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April 24, 1996, Vol 275, No. 16 >
ARTICLE | April 24, 1996

The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline FREE

Michael C. Fiore, MD, MPH; David W. Wetter, PhD; William C. Bailey, MD; Glen Bennett, MPH; Stuart J. Cohen, EdD; Sally Faith Dorfman, MD, MSHSA; Michael G. Goldstein, MD; Ellen R. Gritz, PhD; Victor Hasselblad, PhD; Jack E. Henningfield, PhD; Richard B. Heyman, MD; John Holbrook, MD; Corinne Husten, MD, MPH; Carlos Roberto Jaen, MD, PhD; Connie Kohler, DrPH; Thomas E. Kottke, MD, MSPH; Harry A. Lando, PhD; Marc Manley, MD, MPH; Robert Mecklenburg, DDS, MPH; Cathy Melvin, PhD, MPH; Patricia Dolan Mullen, DrPH; Louise M. Nett, RN, RRT; Thomas M. Piasecki, MS; Lawrence Robinson, MD, MPH; Debra Rothstein, PhD; David L. Schriger, MD, MPH; Maxine L. Stitzer, PhD; Sylvie Stachenko, MD, MSC, FCFP; Anthony Tommasello, MS; Louise Villejo, MPH, CHES; Mary Ellen Wewers, PhD, RN; Timothy B. Baker, PhD
[+] Author Affiliations

A complete list of the members of the Smoking Cessation Clinical Practice Guideline Panel and Staff appears at the end of this article.

Drs Fiore and Baker have worked on clinical research studies funded in part by ALZA Corporation, CIBA-Geigy Corporation, Elan Pharmaceutical, Lederle Laboratories, and Marion Merrell Dow, Inc. Dr Goldstein has received research support from BristolMyers Squibb Company, Glaxo Wellcome, Dupont Merck, Eli Lilly, and Boehringer Ingelheim and is a member of the speaker's bureau for Bristol-Myers Squibb and Pfizer, Inc. Dr Henningfield is a consultant to Corporate Health Policies Group, which consults to the pharmaceutical industry on nicotine replacement products.

Reprints: Michael C. Fiore, MD, MPH, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, 1300 University Ave, Madison, WI 53706.


JAMA. 1996;275(16):1270-1280. doi:10.1001/jama.1996.03530400058039
Text Size: A A A
Published online
Article
References

Objective.  —To summarize the Smoking Cessation Clinical Practice Guideline that provides recommendations for 3 groups of professionals: primary care clinicians, smoking cessation specialists, and health care administrators, insurers, and purchasers.

Participants.  —An independent panel of scientists, clinicians, consumers, and methodologists selected by the US Agency for Health Care Policy and Research.

Evidence.  —English-language, peer-reviewed literature published between 1975 and 1994 that addresses the assessment and treatment of tobacco dependence, nicotine addiction, and clinical practice.

Consensus Process.  —Four panel meetings were held over 2 years to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The Guideline was repeatedly reviewed and revised.

Conclusions.  —The panel recommendations address 3 audiences. Major recommendations for primary care clinicians are to use officewide systems to identify smokers, treat every smoker with a cessation or motivational intervention, offer nicotine replacement except in special circumstances, and schedule follow-up contact to occur after cessation. Major recommendations to smoking cessation specialists are to use multiple individual or group counseling sessions lasting at least 20 minutes each with sessions spanning multiple weeks, offer nicotine replacement, and provide problem-solving and social support counseling. Major recommendations for health care administrators, insurers, and purchasers are that tobacco-user identification systems be used in all clinics and that smoking cessation treatment be supported through staff education and training, dedicated staff, changes in hospital policies, and the provision of reimbursement for tobaccodependence treatment.(JAMA. 1996;275:1270-1280)

