among smokers who are aware of the ill effects of smoking , 3 out of 4 individuals are interested in quitting .
one of the most important responsibilities of a countries health care system is to treat nicotine dependence .
this effort consists of different methods such as simple clinical counseling , medications and quit lines .
the cost of these methods differs , however and these methods are not equally effective .
it also is important to match the treatment method to the local and cultural context as well as to clients current needs .
repeated consultation is important in reinforcing the necessity of quitting smoking at every clinical visit .
this intervention is relatively cost - effective , because it is part of the existing health care services which are used by the majority of smokers .
these interventions are effective because they are offered by health care providers , who are respected by the public and smokers also have a good relationship with them . moreover , it is important to provide the quit lines services free- of- charge from any telephone .
even old telephone line systems that responded only to incoming calls showed very significant results .
in addition to clinical counseling and quit lines for consultation , an effective treatment can include medication .
medication includes nicotine replacement therapy ( nrt ) ( patches , gum , sublingual tablets , lozenges , inhalers and nasal spray ) and prescribed drugs such as bupropion and varenicline . in general , medication is more expensive than medical counseling and quit lines .
now after 9 years from the first educational interventions for quitting smoking and one of two complementary integrated programs in the primary health care network , the situation for counseling , human resources and medication is not suitable at the country level and there is insufficient documentation and studies in this regard .
thus , it was considered beneficial to identify the best current evidence and incorporate the latest outcomes .
this would allow for development of an appropriate framework necessary to assess different methods in order to select the best approaches for essential interventions at the country level .
this study specifically targeted decision makers in iran to enable a quantitative systematic review based on the two following two main questions : 
 which smoking cessation methods are most published?which one is the most effective method ? 
 
based on a cross - sectional study , english publications from 2000 to 2012 in pubmed were selected . to find articles related to quitting smoking ,
we considered one of the following keywords from a title : quit or cessation , nrt , champix or varenicline or chantix , zyban or bupropion sustained - release , combination therapy , training , self - learning material , behavior therapy , quit and win , hypnosis , telephone consulting , acupuncture , interactive voice response ( ivr ) , e - cigarettes , pharmacological treatments , non - pharmacological treatments , personal methods , non - nicotine medications . in an expert panel meeting it was proposed to include relevant articles ( at a minimum , these must include the abstracts ) .
unpublished and duplicated articles and opinion based papers were excluded as they were not classified as relevant .
articles were reviewed separately by two qualified assistants , who were trained and calibrated to achieve desirable agreement in the selecting of articles . in order to reach check reliability ,
a pilot inter - rater reliability assessment was conducted by the author ( gh ) .
the inter - rater reliability was 67% before discussion ; any discrepancies in answers were discussed and a consensus was achieved on review . after the training and pilot assessment , the author ( gh ) determined that the assistants were ready to do the search .
the reports of the assistants were observed again by the author ( gh ) , who determined when the assistants were ready to work alone . finally , the assistants selected and categorized the articles according to the following criteria for each method : total number of articles , the number of articles that supported quit smoking efforts , the number of articles that did not support quit smoking efforts and the number of articles without any firm conclusions . again in order to assess the reliability of each assistant , one method was selected randomly and the recorded results were compared by the author ( gh ) . if there were discrepancies in the figures , these were corrected by author ( gh ) .
different methods were used for rating articles and the strengths and weakness of each were discussed through an expert panel meeting . finally , the best scoring model was accepted for each stop - smoking method , which included a maximum of 40 scores of which 20 scores were for articles that supported methods ( positive articles minus negative articles ) and 20 points for the highest proportion of supported to the total number of articles .
for scoring of each article , one point was possible , since we did not consider differences between articles which were published in pubmed .
however , a point was not given for articles that did not have a clear result . because newer treatment methods had less chance for having more published articles ; an index of positive articles to total articles
this search resulted in a folder with 3081 titles of articles ; of which 1436 were inaccessible ( at a minimum an abstract ) . out of 1645 remaining articles ,
713 were not about treatment and its effect on quitting smoking ( they were about history , smoking cessation programs in countries , relevant policies , rules and regulations for stopping smoking , article 14 of world health organization [ who ] framework convention on tobacco control , etc . ) of the 932 remaining articles , 62 articles did not support quit smoking methods ( with no good results or side - effects ) .
of 870 remaining manuscript , 90 cases did not demonstrate a clear result ( even whether the method is usable ) [ figure 1 ] .
