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Clinical guidelines

Supporting smoking cessationA guide for health professionals

Evidence for recommendations

Explanation of levels of evidence
Level I Evidence obtained from systematic review of relevant randomised controlled trials
Level II Evidence obtained from one or more well designed, randomised controlled trials
Level III Evidence obtained from well designed, non-randomised controlled trials, or from well designed cohort or case control studies
Level IV Evidence obtained from case series, either post-test or pre-test and post-test
Level V Opinions of respected authorities based on clinical experience, descriptive studies, reports of expert committees
No evidence No evidence was found relevant to general practice on the issue being considered
Source: National Health and Medical Research Council (NHMRC). A guide to the development, evaluation and implementation of clinical practice guidelines. Canberra: NHMRC, 1999.


Strength of recommendation
A There is good evidence to support the recommendation.
B There is fair evidence to support the recommendation.
C There is poor evidence regarding the inclusion or exclusion of the recommendation, but recommendations may be made on other grounds.
Source: United States Preventive Services Task Force. Guide to clinical preventive services. 2nd edn. Baltimore: Williams and Wilkins, 1996.

Readers should note some important changes from earlier guidelines.

  • The emphasis on the Stages of Change Model as an approach to smoking cessation has been changed because the evidence does not support the restriction of quitting advice and encouragement only to those smokers perceived to be in a stage of readiness.
  • A key message is that all people who smoke, regardless of whether they express a desire to stop or not, should be advised to stop smoking.
  • New data have been included about varenicline, mental health and cardiovascular disease.
  • Changes to the approved use of nicotine replacement therapy in Australia are included.
  • A section dealing with smoking cessation methods which have not yet been researched but may prove useful is included.
  • The guide covers smoking cessation in high prevalence populations and in populations with special needs.

A summary of the evidence and recommendations is listed in Appendix 1.

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