This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Tobacco  • Alert me on articles by topic  Social Bookmarking   What's this?

A US Public Health Service Report

The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives

JAMA. 2000;283:3244-3254.

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.

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Health Consequences of Eclipse Cigarettes
, , , and
JAMA. ;284():2995-2996.
FULL TEXT  

Non-English Reports of Medical Research
, , , , and
JAMA. ;284():2996-2997.
FULL TEXT  

RELATED ARTICLE

June 28, 2000
JAMA. ;283():3317-3318.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A smoking ban in public places increases the efficacy of bupropion and counseling on cessation outcomes at 1 year
Grassi et al.
Nicotine Tob Res 2009;11:1114-1121.
ABSTRACT | FULL TEXT  

Adolescent Medical Providers' Willingness to Recommend Genetic Susceptibility Testing for Nicotine Addiction and Lung Cancer Risk to Adolescents
O'Neill et al.
J Pediatr Psychol 2009;34:617-626.
ABSTRACT | FULL TEXT  

Smoking and depression: is smoking cessation effective?
Ischaki and Gratziou
Ther Adv Respir Dis 2009;3:31-38.
ABSTRACT  

Dissociation Between Hospital Performance of the Smoking Cessation Counseling Quality Metric and Cessation Outcomes After Myocardial Infarction
Reeves et al.
Arch Intern Med 2008;168:2111-2117.
ABSTRACT | FULL TEXT  

Live Fast, Die Young, Leave a Good-looking Corpse
Burns
Arch Intern Med 2008;168:1946-1947.
FULL TEXT  

Patient-Centered Quality Indicators for Pulmonary Resection
Cassivi et al.
Ann. Thorac. Surg. 2008;86:927-932.
ABSTRACT | FULL TEXT  

A Randomized Trial of Nicotine Nasal Spray in Adolescent Smokers
Rubinstein et al.
Pediatrics 2008;122:e595-e600.
ABSTRACT | FULL TEXT  

Update on pharmacologic and nonpharmacologic therapies for smoking cessation
Schmelzle et al.
cfp 2008;54:994-999.
ABSTRACT | FULL TEXT  

Smoking cessation in primary care
David and Munafo
BMJ 2008;336:1200-1201.
FULL TEXT  

Investigation Into the Cause of Death of a 56-Year-Old Man With Serious Mental Illness
Prochaska et al.
Am. J. Psychiatry 2008;165:453-456.
FULL TEXT  

What Factors Are Important for Pediatric Residents' Smoking Cessation Counseling of Parents?
Dodge et al.
CLIN PEDIATR 2008;47:237-243.
ABSTRACT  

Smoking cessation treatment in a real-life setting: the Greek experience
Rovina et al.
Ther Adv Respir Dis 2007;1:93-104.
ABSTRACT  

Identification of current smokers among renal transplant recipients
Nguyen et al.
Nephrol Dial Transplant 2007;22:1974-1978.
ABSTRACT | FULL TEXT  

References
APPI Online CME 2007;2007:2-2.
FULL TEXT  

Depressive Symptoms, Smoking, Drinking, and Quality of Life Among Head and Neck Cancer Patients
Duffy et al.
Psychosomatics 2007;48:142-148.
ABSTRACT | FULL TEXT  

Addressing Nicotine Dependence in Psychodynamic Psychotherapy: Perspectives From Residency Training
Prochaska et al.
Acad. Psychiatry 2007;31:8-14.
ABSTRACT | FULL TEXT  

Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy
Tonnesen et al.
Eur Respir J 2007;29:390-417.
ABSTRACT | FULL TEXT  

Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing
Okuyemi et al.
Health Educ Behav 2007;34:43-54.
ABSTRACT  

The US Public Health Service "treating tobacco use and dependence clinical practice guidelines" as a legal standard of care
Torrijos and Glantz
Tobacco Control 2006;15:447-451.
ABSTRACT | FULL TEXT  

Potential for Genetics to Promote Public Health: Genetics Research on Smoking Suggests Caution About Expectations
Carlsten and Burke
JAMA 2006;296:2480-2482.
FULL TEXT  

Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors
Prochaska et al.
Acad. Psychiatry 2006;30:372-378.
ABSTRACT | FULL TEXT  

