RESEARCH to PRACTICE
Promoting Cessation of Tobacco Use
Glen D. Morgan, PhD; Brion J. Fox, JD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 12 - DECEMBER 2021
Tobacco exacts an exorbitant toll on the nation's health, causing more than 450,000 deaths yearly. Although rates of smoking (the most common form of tobacco use) among adults have decreased in the past two decades, the decline has recently leveled off. Of additional concern is that youth tobacco use is increasing (1). A combination of recent scientific advances and social, legal, and public policy developments provides an unprecedented opportunity to reduce the burden of death and disease caused by tobacco use (2). Reducing tobacco use among adults and adolescents is an important public health goal.
Guideline for Cessation
Physicians and healthcare systems will play a key role in achieving this objective. This effort will undoubtedly be facilitated by the recently released Public Health Service Clinical Practice Guideline, "Treating Tobacco Use and Dependence" (3,4). The guideline was developed by a consortium of seven government and nonprofit organizations that reviewed more than 6,000 articles to identify empirically based and validated assessments and treatments for tobacco dependence.
The report contains evidence-based information about behavioral counseling, first-line pharmacologic therapies (sustained release bupropion hydrochloride and nicotine-delivery agents such as gum, patches, inhalers, and nasal sprays) and second-line pharmacologic therapies (clonidine hydrochloride and nortriptyline hydrochloride) that are effective in helping patients to stop using tobacco. An overarching conclusion of the panel was that tobacco cessation treatments are effective and extremely cost-effective compared with other routine medical and disease-prevention interventions (3,4).
Healthcare Providers as Facilitators
Since most tobacco users see healthcare practitioners yearly, systematic institutional identification and tracking of these patients is a critical first step to effective care. The guideline concludes that tobacco dependence should be viewed as a chronic disease, not unlike diabetes or hypertension. Effective treatments, however, are available, and clinicians should be ready to treat their patients through periods of relapse and remission. As such, every patient who uses tobacco should be offered a treatment shown to be effective. Even a brief consultation (3 minutes or less) at each clinic visit will significantly improve abstinence rates.
Steps to Cessation: The Five A's
The guideline provides different brief interventions for treating patients based on their smoking status (4). Physicians should:
Motivating Patients: The Five R's
Physicians who wish to motivate patients to quit using tobacco should explain "the 5 R's":
Relapse Prevention and Counseling
Patients will relapse, and the following steps should help patients who are making an attempt to quit:
Tools to Help Patients
Physicians will need to play an active role in helping their tobacco-using patients to quit. With the publication of the evidence-based PHS guideline (3,4), physicians now have additional tools they need to fulfill this role.
Dr Morgan is a program director in the Division of Cancer Control and Population Sciences at the National Cancer Institute in Rockville, Maryland. Mr Fox is a research fellow in the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School in Madison. Address correspondence to Glen D. Morgan, PhD, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Rm 4034 MSC 7337, Rockville, MD; e-mail to [email protected].