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Tobacco guidelines get update

Panel says counseling, medications help people quit smoking

Rockville, Md.—An updated clinical practice guideline on smoking cessation released May 7 by the U.S. Public Health Service identifies new counseling and medication treatments as effective tools to help 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 who reviewed more than 8,700 research articles published between 1975 and 2007.

The updated guideline says seven medications the Food and Drug Administration has approved for smoking cessation dramatically increase the success of quitting: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch and varenicline.

The panel 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, such as the national 1-800-QUIT-NOW, which connects callers to state-based programs, were found to be effective, able to reach a large number of people, provided broad access to cessation counseling for diverse populations, and are easy for clinicians and patients to use.

Dr. K. Vendrell Rankin, professor, Department of Public Health Sciences at Baylor College of Dentistry, served as one of 70 external reviewers for the guideline and represented the ADA in the process.

"As a dentist, teacher and tobacco treatment specialist, I believe that one of the most significant additions are the principles of motivational interviewing—express empathy, develop discrepancy, roll with resistance and support self-efficacy," said Dr. Rankin. "We know that patients don't walk into the dental office ready to quit smoking or chewing tobacco, nor are they equipped to do so with only the aid of a prescription.

"The update includes examples of clinician dialogue that can help increase patient motivation," Dr. Rankin added. "Open-ended questions such as, 'How important do you think it is for you to quit smoking?' allow the patient to use their own words, to be involved in their treatment, to take responsibility for their own behavior change. This approach has proven to be more effective than clinician exhortations, lectures or arguments for quitting, which tend to increase resistance."

Other recommendations issued in the 2008 PHS guideline update include:

  • 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.
  • 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 the Agency for Healthcare Research and Quality at 1-800-358-9295.

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