REFERENCES

1 +
US Dept of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990;. DHHS publication CDC 90-8416.
2 +
Fiore MC, Wetter DW, Bailey WC, et al. Smoking Cessation Clinical Practice Guideline . Rock-ville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; 1996;.
3 +
Hedges LV, Olkin I. Statistical Methods for Meta-analysis . New York, NY: Academic Press; 1985;.
4 +
Tomar SL, Husten CG, Manley MW.  Do dentists and physicians advise tobacco users to quit? J Am Dent Assoc . 1996;;127:259-265.
5 +
Hayward RA, Meetz HK, Shapiro MF, Freeman DE.  Utilization of dental services: 1986 patterns and trends. J Public Health Dent . 1989;;49:147-152.
6 +
US Dept of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994;.
7 +
National Cancer Institute.  Tobacco and the clinician: interventions for medical and dental practice. Natl Cancer Inst Monogr . 1994;;5:1-22. NIH publication 94-3693.
8 +
Ockene JK.  Smoking intervention: the expanding role of the physician. Am J Public Health . 1987;; 77:782-783.
9 +
Pederson LL.  Compliance with physician advice to quit smoking: a review of the literature. Prev Med . 1982;;11:71-84.
10 +
Anda RF, Remington PL, Sienko DG, Davis RM.  Are physicians advising smokers to quit? the patient's perspective. JAMA . 1987;;257:1916-1919.
11 +
Frank E, Winkleby MA, Altman DG, Rockhill B, Fortmann SP.  Predictors of physicians' smoking cessation advice. JAMA . 1991;;266:3139-3143.
12 +
Centers for Disease Control and Prevention.  Physician and other health care professional counseling of smokers to quit: United States, 1991. MMWR Morb Mortal Wkly Rep . 1993;;42:854-857.
13 +
Jaen CR, Stange KC, Nutting PA.  Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract . 1994;; 38:166-171.
14 +
Prochaska JO, Goldstein MG.  Process of smoking cessation: implications for clinicians. Clin Chest Med . 1991;;42:727-775.
15 +
Kottke TE, Solberg LI.  Is it not time to make smoking a vital sign? Mayo Clin Proc . 1995;;70:303-304.
16 +
Fiore MC, Baker TB.  Smoking cessation treatment and the good doctor club. Am J Public Health . 1995;;85:161-163.
17 +
Glynn TJ, Manley MW. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for Physicians . Bethesda, Md: US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1990;. NIH publication 90-3064.
18 +
American Medical Association Guidelines for the Diagnosis and Treatment of Nicotine Dependence: How to Help Your Patients Stop Smoking . Washington, DC: American Medical Association; 1994;.
19 +
Gilchrist V, Miller RS, Gillanders WR, et al.  Does family practice at residency teaching sites reflect community practice? J Fam Pract . 1993;;37: 555-563.
20 +
Lichtenstein E, Hollis JF.  Patient referral to a smoking cessation program: who follows through? J Fam Pract . 1992;;34:739-744.
21 +
Fiore MC, Novotny TE, Pierce JP, et al.  Methods used to quit smoking in the United States: do cessation programs help? JAMA . 1990;;263:2760-2765.
22 +
Hall SM, Munoz RF, Reus VI.  Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. J Consult Clin Psychol . 1994;;62:141-146.
23 +
Zelman DC, Brandon TH, Jorenby DE, Baker TB.  Measures of affect and nicotine dependence predict differential response to smoking cessation treatments. J Consult Clin Psychol . 1992;;60:943-952.
24 +
Orleans CT.  Treating nicotine dependence in medical settings: a stepped-care model.  In: Orleans CT, Slade J, eds. Nicotine Addiction: Principles and Management . New York, NY: Oxford University Press; 1993;:145-161.
25 +
Abrams DB, Orleans CT, Niaura RN, Goldstein MG, Prochaska JO, Velicer W.  Treatment issues in smoking cessation: a stepped care approach. Tobacco Control . 1993;;2( (suppl) ):17-34.
26 +
Abrams DB, Orleans CT, Niaura RN, Goldstein MG, Prochaska JO, Velicer W.  Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: a combined stepped care and matching model. Ann Behav Med . In press.
27 +
Hughes JR, Frances RJ.  How to help psychiatric patients stop smoking. Psychiatr Serv . 1995;; 46:435-445.
28 +
HMO Industry Profile: 1993 Edition . Washington, DC: Group Health Association of America; 1993;.
29 +
