Health Care
Treating Tobacco Use & Dependence
Public Health Service Guidelines
The PHS guideline was developed by a private-sector panel of experts convened by a consortium of Federal and non-Federal partners. It is the product of a 2-year effort by a panel of tobacco dependence experts, representatives from sponsoring organizations, and professional staff. The guideline builds on a smoking cessation guideline first issued by the Federal Government in 1996. The partners that convened the experts included the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention, the National Cancer Institute, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, the Robert Wood Johnson Foundation, and the University of Wisconsin Medical School's Center for Tobacco Research and Intervention. Employing explicit scientific methodology and expert clinical judgment, the panel developed recommendations on the successful treatment of tobacco use and dependence.
The purpose of these guidelines are to provide clinicians, tobacco dependence specialists, public health professionals, health care administrators, insurers, purchasers, and tobacco users with evidence-based recommendations regarding clinical interventions use a systems approach to address smoking cessation. The key recommendations offered by the guidelines are as follows:
- Tobacco dependence is a chronic condition and often required repeated interventions. Long - t erm or even permanent abstinence can be produced through appropriate treatments.
- Every tobacco user should be offered treatment identified as effective or brief interventions to increase his/her motivation to quit depending on their levels of motivation.
- The guidelines also maintain that it is essential for clinicians and health care delivery systems (including administrators, insurers, and purchasers) to institutionalize the consistent identification, documentation, and treatment of every tobacco user seen in a health care setting.
- There is a strong dose-response relation between the intensity of tobacco dependence counseling and its effectiveness. Treatments involving person-to-person contact (via individual, group, or proactive telephone counseling) are consistently effective and their effectiveness increases with treatment intensity (e.g., minutes of contact).
- Three types of counseling and behavioral therapies were found to be especially effective and should be used with all patients attempting tobacco cessation:
Provision of practical counseling (problem solving/skills training);
Provision of social support as part of treatment (intra-treatment social support); and Help in securing social support outside of treatment (extra- treatment social support)
- Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications (i.e. history of seizure, eating disorders, etc.), these should be used with all patients attempting to quit smoking.
(The links for the complete guidelines have been provided in the resources section.)
The guidelines identify five first-line pharmacotherapies as reliable for increasing long-term smoking abstinence rates:
- Bupropion SR
- Nicotine gum
- Nicotine inhaler
- Nicotine nasal spray
- Nicotine patch
Clonidine and Nortriptyline were identified as effective second-line pharmacotherapies and may be considered by clinicians if first-line pharmacotherapies are found to be not effective. Over-the-counter nicotine patches are effective relative to placebo, and their use should be encouraged.
- Tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions. Insurers should reimburse clinicians and specialists for delivery of effective tobacco dependence treatments and include these interventions among the defined duties of clinicians.
Copyright 2008, Hamilton County Tobacco-Free Partnership
Funded by Ohio Tobacco Use Prevention and Control Foundation
and The Hamilton County General Health District