approaches it is important to note that most of the alternative approaches below have minimal evidence to support their use, and their efficacy and safety should be discussed with a healthcare professional before starting. acupuncture: acupuncture has been explored as an adjunct treatment method for smoking cessation. a 2014 cochrane review was unable to make conclusions regarding acupuncture as the evidence is poor. a 2008 guideline found no difference between acupuncture and placebo, found no scientific studies supporting laser therapy based on acupuncture principles but without the needles.: 99 hypnosis: hypnosis often involves the hypnotherapist suggesting the unpleasant outcomes of smoking to the patient. clinical trials studying hypnosis and hypnotherapy as a method for smoking cessation have been inconclusive.: 100 a cochrane review was unable to find evidence of benefit of hypnosis in smoking cessation, and suggested if there is a beneficial effect, it is small at best. however, a randomized trial published in 2008 found that hypnosis and nicotine patches "compares favorably" with standard behavioral counseling and nicotine patches in 12-month quit rates. herbal medicine: many herbs have been studied as a method for smoking cessation, including lobelia and st john's wort. the results are inconclusive, but st. johns wort shows few adverse events, but is a contraindication to many medications. lobelia has been used to treat respiratory diseases like asthma and bronchitis, and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the fda's poisonous plant database. lobelia can still be found in many products sold for smoking cessation and should be used with caution. herbal products should be discussed with healthcare professionals before use to confirm safety with other medications. smokeless tobacco: there is little smoking in sweden, which is reflected in the very low cancer rates for swedish men. use of snus (a form of steam-pasteurized, rather than heat-pasteurized, air-cured smokeless tobacco) is an observed cessation method for swedish men and even recommended by some swedish doctors. however, the report by the scientific committee on emerging and newly identified health risks (scenihr) concludes "stp (smokeless tobacco products) are addictive and their use is hazardous to health. evidence on the effectiveness of stp as a smoking cessation aid is insufficient." a recent national study on the use of alternative tobacco products, including snus, did not show that these products promote cessation. aversion therapy: it is a method of treatment works by pairing the pleasurable stimulus of smoking with other unpleasant stimuli. a cochrane review reported that there is insufficient evidence of its efficacy. nicotine vaccines: nicotine vaccines (e.g., nicvax and ta-nic) work by reducing the amount of nicotine reaching the brain; however, this method of therapy needs more investigations to establish its role and determine its side effects. technology and machine learning: research studies using machine learning or artificial intelligence tools to provide feedback and communication with those who are trying to quit smoking are increasing, yet the findings are so far inconclusive. psilocybin has been being investigated as a potential smoking cessation aid for several years. in 2021, johns hopkins medicine has been awarded a grant from the national institutes of health to explore the potential impacts of psilocybin and talk therapy on tobacco addiction. special populations children and adolescents methods used with children and adolescents include: motivational enhancement psychological support youth anti-tobacco activities, such as sport involvement school-based curricula, such as life-skills training school-based nurse counseling sessions access reduction to tobacco anti-tobacco media family communication cochrane reviews, mainly of studies combining motivational enhancement and psychological support, concluded that "complex approaches" for smoking cessation among young people show promise. the 2008 us guideline recommends counselling-style support for adolescent smokers on the basis of a meta-analysis of seven studies.: 159–161 neither the cochrane review nor the 2008 guideline recommends medications for adolescents who smoke. pregnant women smoking during pregnancy can cause adverse health effects in both the woman and the fetus. the 2008 us guideline determined that "person-to-person psychosocial interventions" (typically including "intensive counseling") increased abstinence rates in pregnant women who smoke to 13.3%, compared with 7.6% in usual care.: 165–167 mothers who smoke during pregnancy have a greater tendency towards premature births. their babies are often underdeveloped, have smaller organs, and weigh much less than the average baby weight. in addition, these babies have weaker immune systems, making them more susceptible to many diseases such as middle ear inflammations and asthmatic bronchitis, as well as metabolic conditions such as diabetes and hypertension, all of which can bring significant morbidity. additionally, a study published by american academy of pediatrics shows that smoking during pregnancy increases the chance of sudden unexpected infant death ((suid) or (sids)). there is also an increased chance that the child will be a smoker in adulthood. a systematic review showed that psychosocial interventions help women to stop smoking in late pregnancy and can reduce the incidence of low birth weight infants. it is a myth that a female smoker can cause harm to a fetus by quitting immediately upon discovering she is pregnant. this idea is not based on any medical study or fact. in a uk study that included 1140 pregnant women, e-cigarettes were found to be as effective as nicotine patches at helping pregnant women to quit smoking. the safety of the two products was also similar. however, life style modification are the preferred method for pregnant women, and they should discuss smoking cessation techniques with a healthcare professional. schizophrenia main article: schizophrenia and tobacco smoking studies across 20 countries show a strong association between patients with schizophrenia and smoking. people with schizophrenia are much more likely to smoke than those without the disease. for example, in the united states, 80% or more of people with schizophrenia smoke, compared to 20% of the general population in 2006. hospitalized smokers percent increase of success for six months over unaided attempts for each type of quitting (chart from west & shiffman based on cochrane review data: 59 smokers who are hospitalised may be particularly motivated to quit.: 149–150 a 2012 cochrane review found that interventions beginning