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Behavioral and Pharmacologic Treatments to Help Adults Quit Smoking: U.S. Preventive Services Task Force Recommendation Statement FREE

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This article was published online first at www.annals.org on 22 September 2015.


The full report is titled “Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 20 October 2015 issue of Annals of Internal Medicine (volume 163, pages 622-634). The authors are A. Siu, for the U.S. Preventive Services Task Force.


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Ann Intern Med. 2015;163(8):I-40. doi:10.7326/P15-9032
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22 92015.

Who developed these recommendations?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Smoking increases the risk for heart disease, lung disease, and some types of cancer. Smoking also increases the risk for bad outcomes of pregnancy, including miscarriage, low birthweight, and early delivery. Helping patients to stop smoking is important for doctors. Providing counseling can help some patients who smoke to quit. For other patients (if they are not pregnant), drugs may be more helpful. Combinations of both counseling and drugs are often most effective. In 2009, the USPSTF recommended that clinicians ask all adult patients about smoking, help those who smoke to quit, and give pregnant patients pregnancy-focused messages about quitting. The USPSTF wanted to see whether new studies would change its recommendations.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research on the benefits and harms of treatments to help adults (including pregnant women) quit smoking. They focused on things that could be done in primary care settings, including behavioral interventions (such as in-person behavioral support and counseling, telephone counseling, and self-help mat-erials), drugs (such as nicotine replacement therapy [NRT], bupropion sustained-release, and varenicline), and electronic nicotine delivery systems (such as electronic cigarettes).

What did the authors find?

The USPSTF found convincing evidence that both behavioral treatments and drugs for smoking cessation improve cessation rates in nonpregnant adults; combinations of both can help the most. The USPSTF also found convincing evidence that using 2 types of NRT improves cessation rates over using 1 type. Adding NRT to bupropion improved quitting over bupropion alone. In pregnant women, behavioral treatments were found to improve smoking cessation rates, improve infant birthweight, and reduce preterm birth. The USPSTF found inadequate evidence on the benefits of NRT and no evidence on the benefits of bupropion sustained-release or varenicline in pregnant women who smoke or improvement of birth outcomes in infants.

The USPSTF concluded that the harms of behavioral interventions for smoking cessation in nonpregnant or pregnant adults are small to none. The USPSTF found adequate evidence that the harms of NRT, bupropion, or varenicline for smoking cessation in nonpregnant adults are small but did not find enough information on the harms of these drugs during pregnancy.

The USPSTF found inadequate evidence to determine the benefits and harms of electronic nicotine delivery systems on achievement of smoking cessation in either nonpregnant or pregnant adults.

What does the USPSTF recommend that patients and doctors do?

The USPSTF recommends that clinicians ask all nonpregnant adults about smoking and advise them to quit and provide behavioral treatments and approved drugs for quitting if they smoke.

The USPSTF recommends that clinicians ask all pregnant women about smoking and advise them to quit and provide behavioral treatments if they smoke.

Current information is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for smoking cessation in pregnant women.

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

What are the cautions related to these recommendations?

These recommendations do not apply to children and adolescents.

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