USPSTF Draft Recommendation
Tobacco Use: Ask Patients, Offer Advice, Provide Options
June 10, 2020, 03:57 pm News Staff – Tobacco use is the leading cause of preventable disease, disability and death in the United States. Although cigarette smoking rates among U.S. adults have declined steadily over the years, reaching an all-time low of 13.7% in 2018, the downside is that about 49 million adults still use cigarettes and other tobacco products, a behavior that puts them and others at increased risk for a number of negative health effects.
On June 2, the U.S. Preventive Services Task Force posted on its website a draft recommendation statement and draft evidence review regarding interventions for tobacco cessation in adults, including pregnant individuals.
Based on its review of the evidence, the task force issued four separate recommendations:
- Primary care clinicians should ask all nonpregnant adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy to help them quit. This is an "A" recommendation.
- Clinicians should ask pregnant individuals about tobacco use, advise them to quit, and provide behavioral cessation interventions. This is also an "A" recommendation.
- Among pregnant individuals only, current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapeutic interventions for tobacco cessation -- an "I" recommendation.
- Finally, for all adults -- including pregnant individuals -- current evidence is insufficient to assess the balance of benefits and harms of using electronic cigarettes for tobacco cessation. Rather, clinicians should direct patients who use tobacco to other cessation interventions that have been shown to be safe and effective.
"Quitting smoking and other forms of tobacco is one of the best things people can do for their health," said task force member Michael Silverstein, M.D., M.P. H., in a news release. "There are multiple safe and proven ways to help adults quit tobacco -- the best one is the one that works."
STORY HIGHLIGHTS
The draft recommendation on tobacco cessation interventions for adults was posted roughly six weeks after the USPSTF issued a final recommendation statement on primary care interventions for the prevention and cessation of tobacco use in children and adolescents. That statement recommended that primary care clinicians provide interventions such as education or brief counseling to prevent initiation of tobacco use in school-age children and adolescents.
Update of Previous Recommendation
The draft recommendation updates the task force's 2015 final recommendation statement on behavioral and pharmacotherapeutic interventions for tobacco smoking cessation in adults, including pregnant women. The AAFP supported the 2015 recommendation.
Despite the inclusion of additional evidence and updated language, the recommendations in the current draft statement are the same as those issued in 2015. In addition, even though the task force included evidence from several trials published since 2015 in its draft evidence review, research gaps were noted in two areas.
The USPSTF stated that more research needs to be conducted to gain a better understanding of the effectiveness of e-cigarettes for smoking cessation, as well as of the potential short- and long-term harms associated with cigarette use.
The task force also said additional studies are needed on pharmacotherapy options -- in particular, nicotine replacement therapies such as nicotine transdermal patches, lozenges, gums, inhalers and nasal sprays -- for pregnant people in whom behavioral counseling interventions are not effective.
In the news release, task force member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E., specifically addressed the recommendation statements aimed at pregnant individuals, noting that, "When it comes to helping people quit and supporting a healthy pregnancy, we know that behavioral counseling is effective, but we still need more research on whether medications are a safe option."
Next Steps
The USPSTF is accepting comments on the draft recommendation statement and draft evidence review until 8 p.m. ET June 29. All comments received will be considered as the task force prepares its final recommendation.
The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and will provide comments to the task force. The Academy will release its own recommendation on the topic after the task force finalizes its guidance.