The Influence of Smoking Cessation on Hemodynamics and Arterial Compliance
Oren et al.
ANGIOLOGY 2006;57:564-568.
ABSTRACT  

Chronic Obstructive Pulmonary Disease, Risk Factors, and Outcome Trials: Comparisons with Cardiovascular Disease
Ramsey and Hobbs
Proc Am Thorac Soc 2006;3:635-640.
ABSTRACT | FULL TEXT  

Optimal Medical Management of Peripheral Arterial Disease
Rice and Lumsden
VASC ENDOVASCULAR SURG 2006;40:312-327.
ABSTRACT  

Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial.
Tonstad et al.
JAMA 2006;296:64-71.
ABSTRACT | FULL TEXT  

A Systems-Based Intervention to Promote Smoking as a Vital Sign in Patients Served by Community Health Centers
Maizlish et al.
American Journal of Medical Quality 2006;21:169-177.
ABSTRACT  

Tobacco dependence treatment: time to change the paradigm.
Sachs
Chest 2006;129:836-839.
FULL TEXT  

Non-smokers seeking help for smokers: a preliminary study.
Zhu et al.
Tobacco Control 2006;15:107-113.
ABSTRACT | FULL TEXT  

Randomized Controlled Trial on Lifestyle Modification in Hypertensive Patients
Cakir and Pinar
West J Nurs Res 2006;28:190-209.
ABSTRACT  

Outcomes of Bupropion Therapy for Smoking Cessation During Routine Clinical Use
Paluck et al.
The Annals of Pharmacotherapy 2006;40:185-190.
ABSTRACT | FULL TEXT  

Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation
Petersen et al.
Tobacco Control 2006;15:30-34.
ABSTRACT | FULL TEXT  

Use of nicotine replacement therapy and the risk of acute myocardial infarction, stroke, and death
Hubbard et al.
Tobacco Control 2005;14:416-421.
ABSTRACT | FULL TEXT  

Atheromatous embolization
Liew and Bartholomew
Vasc Med 2005;10:309-326.
ABSTRACT  

Peer-Delivered Smoking Counseling for Childhood Cancer Survivors Increases Rate of Cessation: The Partnership for Health Study
Emmons et al.
JCO 2005;23:6516-6523.
ABSTRACT | FULL TEXT  

MediClass: A System for Detecting and Classifying Encounter-based Clinical Events in Any Electronic Medical Record
Hazlehurst et al.
J. Am. Med. Inform. Assoc. 2005;12:517-529.
ABSTRACT | FULL TEXT  

How Prepared Are Psychiatry Residents for Treating Nicotine Dependence?
Prochaska et al.
Acad. Psychiatry 2005;29:256-261.
ABSTRACT | FULL TEXT  

Helping Surgical Patients Quit Smoking: Why, When, and How
Warner
Anesth. Analg. 2005;101:481-487.
ABSTRACT | FULL TEXT  

When Health Policy Is the Problem
Knickman
Journal of Health Politics, Policy and Law 2005;30:367-374.
 

Physician Tobacco Advice to Preteens in a Smoking-Prevention Randomized Trial: Steering Clear
McAfee et al.
J Pediatr Psychol 2005;30:371-376.
ABSTRACT | FULL TEXT  

Putting Policy Theory to Work: Tobacco Control in California
Blackman
Policy Politics Nursing Practice 2005;6:148-155.
ABSTRACT  

Handbook of Clinical Alcoholism Treatment
GOLD and BRANDT
Am. J. Psychiatry 2005;162:1038-1039.
FULL TEXT  

Frequency of Physician-Directed Assistance for Smoking Cessation in Patients Receiving Cessation Medications
Solberg et al.
Arch Intern Med 2005;165:656-660.
ABSTRACT | FULL TEXT  

Efficacy of a smoking cessation intervention using the AHCPR guideline tailored for Koreans: a randomized controlled trial
KIM et al.
HEALTH PROMOT INT 2005;20:51-59.
ABSTRACT | FULL TEXT  

Preoperative Smoking Cessation: The Role of the Primary Care Provider
Warner
Mayo Clin Proc. 2005;80:252-258.
ABSTRACT  

