Stepped-Care Smoking Cessation: Meds First, Devices and Harm Reduction Later
This narrative review consolidates guideline-concordant pharmacotherapy with emerging digital, neuromodulation, and harm-reduction options into a pragmatic stepped-care model for primary care behavioral health and addiction pharmacists.
vareniclinebupropionnicotine replacement therapycytisinenortriptylineclonidinee-cigarettesnicotine pouchesrepetitive transcranial magnetic stimulationvagal nerve stimulationsmoking cessationnicotine dependencetobacco use disorderharm reductiondigital therapeuticsnarrative reviewprimary careBehavioral Health / Addiction Medicine
Background Information
Maximize smoking cessation success with new digital and harm-reduction tools.
Smoking remains a major cause of preventable illness and death, yet effective treatments are underutilized. The review supports using FDA-approved pharmacotherapy with behavioral counseling as standard care, with digital tools and rTMS as emerging adjuncts. Primary care should integrate harm-reduction and digital tools with standard treatments to enhance smoking cessation efforts. Incorporate digital tools and harm reduction into standard smoking cessation strategies.
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Citation:Croghan IT, Hurt RT, Elrashidi MY, et al. Smoking Cessation in Primary Care: A Narrative Review of Evidence-Based Treatment, Emerging Technology, and Harm Reduction Approaches. Journal of primary care & community health. 2026;17:21501319261468510. doi:10.1177/21501319261468510