Offer Smokers Variety of Cessation Options, Says USPSTF

Evidence Lacking on Using E-Cigarettes As Cessation Tool

May 12, 2015 03:32 pm Chris Crawford
[Woman getting patch on arm]

Smoking is the leading preventable cause of disease, disability and death in the United States, resulting in more than 480,000 premature deaths each year and accounting for about one in every five deaths. According to the CDC, an estimated 42.1 million adults in the United States -- or almost 18 percent of the population -- currently smoke.

The U.S. Preventive Services Task Force (USPSTF) addressed these grim statistics when, on May 5, it released its draft recommendation( on behavioral interventions and medications for smoking cessation in adults, including pregnant women. In short, the task force recommends that physicians ask all adults about tobacco use and encourage those who smoke to quit using appropriate cessation aids.

"Quitting smoking can be difficult, but it is one of the most important actions people can take for their health," said USPSTF Chair Albert Siu, M.D., M.S.P.H., in a news release.( "Fortunately, there are many effective smoking cessation aids available to help."

Story highlights
  • The U.S. Preventive Services Task Force has released a draft recommendation on smoking cessation in adults and recommends that physicians offer a variety of cessation aids.
  • For pregnant women, the USPSTF recommended behavioral interventions only because not enough evidence was available to assess the benefits and harms of pharmacotherapeutic interventions.
  • There also wasn't enough evidence for the task force to assess the benefits and harms of using e-cigarettes for smoking cessation in all adults.

The task force reviewed evidence( on smoking cessation interventions and recommended that for nonpregnant adults who smoke, physicians should offer behavioral therapy or FDA-approved medications, including nicotine-replacement therapy, alone or in combination (A recommendation).(

For pregnant women, the USPSTF recommended behavioral interventions (A recommendation) only because not enough evidence was available (I recommendation) to assess the benefits and harms of pharmacotherapeutic interventions for this population.

There also wasn't enough evidence for the Task Force to assess the benefits and harms of using e-cigarettes for smoking cessation in adults (I recommendation).

The current draft recommendation updates and is consistent with the USPSTF's 2009 recommendation. This version adds a review of evidence on electronic nicotine delivery systems (ENDS) -- or e-cigarettes -- which have become more widespread since the previous recommendation was released. But again, it found insufficient evidence to recommend for or against the use of ENDS for tobacco cessation.

The AAFP released its own recommendation statement in 2009, which mirrored the USPSTF's guidance.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that when she was working with patients who wanted to quit smoking, her recommendation depended on what they were willing or able to do.

AAFP Presses President to Act on FDA Tobacco Deeming Rule

On April 28, the AAFP signed on to a letter to the president(5 page PDF) urging him to see that the FDA quickly finalizes the proposed rule implementing certain provisions of the Federal Food, Drug and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act.(

This legislation grants the FDA regulatory oversight of e-cigarettes, cigars and several other tobacco products it previously had not regulated as long as the HHS secretary deems these tobacco products subject to the FDA's jurisdiction. The proposed regulation, fittingly known as the "tobacco deeming rule," offers two options for doing so.

"This public health regulation is long overdue," says the letter, which was signed by 30 other stakeholder groups. "Further delay will only serve the interests of tobacco companies, which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.

"We ask for your leadership in ensuring your administration quickly finalizes the regulation."

"I discussed what their support system was and what their 'triggers' tended to be in order to come up with a plan that worked for them," she said. "I offered support through regular visits with me, counseling or participation with a support group. I also encouraged patients to take prescription medication to increase their success, although this was often not financially feasible due to lack of insurance coverage. And some patients felt strongly that they needed nicotine replacement, while others felt strongly about going 'cold-turkey.'"

As to the newest piece of this recommendation -- the USPSTF's I recommendation on benefits and harms of e-cigarettes for smoking cessation -- Frost said just as there is insufficient evidence now, she doesn't see enough evidence coming to light in the future to support e-cigarette use.

"The question is not if (e-cigarettes) are bad for your health, but if they are better for you than tobacco," she said. "E-cigarette manufacturers are advertising them as an aid to quitting smoking. So far, evidence does not support this assertion, but the data are too limited to make a definite recommendation against."

If a patient wanted to start using e-cigarettes to help him/her quit smoking, Frost said she would strongly discourage that because data are emerging that e-cigarettes are bad for patients' health and do not help them quit. "I would inform them that by trying e-cigarettes, they could actually cause themselves more harm," she said.

The USPSTF's draft recommendation statement and evidence review are posted for public comment( through June 1. The AAFP will submit its comments on the recommendation during this time.

"There is no question that smoking has negative, potentially fatal effects on health," Frost said. "Most smokers understand this risk, but find it difficult to quit. My hope is that with this recommendation, pharmacotherapy will be more routinely prescribed and behavioral interventions will be more widely available to help with smoking cessation."

Related AAFP News Coverage
Include Cigars, E-cigarettes in Final Tobacco-deeming Rule, Say AAFP, Other Groups