Anesthesiologists, General Surgeons, and Tobacco Interventions in the Perioperative Period
Warner et al.
Anesth. Analg. 2004;99:1766-1773.
ABSTRACT | FULL TEXT  

Treatment of Tobacco Use in an Inpatient Psychiatric Setting
Prochaska et al.
Psychiatr. Serv. 2004;55:1265-1270.
ABSTRACT | FULL TEXT  

Bupropion for Smoking Cessation: A Randomized Trial
Simon et al.
Arch Intern Med 2004;164:1797-1803.
ABSTRACT | FULL TEXT  

Smoking cessation services: use them or lose them
Britton
Thorax 2004;59:548-549.
FULL TEXT  

Individualizing Nicotine Replacement Therapy for the Treatment of Tobacco Dependence: A Randomized Trial
Lerman et al.
ANN INTERN MED 2004;140:426-433.
ABSTRACT | FULL TEXT  

Nicotine replacement therapy
Molyneux
BMJ 2004;328:454-456.
FULL TEXT  

A Silence That Kills
Haviland
AJPH 2004;94:176-178.
FULL TEXT  

Out of the Ashes: The Life, Death, and Rebirth of the "Safer" Cigarette in the United States
Fairchild and Colgrove
AJPH 2004;94:192-204.
ABSTRACT | FULL TEXT  

Diabetic Patients Who Smoke: Are They Different?
Solberg et al.
Ann Fam Med 2004;2:26-32.
ABSTRACT | FULL TEXT  

To Whom Do Psychiatrists Offer Smoking-Cessation Counseling?
Himelhoch and Daumit
Am. J. Psychiatry 2003;160:2228-2230.
ABSTRACT | FULL TEXT  

Effectiveness of Bupropion Sustained Release for Smoking Cessation in a Health Care Setting: A Randomized Trial
Swan et al.
Arch Intern Med 2003;163:2337-2344.
ABSTRACT | FULL TEXT  

Impediment Profiling for Smoking Cessation: Preliminary Experience
Katz et al.
Behav Modif 2003;27:524-537.
ABSTRACT  

Tobacco Cessation in Primary Care: Maximizing Intervention Strategies
Anczak and Nogler
Clin Med Res 2003;1:201-216.
ABSTRACT | FULL TEXT  

Diagnosis of Airflow Limitation Combined With Smoking Cessation Advice Increases Stop-Smoking Rate
Gorecka et al.
Chest 2003;123:1916-1923.
ABSTRACT | FULL TEXT  

Clinical trial comparing nicotine replacement therapy (NRT) plus brief counselling, brief counselling alone, and minimal intervention on smoking cessation in hospital inpatients
Molyneux et al.
Thorax 2003;58:484-488.
ABSTRACT | FULL TEXT  

Teen smoking cessation
Mermelstein
Tobacco Control 2003;12:i25-34.
ABSTRACT | FULL TEXT  

One year effectiveness of an individualised smoking cessation intervention at the workplace: a randomised controlled trial
Rodriguez-Artalejo et al.
Occup. Environ. Med. 2003;60:358-363.
ABSTRACT | FULL TEXT  

TOBACCO CONTROL AS A LIFETIME PROCESS
CA Cancer J Clin 2003;53:134-135.
FULL TEXT  

Tobacco Control for Clinicians Who Treat Adolescents
Sargent and DiFranza
CA Cancer J Clin 2003;53:102-123.
ABSTRACT | FULL TEXT  

Does Insurance Coverage For Drug Therapy Affect Smoking Cessation?
Boyle et al.
Health Aff (Millwood) 2002;21:162-168.
ABSTRACT | FULL TEXT  

Smoking Patterns of Household Members and Visitors in Homes With Children in the United States
Schuster et al.
Arch Pediatr Adolesc Med 2002;156:1094-1100.
ABSTRACT | FULL TEXT  

Effective Tobacco Dependence Treatment
Fiore et al.
JAMA 2002;288:1768-1771.
FULL TEXT  

The Behavior Change Consortium: setting the stage for a new century of health behavior-change research
Ory et al.
Health Educ Res 2002;17:500-511.
ABSTRACT | FULL TEXT  