study selection flow diagram nrt , champix and zyban respectively with 352 , 117 and 71 cases were the most advised method and e - cigarette and non - nicotine medication with one case were the least advised methods . for each method
the number of advising articles to the total was 31 out of 32 and for nrt was 376 of 407 ( which was considered the maximum score ) .
willpower with two out of 9 was the lowest score and finally nrt with a score of 39 and champix and training with a score of 36 were the best methods .
the number of selected articles and the results are shown in tables 1 and 2 .
prevalence of smoking cessation methods in included articles ( n=932 ) and the results obtained by number of articles and based on classification of the studies prevalence of quit smoking methods in the included articles ( n=932 and their scores )
unfortunately , after a decade of offering quit smoking services , the situation is not so positive in iran and is still based on older methods such as 15 mg nicotine patches and group therapy .
these services have not been updated on the basis of more recent evidence . for determining which quit smoking methods are maximally effective , a comprehensive review of all recent articles was a necessity in order to obtain suitable qualitative indicators for selecting effective quit smoking methods . in this study
, it was found that three methods  nrt , champix and education for quitting smoking  are advised most frequently based on the articles referenced in pubmed between the years 2000 and 2012 .
these findings are informative in updating the health care services at the country level and a combination of these methods might be provided . many countries that offer cessation services follow better methods through evaluation and incorporating necessary modifications to these methods . as displayed in the results , nrt , champix , training , combination treatment , zyban and self - help materials received the highest scores with over 30 points ; multi - drug treatment , acupuncture , some methods without medication such as nurse counseling , non - nicotine drugs , will power and e - cigarettes had the lowest scores with less than 20 and the remaining methods including behavioral methods , quit and win , telephone counseling and ivr and hypnotism were in the middle .
the results of this study are consistent with the findings of high impact articles in who , centers for disease control and prevention and cochrane , and these results also were consistent with the writers experience .
however , it was necessary to prioritize quitting methods based on a new quantitative analysis and simple qualitative methods in order to gain the support of decision makers for further necessary interventions .
that is because the systematic reviews , such as cochrane , do not provide guidance on which of the effective methods are best for a particular environment . in the systematic reviews articles
finding the relevant articles was challenging in the current study because we selected a huge number of articles for a particular selected method ( based on the accessibility of the full text or abstract ) .
boyle et al . and linder et al . in their studies have reported that use of electronic medical registration and continuous use of nicotine patches can increase success of smoking cessation attempts .
this study was the first quantitative study , which provided us with a wide perspective about all tobacco cessation methods .
scores were based in part on number of publications , thereby creating a bias in favor of older methods with more opportunity for publication .
some of the newer methods are quite recent and therefore not surprisingly have few published assessments .
this study could be a useful indicator of effective quit smoking methods based on updated scientific documents .
the results of this study could be used as a reference for decision makers who are charged with selecting cessation methods at the country level that will produce good outcomes .
methods that obtained the higher scores have been applied most frequently in interventions that have had positive effects on quit rates . according to the updated scientific and updated evidence based on a simple and quantitative approach , quit smoking methods with high and better scores including nrt , champix and training have been recognized as effective and the other methods have received lower scores .
further studies are needed to implement a comparative study on qualitative and quantitative smoking cessation methods that could lead to increased quit rates at the country level .
 background : during recent years , there have been many advances in different types of pharmacological and non - pharmacological tobacco control treatments . in this study , we aimed to identify the most effective smoking cessation methods used in quit based upon a review of the literature.methods:we did a search of pubmed , limited to english publications from 2000 to 2012 . 
 two trained reviewers independently assessed titles , abstracts and full texts of articles after a pilot inter - rater reliability assessment which was conducted by the author ( gh ) . 
 the total number of papers and their conclusions including recommendation of that method ( positive ) or not supporting ( negative ) was computed for each method . 
 the number of negative papers was subtracted from the number of positive ones for each method . in cases of inconsistency between the two reviewers , 
 these were adjudicated by author.results:of the 932 articles that were critically assessed , 780 studies supported quit smoking methods . in 90 studies , the methods were not supported or rejected and in 62 cases the methods were not supported . nicotine replacement therapy ( nrt ) , champix and zyban with 352 , 117 and 71 studies respectively were the most supported methods and e - cigarettes and non - nicotine medications with one case were the least supported methods . 
 finally , nrt with 39 and champix and education with 36 scores were the most supported methods.conclusions:results of this review indicate that the scientific papers in the most recent decade recommend the use of nrt and champix in combination with educational interventions . 
 additional research is needed to compare qualitative and quantitative studies for smoking cessation . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSIONS