Clinical Edge

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Interventions to Prevent Tobacco Use

Smoking cessation guidelines for adults

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The US Preventive Services Task Force (USPSTF) has updated its 2009 recommendation statement on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women. Among the key recommendations for clinicians are:

• Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to adults who use tobacco.

• Ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco.

• Current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women.

• Current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women.

Citation: Siu AL, et al. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. preventive services task force recommendation statement. Ann Intern Med. [Published online ahead of print September 22, 2015]. doi: 10.7326/M15-2023.

Commentary: Tobacco use remains the leading preventable cause of disease, disability, and death in the US, and causes more than 480,000 premature deaths each year. In total, including cancer and cardiovascular deaths, tobacco use is responsible for 1 in every 5 deaths in the US. While half of all adult smokers have quite smoking, 18% of the US adult population still smokes1. Pharmacologic management with nicotine replacement therapy (NRT) or bupropion SR improves cessation rates by about 80% compared to not using medications and use of varenicline improves cessation rates by over 100%. Combining the nicotine patch with a rapid-delivery form of NRT such as gum improves cessation compared to using just 1 type. Behavioral counseling, either in the clinician’s office or in a separate group, adds to the effectiveness of pharmacologic measures. —Neil Skolnik, MD

1. Jamal A, Agaku IT, O’Connor E, King BA, Kenemer JB, Neff L. Current cigarette smoking among adults—United States, 2005-2013. MMWR Morb Mortal Wkly Rep. 2014;63:1108-12.

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