Read this first
This is the newest pathway here, and it was built differently from most of the others. It comes from the published guidelines and the research rather than from an existing OneVillage program, so every claim in it, and in the reading that comes with each week, is numbered to the paper it came from. All of it was reviewed and signed by our lead clinician, Michelle Kirschner, APRN-BC: the program, the safety rules, and the documents you will read. Nothing here sets or changes a medication: that conversation is with your prescriber, and your Whole Health Coach helps you prepare for it. If something reads wrong to you, tell your Whole Health Coach. We would rather hear it than not.
Who this is for
Adults who use tobacco or nicotine in any form and want to stop, at any point from thinking about it to having already set a date. You do not have to be certain, and you do not have to be ready in week 1: the evidence supports starting medication in people who are not yet ready to quit, and the pathway is built to hold you either way. We ask who prescribes your medications, because every pharmacotherapy step here ends with them, but not having a prescriber does not stop you enrolling and finding one becomes a named task in module 1. Nothing here sets or changes a dose. Pregnant members are in scope for the behavioral program and their prescriber decides the medication question, because the USPSTF found the evidence on cessation medication in pregnancy insufficient either way. Members quitting alcohol or another substance at the same time are co-managed with Substance Use Recovery rather than moved.
What brings people here
Member reports current cigarette, cigar, pipe, smokeless tobacco or nicotine vape use and wants to stop. Also: a biometric or HRA tobacco flag, a nicotine-exposure score of 0 on the Life's Essential 8 battery this portal already administers, a surgery or pregnancy ahead, or someone on the care team of another pathway hearing that someone smokes. Members already enrolled elsewhere can run this alongside that pathway rather than instead of it, because quitting is the single largest change available on most of them.
Clinical framework
OneVillage-developed; clinically approved by Michelle Kirschner, APRN-BC.
How the 8 weeks run
Baseline assessments, your first SMART goal, and the 1:1 that sets up everything after it.
Specialists and clinicians rotate in, and sessions come thickest here. One change at a time, in the domains your baseline flagged.
Re-score, refresh the care plan, and check in 1:1 on what is and is not working.
The remaining domains, at a lighter cadence, and the work of making the early weeks hold under pressure.
Final re-score, relapse prevention, and the plan for what happens next.
When your sessions fall
The program is built in four-week modules. Sessions come thickest at the start, when what you decide matters most, and step down as things settle. That is 5 sessions of 45 minutes across 8 weeks, counting the visit before week 1.
| Module | Weeks | Sessions | Cadence |
|---|---|---|---|
| Module 1 | Weeks 1 to 4 | 2 | every other week |
| Module 2 | Weeks 5 to 8 | 2 | every other week |
Week by week
- Before you beginBefore you begin
What you smoke and when, without changing any of it yet. The first cigarette of the day and how soon after waking it comes is the single most useful thing you can tell your Whole Health Coach, and your medication list is the second.
- Week 1The attempt, and the ones before it
About 70 percent of people who smoke want to stop, and it takes an average of roughly six attempts before one holds. If you have tried before you are not starting over, you are partway through a normal count. Also the two numbers this pathway will not hide from you: what quitting gives back, and the weight question.
- Week 2Medication, and why it starts before you stop
Nicotine replacement, varenicline and bupropion, what each does and what the trials found. Combination nicotine replacement, a patch plus a fast-acting form, beats a single form. Treatment usually starts before the quit date rather than on it, and often runs longer than the box says.
- Week 3Your quit day and the first 72 hours
Pick the day, then plan backward from it. Which cigarettes are doing a job for you, what replaces each one, what the first three days feel like and when the worst of it passes. The plan is written before the day, because nobody plans well on day two.
- Week 4Mid-program: two weeks in
This is the week people restart, so it is the week we check in. Sleep is disturbed, cravings are still arriving, and the medication may need a change. Every one of those is a treatable problem rather than a failure of will, and a slip is counted without penalty.
- Week 5Weight, appetite and moving
The honest number: about 9 to 11 pounds on average at twelve months, most of it in the first three months, and a wide spread around that. Roughly one in six people loses weight and about one in eight gains more than 22 pounds. What actually helps, and why this is never a reason to go back.
- Week 6Stress, mood, and the job the cigarette was doing
The belief that smoking relieves stress is the one this pathway spends the most time on. What is usually being relieved is withdrawal from the last one. The evidence on mental health after quitting runs the opposite way to the fear: it does not get worse, including for people with a diagnosed condition.
- Week 7Vaping, cutting down, and just one
The e-cigarette question answered with both halves of the record: the trials that found them more effective than nicotine replacement, and the USPSTF's finding that the evidence is not yet enough to recommend them. Plus what cutting down does and does not achieve, and the difference between a slip and a relapse.
