Tobacco

tobacco

Clinical Strategies

Guide to Clinical Preventive Services is the gold standard among clinician guides on preventive patient care. It addresses disease and risk factor screening and counseling about health behaviors. The U.S. Preventive Services Task Force, convened by the U.S. Agency for Healthcare Research and Quality, develops the Guide’s recommendations based on scientific evidence of effectiveness.

The U.S. Preventive Services Task Force tobacco cessation recommendations contain updated information from the evidence-based Public Health Service clinical practice guideline, Treating Tobacco Use and Dependence.

Clinical strategies for tobacco cessation should include the following:

COUNSELING
Treatments involving person-to-person contact via individual, group, or proactive telephone counseling are consistently effective and their effectiveness increases with treatment intensity (e.g., minutes of contact). Every patient who uses tobacco should be offered at least brief treatment:
  • Patients willing to try to quit tobacco use should be provided with treatments identified as effective in this guideline.
  • Patients unwilling to try to quit tobacco use should be provided with a brief intervention designed to increase their motivation to quit.

 

TYPES OF COUNSELING
Three types of counseling and behavioral therapies were found to be especially effective and should be used with all patients attempting tobacco cessation:
  • Provision of practical counseling (problem-solving skills/training).
  • Provision of social support as part of treatment.
  • Help in securing social support outside of treatment.

 

PHARMACOTHERAPIES
Five first-line pharmacotherapies were identified that reliably increase long-term abstinence rates:
  • Bupropion SR
  • Nicotine Gum
  • Nicotine Inhaler
  • Nicotine Nasal Spray
  • Nicotine Patch
Two second-line pharmacotherapies were identified as efficacious and may be considered by clinicians if first-line pharmacotherapies are not effective: Clonidine and Nortriptyline.

 

 

It is essential that physicians and healthcare delivery systems (including administrators, insurers, and purchasers) institutionalize the consistent identification, documentation, and treatment of every tobacco user seen in a health care setting.

 

Population Strategies

Guide to Community Preventive Services or “Community Guide” details effective community-based strategies to promote and safeguard health. These might include media campaigns, educational programs, policy changes, or regulatory action. It is being developed by an independent task force convened by the Centers for Disease Control and Prevention.

These tables summarize the Community Guide’s recommendations on reducing tobacco use. The Community Guide Web site explains each recommendation in detail.

Strategies to Increase Tobacco Cessation
Increase the unit price for tobacco products Strong Evidence of Effectiveness
Mass media campaigns combined with other interventions Strong Evidence of Effectiveness
Provider reminder systems (alone) Sufficient Evidence of Effectiveness
Provider reminder systems plus provider education Strong Evidence of Effectiveness
Reducing patient out-of-pocket costs for effective treatments Sufficient Evidence of Effectiveness
Patient telephone support (quit lines) combined with other interventions Strong Evidence of Effectiveness

 

Strategies to Reduce Tobacco Use Initiationby Children, Adolescents and Adults
Increase the unit price for tobacco products Strong Evidence of Effectiveness
Mass media campaigns combined with other interventions Strong Evidence of Effectiveness

 

Strategies to Reduce Exposure to Environmental Tobacco Smoke
Smoking bans and restrictions Strong Evidence of Effectiveness