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JAMA Patient Page
January 19, 2021

Interventions to Promote Tobacco Cessation

Author Affiliations
  • 1Associate Editor, JAMA
JAMA. 2021;325(3):316. doi:10.1001/jama.2020.25605
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The US Preventive Services Task Force (USPSTF) recently published recommendations on primary care–based interventions to promote tobacco cessation in adults, including pregnant persons.

How Big of a Problem Is Tobacco?

Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2019, nearly 1 in 5 adults in the US used tobacco. Seven percent of women who give birth in the US smoke during pregnancy. Although there are many forms of tobacco use, the most common ones are smoking cigarettes and using e-cigarettes (vaping).

What Interventions Are Used to Promote Tobacco Cessation?

Common approaches for primary care clinicians to approach tobacco use include:

  • Ask about and record smoking status at every health care visit. Consider using a multiple-choice instead of a yes/no answer.

  • “Ask, advise, refer”: ask patients about tobacco use, advise them to quit, and refer them to cessation interventions.

  • “The 5 As”: ask about tobacco use; advise to quit through clear, personalized messages; assess willingness to quit; assist in quitting; and arrange follow-up and support.

Interventions to promote tobacco cessation include behavioral counseling interventions and medications (nicotine replacement therapy such as patch or gum; bupropion; varenicline). In pregnant persons, the USPTF recommends behavioral interventions, but the evidence is not clear enough to recommend for or against medications in pregnant persons.

What Is the Population Under Consideration?

This recommendation applies to adults aged 18 years or older, including pregnant persons. There is a separate USPSTF recommendation statement on primary care interventions for prevention and cessation of tobacco use in children and adolescents.

What Are the Potential Benefits and Harms of Promoting Tobacco Cessation?

For nonpregnant adults, there is good evidence that providing behavioral counseling, medications, or both is effective at decreasing rates of smoking. For pregnant persons, there is good evidence that behavioral interventions decrease smoking rates as well as improve certain perinatal outcomes (such as birth weight). There is not enough evidence on use of medications in pregnant women.

Potential harms of behavioral interventions are slim to none. Potential harms of pharmacotherapy may include some serious side effects, but the risk of these is small. Not enough is known about the harms of pharmacotherapy in pregnant persons.

How Strong Is the Recommendation to Promote Tobacco Cessation in Adults?

For nonpregnant adults, the USPSTF concludes with high certainty that the net benefit of behavioral interventions and pharmacotherapy for smoking cessation, either alone or combined, is substantial. For pregnant persons, the USPSTF concludes with high certainty that the net benefit of behavioral interventions for smoking cessation is substantial. The USPSTF concludes that there is not enough evidence to weigh benefits vs harms of pharmacotherapy for smoking cessation in pregnant persons. There is also not enough evidence to weigh benefits vs harms of using e-cigarettes for tobacco smoking cessation in adults, including pregnant persons.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: Patnode CD, Henderson JT, Coppola EL, et al. Interventions for tobacco cessation in adults, including pregnant persons: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. Published January 19, 2021. doi:10.1001/jama.2020.23541

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