Family physicians are all too familiar with the harms associated with smoking -- as well as the benefits associated with quitting. And while the Office of the Surgeon General routinely issues reports on smoking and health, the last report that focused specifically on smoking cessation(www.google.com) was published three decades ago.
Needless to say, a number of relevant developments have occurred over the past 30 years. Smoking Cessation: A Report of the Surgeon General,(www.hhs.gov) released last month, highlights many of them in new and updated information that includes reviews of evidence-based interventions and strategies FPs could find useful in helping patients reduce their tobacco intake or quit smoking.
"We know more about the science of quitting than ever before," said Surgeon General Jerome Adams, M.D., M.P.H., in a Jan. 23 news release.(www.hhs.gov) "As a nation, we can and must do more to ensure that evidence-based cessation treatments are reaching the people (who) need them."
Many of the report's conclusions will be familiar to family physicians, such as the fact that smoking cessation benefits people at any age. Others delve deeper into facets that may assist FPs in caring for their patients.
- U.S. Surgeon General Jerome Adams, M.D., M.P.H., has released the office's first report on smoking cessation in three decades.
- The report examines treatments proven to help adults quit smoking and highlights strategies that encourage and support smoking cessation.
- The AAFP has created numerous tobacco cessation tools specifically for family physicians.
For example, authors note that more than 60% of U.S. adults who have ever smoked cigarettes have quit, and that although a majority of smokers attempt to quit each year, less than one-third use FDA-approved cessation methods or behavioral counseling to support their attempts.
The report also notes substantial disparities in smoking prevalence among the general population, with considerable differences based on age, race/ethnicity, education level and other factors. In addition, disparities in key indicators of smoking cessation include quit attempts, receiving advice to quit from a health care professional and use of cessation therapies.
Behavioral counseling and FDA-approved cessation medications are cost-effective and increase the likelihood of successfully quitting smoking, the authors report, especially when these treatments are used together. Using combinations of nicotine replacement therapies can further increase the likelihood of quitting.
Effective Interventions and Strategies
FPs may be especially interested in the report chapters that focus on interventions for smoking cessation and treatments for nicotine dependence(www.hhs.gov) and clinical-, system- and population-based strategies that promote smoking cessation.(www.hhs.gov)
Regarding interventions, the authors noted that the FDA has approved seven therapies and medications(2 page PDF) for use as first-line tobacco cessation treatments and said evidence suggests that combinations of short-and long-acting forms of nicotine replacement therapy are more effective in promoting cessation than any single form. The report also suggests a number of treatments that may increase smoking cessation, including text messaging services and web- or Internet-based interventions.
For successful smoking cessation strategies, the report pointed to the Task Force on Community Preventive Services' 2001 recommendations,(www.sciencedirect.com) the Public Health Service's 2008 Treating Tobacco Use and Dependence clinical practice guideline(276 page PDF) and the U.S. Preventive Services Task Force's 2015 recommendations on behavioral and pharmacotherapy interventions for tobacco smoking cessation.(www.uspreventiveservicestaskforce.org)
Health systems approaches that made smoking cessation a standard of care also were found to be effective, as were pictorial health warnings on cigarette packages -- a move the Academy has strongly supported -- and other population-level strategies.
The effectiveness of other strategies remains unclear, however. According to the report, more research on policies focused on reducing point-of-sale advertising, restricting the sale of certain types of tobacco products and use of very-low-nicotine-content cigarettes is needed to determine their effects on smoking cessation.
As for e-cigarettes, the report found inadequate evidence to conclude that they were effective for tobacco cessation and authors said more well-designed studies are needed.
"Overall, a landscape that combines both clinical and treatment-oriented strategies, as well as systems- and population-level strategy changes, is likely to create the most supportive environment for quit attempts and successful cessation," the report stated. "Accordingly, clinicians and public health practitioners should seek to better bridge clinical work with population-based policy approaches to maximize tobacco cessation and reduce the overall prevalence of tobacco use."
In addition to the 2020 report, the surgeon general's office has published related materials on its Tobacco Reports and Publications webpage,(www.hhs.gov) including fact sheets for health care professionals.
The Academy has also created a vast amount of smoking cessation resources for its members. These include the Ask and Act tobacco cessation program, the Tobacco and Nicotine Cessation Toolkit and various treatment and cessation guides.
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Familydoctor.org: Tobacco Addiction(familydoctor.org)