- Week 8Making it hold
Relapse is most likely in the months after a program like this ends, so the last week is about the weeks after it. What the long follow-up shows about what you get back and how slowly, the situations most likely to undo you, and who you call. Your medication plan past week 8 gets settled before you leave.
Who you will work with
Your Whole Health Coach takes your first visit and closes every module, so it is the same person from the first session to the last. The specialists and clinicians below lead the weeks where their work is the focus.
Cindy is a Whole Health Coach with a background in clinical nursing and more than a decade of experience in healthcare. Her experience working closely with patients and multidisciplinary teams has given her a deep understanding of the many factors that contribute to overall health and well-being. Cindy believes that health is about more than any one diagnosis, symptom, or lab result.
Meet Lucy Paulise, who is a career and stress management coach, book writer, and Forbes contributor. Her passion lies in helping people discover and reach their full potential. She specializes in coaching individuals on how to manage stress, anxiety, imposter syndrome, perfectionism, or any other challenges they may face in their work or personal lives that can lead to feeling overwhelmed.
What we work on
| Domain | What this pathway does |
|---|---|
| Nutrition & Metabolism | Weight gain after quitting averages 9 to 11 pounds at twelve months and most of it happens in the first three, with wide variation: about 16 percent of people lose weight and about 13 percent gain more than 22 pounds. It is named in week 1 rather than discovered in week 5, and it is never a reason to keep smoking. Nutrition support is offered from the quit date, not after a gain. |
| Movement & Mobility | Activity is used here for craving management and for the weight question, not as a separate program. Breathlessness and cough usually improve within weeks and are worth tracking, because an early, visible win is what carries people through the withdrawal window. |
| Sleep & Recovery | Nicotine withdrawal disturbs sleep and peaks in the first two weeks. Tracked and expected rather than treated as a new problem, and it is a common reason people restart in week 2. |
| Stress & Resilience | Stress is the most common relapse trigger, and the belief that smoking relieves stress is the belief this pathway spends the most time on. What is being relieved is usually withdrawal from the last cigarette. |
| Mind & Mood | PHQ-9 and GAD-7 at weeks 0, 4 and 8. Quitting does not worsen mental health on the available evidence, including in people with a diagnosed mental health condition, and is associated with small to moderate improvement. Existing psychiatric care is coordinated, never paused: a member on psychiatric medication is told to expect a prescriber conversation, because stopping smoking changes how some drugs are metabolized. |
| Preventive care | Nicotine exposure is one of the eight Life's Essential 8 components, so quitting moves a score this portal already tracks. Lung cancer screening eligibility, blood pressure, and a dental check are raised where they apply. |
How progress is measured
These are the validated tools this pathway uses: at your first visit, at the mid-program review, and at the end.
| Tool | Cadence | Owned by |
|---|---|---|
| Cigarettes or equivalents per day, and time to first one of the day | Weekly | Member + WHC |
| Quit date set, and days since | Every session | WHC |
| Medication started, dose, and still taking it | Every session | RN Navigator |
| Cravings and withdrawal, worst day of the week | Weekly | Member + WHC |
| Weight | Weekly, opt-out | Member |
| PHQ-9 + GAD-7 | Wk 0, 4, 8 | WHC; LCSW reads |
| Life's Essential 8, nicotine exposure component included | Wk 0, 4, 8 | WHC |
| Slips and lapses, counted without penalty | Every session | WHC |
The research behind this pathway
This pathway was built from the guidelines and studies below rather than from a clinician playbook. They are listed so you can read them yourself: every one is a real, published paper and the number at the end of each line is its PubMed ID.
