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New evidence provides clinicians with better tools to help smokers quit

An updated clinical practice guideline released by the U.S. Public Health Service (PHS) has identified new counseling and medication treatments that are effective for helping people quit smoking.

Treating Tobacco Use and Dependence: 2008 Update was developed by a 24-member, private-sector panel of leading national tobacco treatment experts that reviewed more than 8,700 research articles published between 1975 and 2007. The review found that there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.

The 2008 PHS guideline update also found evidence that counseling by itself or especially in conjunction with medication can greatly increase a person's success in quitting. In particular, quitlines were found to be effective and can reach a large number of people. A consortium of eight Federal and private-sector, nonprofit organizations collaborated to sponsor the 2008 PHS guideline update.

They are:

  • The Agency for Healthcare Research and Quality (AHRQ), which coordinated the update.
  • The Centers for Disease Control and Prevention.
  • The National Cancer Institute.
  • The National Heart, Lung, and Blood Institute.
  • The National Institute on Drug Abuse.
  • The Robert Wood Johnson Foundation.
  • The American Legacy Foundation.
  • The Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health.

In addition, more than 40 broad-based organizations have endorsed the guideline. Other recommendations issued in the 2008 PHS guideline update include the following:

  • Clinicians, in their offices and in the hospital, should ask their patients if they smoke and offer counseling and other treatments to help them quit. According to AHRQ's 2007 National Healthcare Quality Report, the percentage of hospitalized heart attack patients who were counseled to quit smoking has increased from 42.7 percent in 2000-2001 to 90.9 percent in 2005. Moreover, 48 States, Puerto Rico, and the District of Columbia all performed above 80 percent on this measure in 2005.
  • If tobacco users are unwilling to make an attempt to quit, clinicians should use the motivational treatments that have been shown effective in promoting future attempts to quit.
  • Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Counseling should include two components:practical counseling and social support.
  • Tobacco cessation treatments also are highly cost-effective relative to other clinical interventions. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication treatments that have been found to be effective in the 2008 PHS guideline update.
  • Counseling treatments have been shown to be effective for adolescent smokers and are now recommended. Additional effective interventions and options for use with children, adolescents, and young adults need to be determined.

The 2008 PHS guideline update and its companion products, which include a consumer guide and a pocket guide for clinicians, are available online at Copies of the 2008 PHS guideline update products are also available by calling 1-800-358-9295.

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