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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 nicotine addiction."

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 vital signs.
  • Ask patients about their desire to quit, reinforcing their intentions.
  • 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 hurt.
  • Create a support network of family and friends to help them stop smoking.
  • Learn how to cope with situations that make them want to resume smoking.
  • Focus less on weight gain. Most people who stop smoking will 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 can 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 inconclusive evidence.

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 doctors.

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 the American Medical Association—the most widely read medical 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 provided comments.

The guideline publications Smoking Cessation: A Guide for Primary Care Physicians; Smoking Cessation: Information for Specialists, and You Can Quit Smoking: Consumer Guide are available free of charge 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 U.S. 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 and clicking on "Clinical Practice Guidelines Online."

Note to Editors: The Food and Drug Administration has approved nicotine gum for over-the counter (OTC) use. The nicotine patch 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.

The information on this page is archived and provided for reference purposes only.


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