Guidelines this pathway follows
- Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons · US Preventive Services Task Force
The A-grade recommendation this pathway is built to deliver: ask, advise, and provide both behavioral support and FDA-approved medication. It is also why this pathway does not push e-cigarettes as a quit method, and why the medication question in pregnancy belongs to a prescriber. PMID 33464343
- Initiating Pharmacologic Treatment in Tobacco-Dependent Adults · American Thoracic Society
Which medication to start, and when. It is the basis for offering medication to members who are not yet ready to quit, and for treating longer than 12 weeks. PMID 32663106
- Treating Tobacco Use and Dependence: 2008 Update · US Public Health Service
The counseling dose this pathway's cadence answers to, and the framework every later guideline builds on. PMID 18617085
- Life's Essential 8 · American Heart Association
Nicotine exposure is one of the eight components, so the score this portal already administers at weeks 0, 4 and 8 moves when a member quits. PMID 35766027
Key studies
- US Preventive Services Task Force (2021). JAMAInterventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement
The USPSTF's current statement. Behavioral support plus FDA-approved medication is an A recommendation for adults who are not pregnant, and behavioral support is an A recommendation in pregnancy. On e-cigarettes as a quit method, and on cessation medication during pregnancy, it found the evidence insufficient to judge either way and said so. PMID 33464343
- Stead LF et al. (2016). Cochrane Database Syst RevCombined pharmacotherapy and behavioural interventions for smoking cessation
53 trials and more than 25,000 people. Medication plus behavioral support beats usual care or a minimal intervention. That combination is the whole design of this pathway: the sessions alone are not the treatment, and neither is the prescription. PMID 27009521
- Leone FT et al. (2020). Am J Respir Crit Care MedInitiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline
Seven recommendations on which medication to start. Two of them shape this pathway directly: start medication even in someone who is not ready to quit, and treat for longer than 12 weeks rather than stopping at the end of a course. PMID 32663106
- Anthenelli RM et al. (2016). LancetNeuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial
The trial that settled the psychiatric safety question these medications had been carrying, in more than 8,000 people, half of them with a psychiatric diagnosis. It found no significant increase in neuropsychiatric events attributable to varenicline or bupropion, and it found all three medications beat placebo. PMID 27116918
- Theodoulou A et al. (2023). Cochrane Database Syst RevDifferent doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation
High-certainty evidence that combination nicotine replacement, a patch plus a fast-acting form, beats a single form, and that 4 mg gum beats 2 mg. It is why this pathway's medication conversation is about combining and dosing rather than about whether to use anything. PMID 37335995
- Aubin HJ et al. (2012). BMJWeight gain in smokers after quitting cigarettes: meta-analysis
62 studies. Average weight gain was about 4 to 5 kg at twelve months and most of it happened in the first three, but the spread is wide: roughly 16 percent lost weight and 13 percent gained more than 10 kg. This pathway states the number in week 1 rather than letting a member find it out in week 5. PMID 22782848
- Taylor GM et al. (2021). Cochrane Database Syst RevSmoking cessation for improving mental health
102 studies and over 169,500 people. Mental health does not get worse after quitting, and anxiety and depression symptoms improved a little to moderately, including in people with a diagnosed mental health condition. The certainty ranges from very low to moderate depending on the outcome. PMID 33687070
- Jha P et al. (2013). N Engl J Med21st-century hazards of smoking and benefits of cessation in the United States
202,248 US adults followed to death or 2006. Smokers lost at least a decade of life expectancy. People who quit at 25 to 34 gained back about 10 of those years, at 35 to 44 about 9, and at 45 to 54 about 6. Quitting before 40 removed about 90 percent of the excess risk of death from continuing. PMID 23343063
- Duncan MS et al. (2019). JAMAAssociation of Smoking Cessation With Subsequent Risk of Cardiovascular Disease
Framingham data on 5,308 people who had ever smoked. Quitting within five years cut cardiovascular events substantially against continuing to smoke. Among the heaviest smokers, risk stayed above that of people who never smoked for more than five years after quitting, which is the honest version of the recovery curve. PMID 31429895
- Anthonisen NR et al. (2005). Ann Intern MedThe effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial
The Lung Health Study randomized 5,887 people to a 10-week cessation program or usual care and followed them for up to 14.5 years. Deaths from any cause were lower in the intervention group, even though only about a fifth of that group had actually stopped at five years. PMID 15710956
- Hajek P et al. (2019). N Engl J MedA Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
886 adults in UK stop-smoking services, all of them getting behavioral support. At one year 18.0 percent of the e-cigarette group had stopped smoking against 9.9 percent on nicotine replacement. Of those who had stopped, 80 percent of the e-cigarette group were still using the product at 52 weeks against 9 percent on nicotine replacement. PMID 30699054
- Lindson N et al. (2026). Cochrane Database Syst RevElectronic cigarettes for smoking cessation
The current update of the living review: high-certainty evidence that nicotine e-cigarettes produce more quits than nicotine replacement therapy, with serious adverse events at similar rates over the trial periods studied. It sits alongside the USPSTF's insufficient-evidence finding rather than replacing it, and both are given to members in week 7. PMID 42642048
- Matkin W et al. (2019). Cochrane Database Syst RevTelephone counselling for smoking cessation
104 trials and 111,653 people. Several sessions of proactive telephone counseling beat a single call or self-help materials. It is why this pathway hands a member the state quitline, at $0 out-of-pocket cost, as a supplement rather than treating our sessions as the only support available between them. PMID 31045250
- Rigotti NA et al. (2022). JAMATreatment of Tobacco Smoking: A Review
The clinical review this pathway's shape follows. About 70 percent of people who smoke want to stop, and it takes an average of around six attempts before one holds. That number is in week 1 on purpose: a member who has tried before has not failed, they are partway through the normal count. PMID 35133411