What are the guideline sources, guidelines and references for Tobacco use ?
Guideline sources The following summarized guidelines for the evaluation and management of tobacco use are prepared by our editorial team based on guidelines from the U.S. Preventive Services Task Force (USPSTF 2021; 2020), the American Thoracic Society (ATS 2020), and the United States Public Health Service (USPHS 2008). 1 2 3 4 Guidelines 1. Screening and diagnosis Indications for screening: As per USPSTF 2021 guidelines, ask all adults about tobacco use. A As per USPHS 2008 guidelines: Ask all patients if they use tobacco and document their tobacco use status on a regular basis. A Recognize that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, https://web.pathway.md/diseases/recuZcED3V0xewcQ2 1/5 6/24/23, 4:06 PM Tobacco use Pathway significantly increase rates of clinician intervention. A 2. Diagnostic investigations Assessment of willingness to quit: assess the patient's willingness to quit once a tobacco user is identified and advised to quit. B 3. Medical management Pharmacotherapy, indications: As per USPSTF 2021 guidelines, offer United States FDA-approved pharmacotherapy for tobacco use cessation in nonpregnant adults. A As per USPHS 2008 guidelines, offer effective pharmacotherapy for tobacco dependence in all patients attempting to quit, except where contraindicated or for specific populations for which there is insufficient evidence of effectiveness (pregnant females, smokeless tobacco users, light smokers, and adolescents). A Pharmacotherapy (nicotine-replacement therapy): offer nicotine gum, A nicotine inhaler, A nicotine lozenge, B nicotine nasal spray, A nicotine patches, A including OTC nicotine patches, B as effective options for smoking cessation treatment. A Show 2 more Pharmacotherapy (bupropion): offer bupropion sustained-release as an effective smoking cessation treatment. A Pharmacotherapy, varenicline: As per ATS 2020 guidelines, offer varenicline over a nicotine patch or bupropion in adult patients using tobacco. B Counsel patients about the relative safety and efficacy of varenicline compared with nicotine patches to promote adherence to pharmacologic therapy. E Show 4 more As per USPHS 2008 guidelines, offer varenicline as an effective smoking cessation treatment. A Pharmacotherapy (other drugs): consider offering clonidine or nortriptyline as a second-line agent for smoking cessation under a physician's supervision. B 4. Nonpharmacologic interventions Behavioral interventions (indications): advise all adult tobacco users to stop using tobacco and provide behavioral interventions. A Behavioral interventions (providers): provide tobacco dependence treatment even if specialized assessments are not used or available. A Show 3 more https://web.pathway.md/diseases/recuZcED3V0xewcQ2 2/5 6/24/23, 4:06 PM Tobacco use Pathway Behavioral interventions (approaches): provide practical counseling (problem-solving skills/skills training), support, and encouragement in patients using tobacco. B Show 2 more Behavioral interventions (formats): use proactive telephone counseling, group counseling, and individual counseling formats in smoking cessation interventions. A Show 2 more Updated evidence: Text messages for smoking cessation In daily or weekly smokers 18 years of age who owned a mobile phone and used the app, personalized text messages were superior to nonpersonalized text messages with respect to biochemically verified continuous abstinence at 6 months. Haoxiang Lin et al. JAMA Netw Open. 2023 Mar 1. Behavioral interventions (intensity): provide multiple counseling sessions as much as possible, in addition to medication, in patients trying to quit smoking. A Show 3 more E-cigarettes: insufficient evidence to assess the balance of benefits and harms of electronic cigarettes for tobacco cessation in adults, including pregnant persons. Direct patients using tobacco to other tobacco cessation interventions with proven effectiveness and established safety. I 5. Specific circumstances Light smokers: identify light smokers, strongly urge them to quit, and provide counseling cessation interventions. B Smokeless tobacco users: Identify patients using smokeless tobacco, strongly urge them to quit, and provide counseling cessation interventions. A Provide brief counseling interventions by clinicians delivering dental health services to all smokeless tobacco users. A Non-cigarette tobacco smokers: identify patients using cigars, pipes, or other non-cigarette forms of smoking tobacco, strongly urge them to quit, and offer the same counseling interventions recommended for cigarette smokers. B Pregnant patients: As per USPSTF 2021 guidelines: Ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation. A