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Consensus Statement
June 28, 2000

A Clinical Practice Guideline for Treating Tobacco Use and DependenceA US Public Health Service Report

Author Affiliations

The Tobacco Use and Dependence Clinical Practice Guideline Update Panel and Staff include the following: Michael C. Fiore, MD, MPH (panel chair), Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; William C. Bailey, MD, University of Alabama at Birmingham; Stuart J. Cohen, EdD, University of Arizona Prevention Center; Sally Faith Dorfman, MD, MSHSA, Medical Society of the State of New York; Brion J. Fox, JD, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; Michael G. Goldstein, MD, Bayer Institute for Health Care Communication; Ellen Gritz, PhD, University of Texas, M. D. Anderson Cancer Center; Victor Hasselblad, PhD, Duke Clinical Research Institute; Richard B. Heyman, MD, American Academy of Pediatrics; Carlos Roberto Jaen, MD, PhD, State University of New York at Buffalo; Douglas Jorenby, PhD, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; Thomas E. Kottke, MD, MSPH, Mayo Clinic; Harry A. Lando, PhD, University of Minnesota School of Public Health; Robert E. Mecklenburg, DDS, MPH, National Cancer Institute; Patricia Dolan Mullen, DrPH, University of Texas School of Public Health; Louise Nett, RN, RRT, National Lung Health Education Program; Megan Piper, MA, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; Lawrence Robinson, MD, MPH, Philadelphia Department of Health; Maxine Stitzer, PhD, Johns Hopkins/Bayview Medical Center; Anthony Tommasello, MS, University of Maryland School of Pharmacy; Louise Villejo, MPH, CHES, University of Texas, M.D. Anderson Cancer Center; Sam Welsch, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison; Mary Ellen Wewers, PhD, RN, Ohio State University; Timothy B. Baker, PhD, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison.
The Tobacco Use and Dependence Clinical Practice Guideline Non-profit and Federal Consortium Representatives include the following: Glen Bennett, MPH, National Heart, Lung, and Blood Institute, National Institutes of Health; Harriett Bennett, BA, Agency for Healthcare Research and Quality; Stephen J. Heishman, PhD, National Institute on Drug Abuse; Corinne Husten, MD, MPH, Office on Smoking and Health, Centers for Disease Control and Prevention; Douglas Kamerow, MD, MPH, Agency for Healthcare Research and Quality; Cathy Melvin, PhD, MPH, Division of Reproductive Health, Centers for Disease Control and Prevention; Glen Morgan, PhD, National Cancer Institute; Ernestine Murray, RN, MAS, Agency for Healthcare Research and Quality; C. Tracy Orleans, PhD, The Robert Wood Johnson Foundation.

JAMA. 2000;283(24):3244-3254. doi:10.1001/jama.283.24.3244
Objective

Objective To summarize the recently published US Public Health Service report Treating Tobacco Use and Dependence: A Clinical Practice Guideline, which provides recommendations for brief clinical interventions, intensive clinical interventions, and system changes to promote the treatment of tobacco dependence.

Participants An independent panel of 18 scientists, clinicians, consumers, and methodologists selected by the US Agency for Healthcare Research and Quality. A consortium of 7 governmental and nonprofit organizations sponsored the update.

Evidence Approximately 6000 English-language, peer-reviewed articles and abstracts, published between 1975 and 1999, were reviewed for data that addressed assessment and treatment of tobacco dependence. This literature served as the basis for more than 50 meta-analyses.

Consensus Process One panel meeting and numerous conference calls and staff meetings were held to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. The updated guideline was then externally reviewed by more than 70 experts and revised.

Conclusions This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use. Brief clinical approaches for patients willing and unwilling to quit are described. Major conclusions and recommendations include: (1) Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved. (2) Effective treatments for tobacco dependence exist and all tobacco users should be offered those treatments. (3) Clinicians and health care delivery systems must institutionalize the consistent identification, documentation, and treatment of every tobacco user at every visit. (4) Brief tobacco dependence treatment is effective, and every tobacco user should be offered at least brief treatment. (5) There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. (6) Three types of counseling were found to be especially effective—practical counseling, social support as part of treatment, and social support arranged outside of treatment. (7) Five first-line pharmacotherapies for tobacco dependence—sustained-release bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch—are effective, and at least 1 of these medications should be prescribed in the absence of contraindications. (8) Tobacco dependence treatments are cost-effective relative to other medical and disease prevention interventions; as such, all health insurance plans should include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the updated guideline.

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