Gelb BD.  Preventive medicine and employee productivity. Harvard Business Rev . 1985;;64( (2) ): 12-16.
30 +
Cummings SR, Rubin SM, Oster G.  The cost-effectiveness of counseling smokers to quit. JAMA . 1989;;261:75-79.
31 +
Healthy People 2000: Midcourse Review and 1995 Revisions . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1995;.
32 +
Kaplan RM, Perkins KA.  Marshaling the evidence for greater regulation and control of tobacco products: a call for action. Ann Behav Med . 1995;; 17:3-14.
33 +
Kenford SL, Fiore MC, Jorenby DE, Smith SS, Wetter D, Baker TB.  Predicting smoking cessation: who will quit with and without the nicotine patch? JAMA . 1994;;271:589-594.
34 +
Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al.  Quitting smoking in the United States in 1986. J Natl Cancer Inst . 1990;;82:1402-1406.
35 +
Sachs DPL, Sawe U, Leischow SJ.  Effectiveness of a 16-hour transdermal nicotine patch in a medical practice setting, without intensive group counseling. Arch Intern Med . 1993;;153:1881-1890.
36 +
Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis RM.  Trends in cigarette smoking in the United States: the changing influence of gender and race. JAMA . 1989;;261:49-55.
37 +
Centers for Disease Control.  Cigarette smoking among blacks and other minority populations. MMWR Morb Mortal Wkly Rep . 1987;;36:405-407.
38 +
Coultas DB, Gong H, Grad R, et al.  Respiratory diseases in minorities of the United States. Am J Respir Crit Care Med . 1994;;149:S93-S131.
39 +
Stotts RC, Glynn TJ, Baquet CR.  Smoking cessation among blacks. J Health Care Poor Under-served . 1991;;2:307-319.
40 +
Orleans CT, Schoenbach VJ, Salmon MA, et al.  A survey of smoking and quitting patterns among black Americans. Am J Public Health . 1989;;79:176-181.
41 +
Brownson RC, Jackson-Thompson TJ, Wilkerson JC, Davis JR, Owens NW, Fisher EB.  Demographic and socioeconomic differences in beliefs about the health effects of smoking. Am J Public Health . 1992;;82:99-103.
42 +
Royce JM, Hymowitz N, Corbett K, Hartwell TD, Orlandi MA.  Smoking cessation factors among African Americans and whites: COMMIT Research Group. Am J Public Health . 1993;;83:220-226.
43 +
The Health Consequences of Smoking for Women: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1980;.
44 +
Mullen PD, Carbonari JP, Tabak ER, Glenday MC.  Improving disclosure of smoking by pregnant women. Am J Obstet Gynecol . 1991;;165:409-413.
45 +
Benowitz NL.  Nicotine replacement therapy during pregnancy. JAMA . 1991;;266:3174-3177.
46 +
Mullen PD, Ramirez G, Groff JY.  A meta-analysis of randomized trials of prenatal smoking cessation interventions. Am J Obstet Gynecol . 1994;; 171:1328-1334.
47 +
Multiple Risk Factor Intervention Trial Research Group.  Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial: findings related to a priori hypotheses of the trial. JAMA . 1990;;263:1795-1801.
48 +
Browman GP, Wong G, Hodson I, et al.  Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med . 1993;;328:159-163.
49 +
Jones RM.  Smoking before surgery: the case for stopping. BMJ . 1985;;290:1763-1764.
50 +
Stevens VJ, Glasgow RE, Hollis JF, Lichtenstein E, Vogt TM.  A smoking-cessation intervention for hospital patients. Med Care . 1993;;31:65-72.
51 +
Hurt RD, Lauger GG, Offord KP, Bruce BK, Dale LC.  An integrated approach to the treatment of nicotine dependence in a medical center setting. Clin Res . 1991;;39:636A.
52 +
Williamson DF, Madans J, Anda RF, Kleinman JC, Giovino GA, Beyers T.  Smoking cessation and severity of weight gain in a national cohort. N Engl J Med . 1991;;324:739-745.
53 +
Emont SC, Cummings KM.  Weight gain following smoking cessation: a possible role for nicotine replacement in weight management. Addict Behav . 1987;;12:151-155.
54 +
Gritz ER, Klesges RC, Meyers AW.  The smoking and body weight relationship: implications for intervention and postcessation weight control. Ann Behav Med . 1989;;11:144-153.
55 +
Klesges RC, Klesges LM.  Cigarette smoking as a dietary strategy in a university population. Int J Eat Disord . 1988;;7:413-419.
56 +