Psychological Intervention and Antidepressant Treatment in Smoking Cessation
Hall et al.
Arch Gen Psychiatry 2002;59:930-936.
ABSTRACT | FULL TEXT  

Impact of Over-the-Counter Sales on Effectiveness of Pharmaceutical Aids for Smoking Cessation
Pierce and Gilpin
JAMA 2002;288:1260-1264.
ABSTRACT | FULL TEXT  

Task Force #1--magnitude of the prevention problem: opportunities and challenges
Benjamin et al.
J Am Coll Cardiol 2002;40:588-603.
FULL TEXT  

Addressing Tobacco in Managed Care: A Survey of Dentists' Knowledge, Attitudes, and Behaviors
Albert et al.
AJPH 2002;92:997-1001.
ABSTRACT | FULL TEXT  

Smoking Cessation: Providing Patients with the Tools to Quit
JWatch Women's Health 2002;2002:9-9.
FULL TEXT  

Treatment of Tobacco Use and Dependence
Rigotti
NEJM 2002;346:506-512.
FULL TEXT  

Evaluation of a nurse-managed minimal-contact smoking cessation intervention for cardiac inpatients
Bolman et al.
Health Educ Res 2002;17:99-116.
ABSTRACT | FULL TEXT  

Tobacco Dependence Curricula in Acute Care Nurse Practitioner Education
Heath et al.
Am J Crit Care 2002;11:27-33.
ABSTRACT | FULL TEXT  

Quality Indicators for the Management of Pneumonia in Vulnerable Elders
Rhew
ANN INTERN MED 2001;135:736-743.
FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 2001;4:E1-11.
FULL TEXT  

Sustained-Release Bupropion for Pharmacologic Relapse Prevention after Smoking Cessation: A Randomized, Controlled Trial
Hays et al.
ANN INTERN MED 2001;135:423-433.
ABSTRACT | FULL TEXT  

Physicians Taking Action Against Smoking: an intervention program to optimize smoking cessation counselling by Montreal general practitioners
Tremblay et al.
CMAJ 2001;165:601-607.
ABSTRACT | FULL TEXT  

Pharmacoeconomics of COPD and Smoking Cessation
Grannis and Hillerman
Chest 2001;120:321-321.
FULL TEXT  

Tobacco Use Outcomes of Adolescents Treated Clinically for Nicotine Dependence
Patten et al.
Arch Pediatr Adolesc Med 2001;155:831-837.
ABSTRACT | FULL TEXT  

Annual Report to the Nation on the Status of Cancer (1973 Through 1998), Featuring Cancers With Recent Increasing Trends
Howe et al.
JNCI J Natl Cancer Inst 2001;93:824-842.
ABSTRACT | FULL TEXT  

Delivery of Smoking Prevention and Cessation Services to Adolescents
Klein et al.
Arch Pediatr Adolesc Med 2001;155:597-602.
ABSTRACT | FULL TEXT  

Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II Euro Heart Survey Programme
Eur Heart J 2001;22:554-572.
ABSTRACT  

Tobacco's Toll: Implications for the Pediatrician
Committee on Substance Abuse
Pediatrics 2001;107:794-798.
ABSTRACT | FULL TEXT  

Update in Addiction Medicine
Schneider et al.
ANN INTERN MED 2001;134:387-395.
FULL TEXT  

Helping Our Clients With Smoking Cessation
Cataldo and Talley
J Am Psychiatr Nurses Assoc 2001;7:26-31.
 

Health Consequences of Eclipse Cigarettes
Burger et al.
JAMA 2000;284:2995-2996.
FULL TEXT  

Quality improvement and accountability in the treatment of tobacco dependence: the need for a national training and certification programme
DAVIS et al.
Tobacco Control 2000;9:355-358.
FULL TEXT  

Other articles noted
Evid. Based Ment. Health 2000;3:104-104.
FULL TEXT  

A 36-Year-Old Woman Who Smokes Cigarettes
Rigotti
JAMA 2000;284:741-749.
FULL TEXT  

Improving the treatment of tobacco dependence
Thun and Glynn
BMJ 2000;321:311-312.
FULL TEXT