CLINICAL QUESTION

Are behavioral and pharmacotherapy interventions effective for smokeless tobacco cessation?

EVIDENCE-BASED ANSWER

For people who use smokeless tobacco, counseling and brief advice are safe and effective in achieving tobacco cessation. (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.) Nicotine replacement therapy (NRT) also increases cessation rates, although the evidence is less robust. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Varenicline (Chantix) is effective in helping people quit. (SOR: A, consistent, good-quality patient-oriented evidence.) Bupropion does not appear to aid in smokeless tobacco cessation.¹ (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

It is estimated that more than 5 million US adults currently use smokeless tobacco products.² Use is more prevalent among people who are uninsured and those with mental health disorders.² Long-term use of smokeless tobacco products is associated with an increased risk of stroke, esophageal cancer, and laryngeal cancer.³ Despite its prevalence and impact on health, smokeless tobacco products have been studied far less than smoked tobacco. This Cochrane review assessed behavioral and pharmacotherapy cessation interventions for smokeless tobacco use.¹