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New Guidelines Challenge All Clinicians To Help Smokers Quit
Press Release Date: April 23, 1996
Clinicians should aggressively help their smoking patients quit,
according to a new clinical practice guideline sponsored by the
HHS' Agency for Health Care Policy and Research. The guideline
released today was developed by a leading panel of smoking
cessation experts. They challenge every clinician including
doctors, nurses, dentists, and others to find out if their
patients smoke, repeatedly encourage them to quit, and recommend
treatments proven to work.
The panel's recommendations include using the nicotine patch or
nicotine gum—which double the chances of successfully
quitting—combined with a clinician's encouragement and
support and practical advice to smokers on how to cope with
situations and behavior that make them want to smoke.
"This is good news for the more than 70 percent of adult smokers
in the United States who would like to quit," said Douglas B.
Kamerow, M.D., M.P.H., AHCPR's director of clinical practice
guideline development. "The guideline is a call to action to
clinicians to approach smoking as a chronic condition that is
very difficult, but not impossible, to treat."
This is the first time the total body of information on smoking
cessation has been analyzed systematically. In developing the
guideline, the panel reviewed over 3,000 scientific articles that
addressed the assessment and treatment of tobacco dependence,
nicotine addiction, and clinical practice.
"This guideline not only challenges the way we practice medicine
but also can tremendously improve the services we are able to
provide smokers who want to quit," said Michael C. Fiore, M.D.,
M.P.H., chair of the guideline panel and director of the
University of Wisconsin's Center for Tobacco Research and
Intervention. "While there is no perfect way to quit, clinicians
are in a unique position to tailor proven treatments to the
particular needs of those patients who want to overcome their
Only half the smokers who see a doctor have ever been urged to
quit, even though smoking is the single greatest preventable
cause of illness and premature death in the United States.
People who smoke are at increased risk of heart disease, cancer,
and other smoking-related illnesses that contribute to over
420,000 deaths a year. Medical costs for smokers are $50 billion
annually, with an additional $47 billion for indirect expenses,
such as time lost from work and disability.
The AHCPR guideline recommends that clinicians:
- Ask every patient at every visit if they smoke.
- Write a patient's smoking status in the medical chart under
- Ask patients about their desire to quit, reinforcing their
- Motivate patients reluctant to quit.
- Help motivated smokers set a quit date.
- Prescribe nicotine replacement therapy, like nicotine gum
and nicotine patch.
- Help patients resolve problems that result from quitting.
Counseling may be helpful to some patients to increase the
likelihood of success.
- Encourage relapsed smokers to try quitting again.
Other recommendations to health care administrators, purchasers,
and insurers include changing health care delivery systems to
make it a standard practice to identify and treat smokers and
other tobacco users.
The guideline's consumer brochure urges smokers to:
- Be committed. Be aware that breaking nicotine addiction
isn't easy and takes a significant individual effort, but
that half the people who have ever smoked have quit.
- Talk with their doctors and discuss nicotine replacement
therapy and smoking cessation programs. Do everything
possible to maximize their chances of success.
- Set a quit date; do not try to "taper off."
- Build on past mistakes. Think about what helped and what
- Create a support network of family and friends to help them
- Learn how to cope with situations that make them want to
- Focus less on weight gain. Most people who stop smoking
gain fewer than 10 pounds, but the health benefits of
quitting smoking outweigh the risks of weight gain.
- Avoid dieting while trying to give up smoking because it
undermine chances of quitting.
Whenever possible, smoking cessation treatments should be
appropriately tailored to ethnic or racial groups. The guideline
also carries recommendations for pregnant women, hospitalized
patients, and persons with psychological problems.
Recommendations also address tobacco prevention and cessation in
children and adolescents, and smokeless tobacco products (snuff
and chewing tobacco).
No conclusions were drawn about the effectiveness of acupuncture,
hypnosis, and drug therapies such as clonidine, antidepressants,
and anxiolytics/benzodiazepines because of insufficient or
The panel also made no recommendations regarding the use of
nicotine nasal sprays and nicotine inhalers. There was limited
data on these products. At the time of the panel's
deliberations, the products were not licensed for prescription
use in the United States. [As the guideline went to press, the
Food and Drug Administration approved the prescription use of
nicotine nasal spray.]
AHCPR plans to disseminate the guideline, cosponsored by the
Centers for Disease Control and Prevention, to a wide range of
clinicians, smoking cessation specialists, health care
administrators, purchasers, and insurers. A quick reference
guide, pocket guide, and consumer version, in English and
Spanish, also will be distributed.
The American Medical Association has received an educational
grant from the Robert Wood Johnson Foundation to send copies of a
pocket guide version of the guideline to 200,000 primary care
AHCPR also will be working with the American Association of
Health Plans (formerly GHAA/AMCRA) to develop a practical guide,
based on the guideline recommendations, targeted to meet the
needs of health care systems.
In addition, today's special tobacco issue of the Journal of
American Medical Association—the most widely read
journal in the United States—features a summary of the
smoking cessation guideline.
The 19-member panel included physicians, nurses, mental health
experts, a dentist, a pharmacist, psychologists, an
epidemiologist, an educator and a consumer representative.
The panel invited 155 outside professionals to review the
document and also made it available for public comment through a
notice in the Federal Register. A total of 71 reviewers
The guideline publications Smoking Cessation: A Guide for
Primary Care Physicians; Smoking Cessation:
Specialists, and You Can Quit Smoking: Consumer Guide are available free of
from the AHCPR Publications Clearinghouse. Call toll-free
800-358-9295 or write
to Smoking Cessation, AHCPR Publications Clearinghouse, P.O. Box
8547, Silver Spring, MD 20907-8547.
Single and bulk copies of the full guideline, Smoking
Cessation: Clinical Practice
Guideline, may be purchased from the
Government Printing Office by calling (202) 512-1800.
The full guideline, quick reference guide, consumer
guide, and articles used in the guideline
meta-analyses will be available on Internet through the AHCPR Home Page. Access the guideline
products by using a Web browser, specifying URL http://www.ahrq.gov/clinic/ and clicking on
Note to Editors: The Food and Drug Administration has approved
nicotine gum for over-the counter (OTC) use. The nicotine
may be approved for OTC use by the end of 1996.
For additional information, contact AHCPR Public Affairs: Karen Migdail, (301) 427-1855 or Salina Prasad, (301) 427-1864.