Klesges RC, Meyers AW, Klesges LM, LaVasque ME.  Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol Bull . 1989;;106:204-230.
57 +
Hall SM, Tunstall CD, Vila KL, Duffy J.  Weight gain prevention and smoking cessation: cautionary findings. Am J Public Health . 1992;;82:799-803.
58 +
Perkins KA.  Issues in the prevention of weight gain after smoking cessation. Ann Behav Med . 1994;; 16:46-52.
59 +
Pirie PL, McBride CM, Hellerstedt W, et al.  Smoking cessation in women concerned about weight. Am J Public Health . 1992;;82:1238-1243.
60 +
Gross J, Stitzer ML, Maldonado J.  Nicotine replacement: effects on postcessation weight gain. J Consult Clin Psychol . 1989;;57:87-92.
61 +
Nides M, Rand C, Dolce J, et al.  Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study. Health Psychol . 1994;;13:354-361.
62 +
Hatsukami D, LaBounty L, Hughes J, Laine D.  Effects of tobacco abstinence on food intake among cigarette smokers. Health Psychol . 1993;;12:499-502.
63 +
Klesges RC, Shumaker SA, eds.  Proceedings of the National Working Conference on Smoking and Body Weight. Health Psychol . 1992;;11( (suppl) ):1-22.
64 +
Noppa H, Bengtsson C.  Obesity in relation to smoking: a population study of women in Göteborg, Sweden. Prev Med . 1980;;9:534-543.
65 +
Stamford BA, Matter S, Fel RD, Papanek P.  Effects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids. Am J Clin Nutr . 1986;;43:486-494.
66 +
Marcus AC, Crane LA, Shopland DR, Lynn WR.  Use of smokeless tobacco in the United States: recent estimates from the current population survey. Natl Cancer Inst Monogr . 1989;;8:17-24.
67 +
Smokeless Tobacco or Health: An International Perspective . Washington, DC: US Dept of Health and Human Services, Public Health Service, National Institutes of Health; 1993;. NIH publication 93-3461.
68 +
Fiore MC, Smith SS, Jorenby DE, Baker TB.  The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA . 1994;;271:1940-1947.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Dept of Health and Human Services. The Health Benefits of Smoking Cessation: A Report of the Surgeon General . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990;. DHHS publication CDC 90-8416.
2 +
Fiore MC, Wetter DW, Bailey WC, et al. Smoking Cessation Clinical Practice Guideline . Rock-ville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; 1996;.
3 +
Hedges LV, Olkin I. Statistical Methods for Meta-analysis . New York, NY: Academic Press; 1985;.
4 +
Tomar SL, Husten CG, Manley MW.  Do dentists and physicians advise tobacco users to quit? J Am Dent Assoc . 1996;;127:259-265.
5 +
Hayward RA, Meetz HK, Shapiro MF, Freeman DE.  Utilization of dental services: 1986 patterns and trends. J Public Health Dent . 1989;;49:147-152.
6 +
US Dept of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994;.
7 +
National Cancer Institute.  Tobacco and the clinician: interventions for medical and dental practice. Natl Cancer Inst Monogr . 1994;;5:1-22. NIH publication 94-3693.
8 +
Ockene JK.  Smoking intervention: the expanding role of the physician. Am J Public Health . 1987;; 77:782-783.
9 +
Pederson LL.  Compliance with physician advice to quit smoking: a review of the literature. Prev Med . 1982;;11:71-84.
10 +
Anda RF, Remington PL, Sienko DG, Davis RM.  Are physicians advising smokers to quit? the patient's perspective. JAMA . 1987;;257:1916-1919.
11 +
Frank E, Winkleby MA, Altman DG, Rockhill B, Fortmann SP.  Predictors of physicians' smoking cessation advice. JAMA . 1991;;266:3139-3143.
12 +
Centers for Disease Control and Prevention.  Physician and other health care professional counseling of smokers to quit: United States, 1991. MMWR Morb Mortal Wkly Rep . 1993;;42:854-857.
13 +
Jaen CR, Stange KC, Nutting PA.  Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract . 1994;; 38:166-171.
14 +
Prochaska JO, Goldstein MG.  Process of smoking cessation: implications for clinicians. Clin Chest Med . 1991;;42:727-775.
15 +
Kottke TE, Solberg LI.  Is it not time to make smoking a vital sign? Mayo Clin Proc . 1995;;70:303-304.
16 +
Fiore MC, Baker TB.  Smoking cessation treatment and the good doctor club. Am J Public Health . 1995;;85:161-163.
17 +
