smoking cessation methods to individuals, however, there is some evidence to suggest that "stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling are neither more nor less effective than their non-stage-based equivalents." how to set a quit date most smoking cessation resources such as the centers for disease control and prevention (cdc) and the mayo clinic encourage smokers to create a quit plan, including setting a quit date, which helps them anticipate and plan for smoking challenges. a quit plan can improve a smoker's chance of a successful quit as can setting monday, as the quit date, given that research has shown that monday more than any other day is when smokers are seeking information online to quit smoking and calling state quitlines. self-help some health organizations manage text messaging services to help people avoid smoking self-help materials may produce a small increase in quit rates specially when there is no other supporting intervention form. "the effect of self-help was weak", and the number of types of self-help did not produce higher abstinence rates.: 89–91 nevertheless, self-help modalities for smoking cessation include: in-person self-help groups such as nicotine anonymous, or web-based cessation resources such as smokefree.gov, which offers various types of assistance including self-help materials. webmd: a resource providing health information, tools for managing health, and support. self-help books such as allen carr's easy way to stop smoking. spirituality: in one survey of adult smokers, 88% reported a history of spiritual practice or belief, and of those more than three-quarters were of the opinion that using spiritual resources may help them quit smoking. a review of mindfulness training as a treatment for addiction showed reduction in craving and smoking following training. physical activities help in the maintenance of smoking cessation even if there is no conclusive evidence of the most appropriate exercise intensity. biochemical feedback various methods allow a smoker to see the impact of their tobacco use and the immediate effects of quitting. using biochemical feedback methods can allow tobacco users to be identified and assessed, and monitoring throughout an effort to quit can increase motivation to quit. evidence-wise, little is known about the effects of using biomechanical tests to determine a person's risk related to smoking cessation. breath carbon monoxide (co) monitoring: carbon monoxide is a significant component of cigarette smoke, and a breath carbon monoxide monitor can be used to detect current cigarette use. carbon monoxide concentration in breath is directly correlated with the co concentration in blood, known as percent carboxyhemoglobin. the value of demonstrating blood co concentration to a smoker through a non-invasive breath sample is that it links the smoking habit with the physiological harm associated with smoking. co concentrations show a noticeable decrease within hours of quitting, which can encourage someone to work on quitting. breath co monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback, similar to how other diagnostic tools such as the stethoscope, the blood pressure cuff, and the cholesterol test have been used by treatment professionals in medicine. cotinine: cotinine, a metabolite of nicotine, is present in smokers. like carbon monoxide, a cotinine test can be a reliable biomarker to determine smoking status. cotinine levels can be tested through urine, saliva, blood, or hair samples. one of the main concerns of cotinine testing is the invasiveness of typical sampling methods. while both measures offer high sensitivity and specificity, they differ in usage method and cost. for example, breath co monitoring is non-invasive, while cotinine testing relies on bodily fluid. for instance, these two methods can be used alone or together when abstinence verification needs additional confirmation. competitions and incentives financial or material incentives to entice people to quit smoking improve smoking cessation while the motivation is in place. competitions that require participants to deposit their own money, "betting" that they will succeed in quitting smoking, appear to be an effective incentive. however, it is more difficult to recruit participants for this type of contest in head-to-head comparisons with other incentive models, such as giving participants nrt or placing them in a more typical rewards program. evidence shows that incentive programs may be effective for pregnant mothers who smoke. as of 2019, there is an insufficient number of studies on "quit and win," and other competition-based interventions and results from the existing studies were inconclusive. workplace incentives a 2008 cochrane review of smoking cessation activities in work-places concluded that "interventions directed towards individual smokers increase the likelihood of quitting smoking". a 2010 systematic review determined that worksite incentives and competitions needed to be combined with additional interventions to produce significant increases in smoking cessation rates. healthcare systems interventions delivered via healthcare providers and healthcare systems have been shown to improve smoking cessation among people who visit those services. a clinic screening system (e.g., computer prompts) to identify whether or not a person smokes doubled abstinence rates, from 3.1% to 6.4%.: 78–79 similarly, the task force on community preventive services determined that provider reminders alone or with provider education effectively promote smoking cessation.: 33–38 a 2008 guideline meta-analysis estimated that physician advice to quit smoking led to a quit rate of 10.2%, as opposed to a quit rate of 7.9% among patients who did not receive physician advice to quit smoking.: 82–83 even brief advice from physicians may have "a small effect on cessation rates", and there is evidence that the physicians' probability of giving smoking cessation advice declines with the person who smokes age. there is evidence that only 81% of smokers age 50 or greater received advice on quitting from their physicians in the preceding year. for one-to-one or person-to-person counselling sessions, the duration of each session, the total contact time, and the number of sessions all correlated with the effectiveness of smoking cessation. for example, "higher intensity" interventions (>10 minutes) produced a quit rate of 22.1% as opposed to 10.9% for "no contact" over 300 minutes of contact time made a quit rate of 25.5% as opposed to 11.0% for "no minutes" and more than 8 sessions produced a quit rate of 24.7% as opposed to 12.4% for 0–1 sessions.: 83–86 both physicians and non-physicians increased abstinence rates compared with self-help or no clinicians.: 87–88 for example, a cochrane review of 58 studies found that nursing interventions increased the likelihood of quitting. another review found some positive effects when trained community pharmacists support patients in their smoking cessation trials. dental professionals also provide a key component in increasing tobacco abstinence rates in the community through counseling patients on the effects of tobacco on oral health in conjunction with an oral exam. according to the 2008 guideline, based on two studies the training of clinicians in smoking cessation methods may increase abstinence rates;: 130 however, a cochrane review found and measured that such training decreased smoking in patients. reducing or eliminating the costs of cessation therapies for smokers increased quit rates in three meta-analyses.: 139–140 : 38–40 in one systematic review and meta-analysis, multi-component interventions increased quit rates in primary care settings. "multi-component" interventions were defined as those that combined two or more of the following strategies known as the "5 a's":: 38–43 ask — systematically identify all tobacco users at every visit advise — strongly urge all tobacco users to quitbreath co monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with its corresponding percent concentration of carboxyhemoglobin assess — determine willingness to make a quit attempt assist — aid the patient in quitting (provide counselling-style support and medication) arrange — ensure follow-up contact substitutes for cigarettes main articles: nicotine replacement therapy and electronic cigarette § smoking cessation nicotine replacement therapy (nrt) is the general term for using products that contain nicotine but not tobacco to aid smoking cessation. these include nicotine lozenges, nicotine gum and inhalers, nicotine patches, and electronic cigarettes. in a review of 136 nrt-related cochrane tobacco addiction group studies, substantial evidence supported nrt use in increasing the chances of successfully quitting smoking by 50 to 60% in comparison to placebo or a non-nrt control group. electronic cigarettes (ecs): there is high‐certainty evidence that ecs with nicotine increase quit rates compared to nrt and moderate‐certainty evidence that they increase quit rates compared to ecs without nicotine. little is known regarding the long-term harms related to vaping. a 2016 uk royal college of physicians report supports using e-cigarettes as a smoking cessation tool. a 2015 public health england report stated that "smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (ec) to stop smoking and stop smoking services should support smokers using ec to quit by offering them behavioural support." however, since little is known about long term effects, other regulated options such as nicotine replacement therapy, varenicline or bupropion should be discussed primarily. alternative