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January 19, 2021
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USPSTF: Ask adults about tobacco use

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United States Preventive Services Task Force recommended that clinicians ask all adults about tobacco use and provide them with behavioral interventions and even FDA-approved pharmacotherapy to help them quit smoking.

The A-level recommendation is “consistent with the 2015 USPSTF recommendation” but incorporated “newer evidence and language in the field of tobacco cessation, including new evidence on the harms of e-cigarettes (ie, vaping),” the task force wrote in JAMA. An evidence report that supported the recommendation included 67 reviews, nine clinical trials addressing e-cigarettes for smoking cessation and seven trials of nicotine replacement therapy use in pregnancy.

Electronic cigarette in one palm and traditional cigarettes in other
The USPSTF recommendations targeted towards smoking among adults now reflect newer tobacco devices, including e-cigarettes. Photo source: Adobe Stock.

Among its other recommendations, the task force stated the following:

  • FDA-approved pharmacotherapies for cessation should only be provided to nonpregnant patients. (A-level recommendation.)
  • The evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant patients.
  • Similarly, the evidence is insufficient to assess the balance of benefits and harms of e-cigarettes for tobacco cessation in adults, including pregnant women. (I-level statement.)
  • Physicians whose patients use tobacco should be steered toward tobacco cessation interventions with “proven effectiveness and established safety.” (I-level statement.)

To help carry out the recommendations, the USPSTF encouraged the use of certain techniques, such as the 5 As — Ask, Advise, Assess, Assist, Arrange follow-up — or the Ask, Advise, Refer method. It also noted that the CDC, HHS and Veterans Affairs websites have resources to help smokers quit and that effective behavioral health cessation interventions include physician advice, individual counseling and mobile phone-based interventions. The FDA-approved pharmacotherapies are nicotine replacement therapy, bupropion sustained-release and varenicline.

“In the absence of clear evidence on the balance of benefits and harms of pharmacotherapy in pregnant women, clinicians are encouraged to consider the severity of tobacco dependence in each patient and engage in shared decision-making to determine the best individual treatment course,” the task force wrote.

Data indicate tobacco use was the “leading preventable cause of disability, disease and death” among U.S. residents in 2014. In addition, slightly less than 21% of U.S. adults in 2019 and a little more than 7% of women who gave birth in 2016 used some type of tobacco product, according to the USPSTF.

In a related editorial, Brenna VanFrank, MD, MPH, a senior medical officer with CDC’s Office on Smoking and Health, and colleagues wrote that a “well-established” evidence base suggests tobacco price increases, smoke-free policies, mass media tobacco education campaigns and access to cessation treatment can encourage individuals to never start smoking or to stop if they do. They encouraged health care professionals to support these efforts.

VanFrank and colleagues added a thorough, team-based approach may also assist in smoking cessation.

“Helping people recover from tobacco use and dependence requires the partnership of the public health community and health care professionals from all specialties and across disciplines to deliver comprehensive support through interventions at individual, system, and population levels,” they wrote. “These efforts must be applied comprehensively and equitably across communities to ensure that no one is left behind.”

References:

Patnode CD, et al. JAMA. 2021;doi:10.1001/jama.2020.23541.

VanFrank B, et al. JAMA. 2021;doi:10.1001/jama.2020.23608.