Glynn TJ, Manley MW. How to Help Your Patients Stop Smoking: A National Cancer Institute Manual for Physicians . Bethesda, Md: US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1990;. NIH publication 90-3064.
18 +
American Medical Association Guidelines for the Diagnosis and Treatment of Nicotine Dependence: How to Help Your Patients Stop Smoking . Washington, DC: American Medical Association; 1994;.
19 +
Gilchrist V, Miller RS, Gillanders WR, et al.  Does family practice at residency teaching sites reflect community practice? J Fam Pract . 1993;;37: 555-563.
20 +
Lichtenstein E, Hollis JF.  Patient referral to a smoking cessation program: who follows through? J Fam Pract . 1992;;34:739-744.
21 +
Fiore MC, Novotny TE, Pierce JP, et al.  Methods used to quit smoking in the United States: do cessation programs help? JAMA . 1990;;263:2760-2765.
22 +
Hall SM, Munoz RF, Reus VI.  Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers. J Consult Clin Psychol . 1994;;62:141-146.
23 +
Zelman DC, Brandon TH, Jorenby DE, Baker TB.  Measures of affect and nicotine dependence predict differential response to smoking cessation treatments. J Consult Clin Psychol . 1992;;60:943-952.
24 +
Orleans CT.  Treating nicotine dependence in medical settings: a stepped-care model.  In: Orleans CT, Slade J, eds. Nicotine Addiction: Principles and Management . New York, NY: Oxford University Press; 1993;:145-161.
25 +
Abrams DB, Orleans CT, Niaura RN, Goldstein MG, Prochaska JO, Velicer W.  Treatment issues in smoking cessation: a stepped care approach. Tobacco Control . 1993;;2( (suppl) ):17-34.
26 +
Abrams DB, Orleans CT, Niaura RN, Goldstein MG, Prochaska JO, Velicer W.  Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: a combined stepped care and matching model. Ann Behav Med . In press.
27 +
Hughes JR, Frances RJ.  How to help psychiatric patients stop smoking. Psychiatr Serv . 1995;; 46:435-445.
28 +
HMO Industry Profile: 1993 Edition . Washington, DC: Group Health Association of America; 1993;.
29 +
Gelb BD.  Preventive medicine and employee productivity. Harvard Business Rev . 1985;;64( (2) ): 12-16.
30 +
Cummings SR, Rubin SM, Oster G.  The cost-effectiveness of counseling smokers to quit. JAMA . 1989;;261:75-79.
31 +
Healthy People 2000: Midcourse Review and 1995 Revisions . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1995;.
32 +
Kaplan RM, Perkins KA.  Marshaling the evidence for greater regulation and control of tobacco products: a call for action. Ann Behav Med . 1995;; 17:3-14.
33 +
Kenford SL, Fiore MC, Jorenby DE, Smith SS, Wetter D, Baker TB.  Predicting smoking cessation: who will quit with and without the nicotine patch? JAMA . 1994;;271:589-594.
34 +
Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al.  Quitting smoking in the United States in 1986. J Natl Cancer Inst . 1990;;82:1402-1406.
35 +
Sachs DPL, Sawe U, Leischow SJ.  Effectiveness of a 16-hour transdermal nicotine patch in a medical practice setting, without intensive group counseling. Arch Intern Med . 1993;;153:1881-1890.
36 +
Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis RM.  Trends in cigarette smoking in the United States: the changing influence of gender and race. JAMA . 1989;;261:49-55.
37 +
Centers for Disease Control.  Cigarette smoking among blacks and other minority populations. MMWR Morb Mortal Wkly Rep . 1987;;36:405-407.
38 +
Coultas DB, Gong H, Grad R, et al.  Respiratory diseases in minorities of the United States. Am J Respir Crit Care Med . 1994;;149:S93-S131.
39 +
Stotts RC, Glynn TJ, Baquet CR.  Smoking cessation among blacks. J Health Care Poor Under-served . 1991;;2:307-319.
40 +
Orleans CT, Schoenbach VJ, Salmon MA, et al.  A survey of smoking and quitting patterns among black Americans. Am J Public Health . 1989;;79:176-181.
41 +
Brownson RC, Jackson-Thompson TJ, Wilkerson JC, Davis JR, Owens NW, Fisher EB.  Demographic and socioeconomic differences in beliefs about the health effects of smoking. Am J Public Health . 1992;;82:99-103.
42 +
Royce JM, Hymowitz N, Corbett K, Hartwell TD, Orlandi MA.  Smoking cessation factors among African Americans and whites: COMMIT Research Group. Am J Public Health . 1993;;83:220-226.