during a hospital stay and continuing for one month or more after discharge were effective in producing abstinence. patients undergoing elective surgery may get benefits of preoperative smoking cessation interventions, when starting 4–8 weeks before surgery with weekly counseling intervention for behavioral support and use of nicotine replacement therapy. it is found to reduce the complications and the number of postoperative morbidity. mood disorders people with mood disorders or attention deficit hyperactivity disorders have a greater chance to begin smoking and a lower chance of quitting smoking. a higher correlation with smoking has also been seen in people diagnosed with the major depressive disorder at any time throughout their lifetime compared to those without it. success rates in quitting smoking were lower for those with a major depressive disorder diagnosis versus people without the diagnosis. exposure to cigarette smoke early on in life, during pregnancy, infancy, or adolescence, may negatively impact a child's neurodevelopment and increase the risk of developing anxiety disorders in the future. homeless and poverty homelessness doubles the likelihood of an individual currently being a smoker. homelessness is independent of other socioeconomic factors and behavioral health conditions. homeless individuals have the same rates of desire to quit smoking. still, they are less likely than the general population to attempt to stop successfully. in the united states, 60–80% of homeless adults are smokers. this is a considerably higher rate than the general adult population of 19%. many current smokers who are homeless report smoking as a means of coping with "all the pressure of being homeless." the perception that homeless people smoke is "socially acceptable" can reinforce these trends. americans under the poverty line have higher rates of smoking and lower rates of quitting than those over the poverty line. while the homeless population is concerned about short-term effects of smoking, such as shortness of breath or recurrent bronchitis, they are not as concerned with long-term consequences. the homeless population has unique barriers to quitting smoking, such as unstructured days, the stress of finding a job, and immediate survival needs that supersede the desire to quit smoking. these unique barriers can be combated through pharmacotherapy and behavioral counseling for high levels of nicotine dependence. the emphasis of immediate financial benefits to those who concern themselves with the short-term over the long-term, partnering with shelters to reduce the social acceptability of smoking in this population, and increased taxes on cigarettes and alternative tobacco products to further make the addiction more difficult to fund. concurrent substance use disorders over three-quarters of people in treatment for substance use are current smokers. providing counseling and pharmacotherapy (nicotine replacement therapy such as patches or gum, varenicline, and/or bupropion) increases tobacco abstinence without increasing the risk of returning to other substance use. comparison of success rates comparison of success rates across interventions can be difficult because of different definitions of "success" across studies. robert west and saul shiffman, authorities in this field recognized by government health departments in a number of countries,: 73, 76, 80 have concluded that, used together, "behavioral support" and "medication" can quadruple the chances that a quit attempt will be successful. a 2008 systematic review in the european journal of cancer prevention found that group behavioural therapy was the most effective intervention strategy for smoking cessation, followed by bupropion, intensive physician advice, nicotine replacement therapy, individual counselling, telephone counselling, nursing interventions, and tailored self-help interventions; the study did not discuss varenicline. factors affecting success individuals who sustained damage to the insula were able to more easily abstain from smoking. quitting can be harder for individuals with darkly pigmented skin than individuals with pale skin since nicotine has an affinity for melanin-containing tissues. studies suggest this can cause the phenomenon of increased nicotine dependence and lower smoking cessation rate in darker-pigmented individuals. there is an important social component to smoking. the spread of smoking cessation from person to person contributes to the decrease in smoking these years. a 2008 study of a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%. nevertheless, a cochrane review determined that interventions to increase social support for a smoker's cessation attempt did not improve long-term quit rates. smokers trying to quit are faced with social influences that may persuade them to conform and continue smoking. cravings are easier to detain when one's environment does not provoke the habit. suppose a person who stopped smoking has close relationships with active smokers. in that case, they are often put into situations that make the urge to conform more tempting. however, in a small group with at least one other not smoking, the likelihood of conformity decreases. the social influence of smoking cigarettes has been proven to rely on simple variables. one researched variable depends on whether there is influence from a friend or non-friend. the research shows that individuals are 77% more likely to conform to non-friends, while close friendships decrease conformity. therefore, if an acquaintance offers a cigarette as a polite gesture, the person who has stopped smoking will be likelier to break his commitment than if a friend had suggested it. recent research from the international tobacco control (itc) four country survey of over 6,000 smokers found that smokers with fewer smoking friends were more likely to intend to quit and to succeed in their quit attempt. expectations and attitude are significant factors. a self-perpetuating cycle occurs when a person feels bad for smoking yet smokes to alleviate feeling bad. breaking that cycle can be a key in changing the sabotaging attitude. smokers with major depressive disorder may be less successful at quitting smoking than non-depressed smokers.: 81 relapse (resuming smoking after quitting) has been related to psychological issues such as low self-efficacy, or non-optimal coping responses; however, psychological approaches to prevent relapse have not been proven to be successful. in contrast, varenicline is suggested to have some effects and nicotine replacement therapy may help the unassisted abstainers. side effects duration of nicotine withdrawal symptoms craving for tobacco 3 to 8 weeks dizziness few days insomnia