Even after a life-threatening vascular event, roughly one-third of all smokers continue to smoke.146,156 Persis- tent cigarette smoking after stroke or TIA is associated with increased longer-term mortality rates,157 159 and evidence identifies an 2-fold risk of stroke recurrence in persistent smokers compared with nonsmokers143 145 and a dose-response relationship.143 Behavioral and pharmacological interventions for tobacco dependence are evidence based through multiple meta-analy- but not in cerebrovascular disease popu- No RCTs have examined smoking cessation interventions on recurrent events after stroke compared with no intervention; however, encouraging evidence of increased smoking cessation rates after stroke in mul- tibehavioral interventions compared with usual care is Recommendation-Specific Supportive Text 1. A meta-analysis of smoking cessation inter- ventions in hospitalized patients identified that intensive counseling interventions initiated in hospital with supportive contacts for at least 1 month after discharge increase smoking cessa- tion rates compared with usual care (RR, 1.37 CLINICAL STATEMENTS AND GUIDELINES Kleindorfer [95% CI, 1.27 1.48]), with comparable findings in patients with CVD (RR, 1.42 [95% CI, 1.29 1.56]) and interventions initiated in rehabilitation nicotine replacement therapy to the interven- tion increased cessation rates compared with intensive counseling alone (RR, 1.54 [95% CI, High-quality evidence supports combined pharmacotherapy (nicotine replace- ment therapy, varenicline, or bupropion) and behavioral interventions compared with usual care, brief advice, or less intensive counseling in smoking cessation (RR, 1.83 [95% CI, 1.68 1.98]) in health care and community settings.140 Group behavior therapy programs for smoking cessation are superior to self-help programs but are not superior to individual counseling of In stroke trials, multibehav- ioral interventions have been associated with a greater likelihood of smoking cessation in the STOP trial (Stroke Prevention Trial in Sickle Cell and an increase of 17% in cessation rates compared with usual care (P=0.001) in the INSPiRE-TMS trial (Intensified Secondary Prevention Intending a Reduction of Recurrent Events in TIA and Minor Stroke Patients).142 2. 