43 +
The Health Consequences of Smoking for Women: A Report of the Surgeon General . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1980;.
44 +
Mullen PD, Carbonari JP, Tabak ER, Glenday MC.  Improving disclosure of smoking by pregnant women. Am J Obstet Gynecol . 1991;;165:409-413.
45 +
Benowitz NL.  Nicotine replacement therapy during pregnancy. JAMA . 1991;;266:3174-3177.
46 +
Mullen PD, Ramirez G, Groff JY.  A meta-analysis of randomized trials of prenatal smoking cessation interventions. Am J Obstet Gynecol . 1994;; 171:1328-1334.
47 +
Multiple Risk Factor Intervention Trial Research Group.  Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial: findings related to a priori hypotheses of the trial. JAMA . 1990;;263:1795-1801.
48 +
Browman GP, Wong G, Hodson I, et al.  Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med . 1993;;328:159-163.
49 +
Jones RM.  Smoking before surgery: the case for stopping. BMJ . 1985;;290:1763-1764.
50 +
Stevens VJ, Glasgow RE, Hollis JF, Lichtenstein E, Vogt TM.  A smoking-cessation intervention for hospital patients. Med Care . 1993;;31:65-72.
51 +
Hurt RD, Lauger GG, Offord KP, Bruce BK, Dale LC.  An integrated approach to the treatment of nicotine dependence in a medical center setting. Clin Res . 1991;;39:636A.
52 +
Williamson DF, Madans J, Anda RF, Kleinman JC, Giovino GA, Beyers T.  Smoking cessation and severity of weight gain in a national cohort. N Engl J Med . 1991;;324:739-745.
53 +
Emont SC, Cummings KM.  Weight gain following smoking cessation: a possible role for nicotine replacement in weight management. Addict Behav . 1987;;12:151-155.
54 +
Gritz ER, Klesges RC, Meyers AW.  The smoking and body weight relationship: implications for intervention and postcessation weight control. Ann Behav Med . 1989;;11:144-153.
55 +
Klesges RC, Klesges LM.  Cigarette smoking as a dietary strategy in a university population. Int J Eat Disord . 1988;;7:413-419.
56 +
Klesges RC, Meyers AW, Klesges LM, LaVasque ME.  Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol Bull . 1989;;106:204-230.
57 +
Hall SM, Tunstall CD, Vila KL, Duffy J.  Weight gain prevention and smoking cessation: cautionary findings. Am J Public Health . 1992;;82:799-803.
58 +
Perkins KA.  Issues in the prevention of weight gain after smoking cessation. Ann Behav Med . 1994;; 16:46-52.
59 +
Pirie PL, McBride CM, Hellerstedt W, et al.  Smoking cessation in women concerned about weight. Am J Public Health . 1992;;82:1238-1243.
60 +
Gross J, Stitzer ML, Maldonado J.  Nicotine replacement: effects on postcessation weight gain. J Consult Clin Psychol . 1989;;57:87-92.
61 +
Nides M, Rand C, Dolce J, et al.  Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study. Health Psychol . 1994;;13:354-361.
62 +
Hatsukami D, LaBounty L, Hughes J, Laine D.  Effects of tobacco abstinence on food intake among cigarette smokers. Health Psychol . 1993;;12:499-502.
63 +
Klesges RC, Shumaker SA, eds.  Proceedings of the National Working Conference on Smoking and Body Weight. Health Psychol . 1992;;11( (suppl) ):1-22.
64 +
Noppa H, Bengtsson C.  Obesity in relation to smoking: a population study of women in Göteborg, Sweden. Prev Med . 1980;;9:534-543.
65 +
Stamford BA, Matter S, Fel RD, Papanek P.  Effects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids. Am J Clin Nutr . 1986;;43:486-494.
66 +
Marcus AC, Crane LA, Shopland DR, Lynn WR.  Use of smokeless tobacco in the United States: recent estimates from the current population survey. Natl Cancer Inst Monogr . 1989;;8:17-24.
67 +
Smokeless Tobacco or Health: An International Perspective . Washington, DC: US Dept of Health and Human Services, Public Health Service, National Institutes of Health; 1993;. NIH publication 93-3461.
68 +
Fiore MC, Smith SS, Jorenby DE, Baker TB.  The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. JAMA . 1994;;271:1940-1947.

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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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