Objective To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive
clinical interventions, and system changes to promote the treatment of tobacco
Participants An independent panel of 18 scientists, clinicians, consumers, and methodologists
selected by the US Agency for Healthcare Research and Quality. A consortium
of 7 governmental and nonprofit organizations sponsored the update.
Evidence Approximately 6000 English-language, peer-reviewed articles and abstracts,
published between 1975 and 1999, were reviewed for data that addressed assessment
and treatment of tobacco dependence. This literature served as the basis for
more than 50 meta-analyses.
Consensus Process One panel meeting and numerous conference calls and staff meetings were
held to evaluate meta-analytic and other results, to synthesize the results,
and to develop recommendations. The updated guideline was then externally
reviewed by more than 70 experts and revised.
Conclusions This evidence-based, updated guideline provides specific recommendations
regarding brief and intensive tobacco cessation interventions as well as system-level
changes designed to promote the assessment and treatment of tobacco use. Brief
clinical approaches for patients willing and unwilling to quit are described.
Major conclusions and recommendations include: (1) Tobacco dependence is a
chronic condition that warrants repeated treatment until long-term or permanent
abstinence is achieved. (2) Effective treatments for tobacco dependence exist
and all tobacco users should be offered those treatments. (3) Clinicians and
health care delivery systems must institutionalize the consistent identification,
documentation, and treatment of every tobacco user at every visit. (4) Brief
tobacco dependence treatment is effective, and every tobacco user should be
offered at least brief treatment. (5) There is a strong dose-response relationship
between the intensity of tobacco dependence counseling and its effectiveness.
(6) Three types of counseling were found to be especially effective—practical
counseling, social support as part of treatment, and social support arranged
outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence—sustained-release
bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray,
and nicotine patch—are effective, and at least 1 of these medications
should be prescribed in the absence of contraindications. (8) Tobacco dependence
treatments are cost-effective relative to other medical and disease prevention
interventions; as such, all health insurance plans should include as a reimbursed
benefit the counseling and pharmacotherapeutic treatments identified as effective
in the updated guideline.