Final US Smoking Cessation Recommendations Released

Jury Out on e-Cigarettes as a Smoking Cessation Aid

Megan Brooks

September 22, 2015

Clinicians should ask all adults about their tobacco use, advise them to quit if they do smoke, and provide evidence-based behavioral therapies and medications to help them quit, the US Preventive Services Task Force (USPSTF) advised in its final recommendation statement on smoking cessation in adults.

There remains insufficient evidence to weigh the balance of benefits and harms of e-cigarettes for smoking cessation, the task force said, issuing an "I" statement, meaning it cannot at this time recommend for or against electronic nicotine delivery systems to help smokers kick the habit.

An estimated 42.1 million US adults (almost 18% of the population) continue to smoke tobacco. Smoking is the chief preventable cause of disease, disability, and death in the United States. Smoking causes more than 480,000 premature deaths annually and accounts for approximately 1 in every 5 deaths.

"One of the most important steps people can take for their health is to quit smoking, or to never start. The good news is that there are many effective interventions to help people stop smoking," task force chair Albert Sui, MD, MSPH, said in a statement.

The USPSTF final recommendations match draft recommendations issued in May 2015, which updated the USPSTF recommendations of 2009.

The final recommendations were published online September 21 in Annals of Internal Medicine and on the task force's website.

On the basis of a review of the latest evidence on smoking cessation interventions, for nonpregnant adults, the task force recommends behavioral therapy or US Food and Drug Administration (FDA)–approved medications, including nicotine replacement therapy, alone or in combination.

This is a grade A recommendation. FDA-approved smoking cessation medications and behavioral interventions are both effective; combinations of interventions are most effective, and all types should be offered to patients.

For pregnant women, the task force recommends behavioral interventions. This is also a grade A recommendation. They found insufficient evidence for the use of smoking cessation medications, including nicotine replacement therapy, in pregnant women and therefore issued an "I" statement and called for more research.

Jury Out on e-Cigs

Because of growing interest in electronic nicotine delivery systems as a potential option to help patients quit or cut back on conventional cigarettes, the USPSTF reviewed the evidence in support of this but found little strong evidence. They issued an "I" statement in their final recommendation.

There remains insufficient evidence to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women, they conclude. The USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety.

But Elyse R. Park, PhD, MPH, from the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston, thinks doctors do need to have a discussion about e-cigarettes with patients.

"What providers say to patients is just as important as what they don't say. We know that a lot of patients are using and experimenting with e-cigarettes, and I do think physicians should discuss e-cigarettes with patients who show an interest," she noted in an interview with Medscape Medical News, even though the jury is out on their value in helping patients cut back on traditional cigarettes.

Dr Park, who was not involved in the USPSTF recommendations, said studies show that "pretty consistently, providers do ask, advise, and assess" whether their patients smoke, but fewer refer their patients for smoking cessation counseling or make a medication recommendation and arrange follow-up meetings.

"What studies have consistently found is that when you do these more active steps, assist and arrange follow-up, that it actually makes a difference as to whether patients quit," she said.

Yet studies also show that providers often do not have places to refer patients for smoking cessation, or they do not have the time or training to make smoking cessation recommendations, Dr Park said.

"The [USPSTF] recommendations are important and well timed with the Affordable Care Act enhanced coverage of smoking cessation treatment, but it will be important to figure out how they will be implemented, how we are going to give providers and offices the additional resources to do this," Dr Park explained.

She noted that in Massachusetts, the QuitWorks website is "a great place" to refer patients who smoke. "QuitWorks provides phone counseling and 4 weeks of free nicotine replacement therapy for patients who are motivated to quit, and for patients who are not motivated to quit, they will provide informational resources."

Ann Intern Med. Published online September 21, 2015. Full text


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