https://web.pathway.md/diseases/recuZcED3V0xewcQ2 3/5 6/24/23, 4:06 PM Tobacco use Pathway Insufficient evidence to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons. I As per USPHS 2008 guidelines: Offer person-to-person psychosocial interventions exceeding minimal advice to quit whenever possible in pregnant patients using tobacco because of the serious risks of smoking to the pregnant patient and the fetus. A Offer effective tobacco dependence interventions to pregnant patients using tobacco at the first prenatal visit and throughout the course of pregnancy as, although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits. B Pediatric patients (assessment): Ask children and adolescents about tobacco use and provide a strong message regarding the importance of totally abstaining from tobacco use. B Ask parents about tobacco use and offer cessation advice and assistance to protect children from secondhand smoke. B Pediatric patients (prevention): provide interventions, including education or brief counseling, to prevent the initiation of tobacco use in school-aged children and adolescents. B Pediatric patients, management: As per USPSTF 2020 guidelines, insufficient evidence to assess the balance of benefits and harms of primary care-feasible interventions for the cessation of tobacco use in school-aged children and adolescents. I As per USPHS 2008 guidelines: Provide counseling interventions in adolescent patients using tobacco to aid in quitting smoking. B Recognize that cessation counseling delivered in pediatric settings has been shown to be effective in increasing abstinence among parents using tobacco. Ask parents about tobacco use and offer them cessation advice and assistance to protect children from secondhand smoke. B 6. Follow-up and surveillance Assessment of abstinence: assess all patients receiving a tobacco dependence intervention for abstinence at the completion of treatment and during subsequent contacts. B Show 2 more Weight gain after quitting smoking: consider prescribing bupropion sustained-release or nicotine replacement therapy (in particular, nicotine gum and nicotine lozenge) to delay weight gain after quitting in patients greatly concerned about weight gain. C 7. Quality improvement https://web.pathway.md/diseases/recuZcED3V0xewcQ2 4/5 6/24/23, 4:06 PM Tobacco use Pathway Health service coverage: include treatments proved to be effective for smoking cessation as covered services in public and private health benefit plans as providing tobacco dependence treatments (both medication and counseling) as a paid or covered benefit by health insurance plans has been shown to increase the proportion of smokers proceeding to cessation treatment, attempting to quit and successfully quitting. A Show 2 more Health professional training: train all clinicians and clinicians-in-training in effective strategies to assist tobacco users willing to make a quit attempt and to motivate those unwilling to quit. Couple training with systems changes for more effectiveness. B References 1. Richard B. Heyman, MD, Howard K. Koh et al. Treating Tobacco Use and Dependence: 2008 Update. USPHS. 2008 May. Open 2. US Preventive Services Task Force, Douglas K Owens, Karina W Davidson et al. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2020 Apr 28;323 16 1590 1598. Open 3. US Preventive Services Task Force, Alex H Krist, Karina W Davidson et al. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Jan 19;325 3 265 279. Open 4. Frank T Leone, Yuqing Zhang, Sarah Evers-Casey et al. Initiating Pharmacologic Treatment in Tobacco- Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020 Jul 15;202 2):e5-e31. Open 5. Thombs BD, Jaramillo Garcia A, Reid D et al. Recommendations on behavioural interventions for the prevention and treatment of cigarette smoking among school-aged children and youth. CMAJ. 2017 Feb 27;189 8 E310 E316. Open 6. Siu AL, U.S. Preventive Services Task Force. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015 Oct 20;163 8 622 34. Open 7. Moyer VA. Primary care interventions to prevent tobacco use in children and adolescents: U.S. preventive services task force recommendation statement. Pediatrics. 2013 Sep;132 3 560 5. Open 8. Timothy B Baker, Megan E Piper, Stevens S Smith et al. Effects of Combined Varenicline With Nicotine Patch and of Extended Treatment Duration on Smoking Cessation. JAMA. 2021 Oct 19;326 15 1485 1493. Open 9. Lisa Sanderson Cox, Nicole L Nollen, Matthew S Mayo et al. Effect of Varenicline Added to Counseling on Smoking Cessation Among African American Daily Smokers: The Kick It at Swope IV Randomized Clinical Trial. JAMA. 2022 Jun 14;327 22 2201 2209. 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