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Tobacco use

What's new

Updated 2024 WHO guidelines for smoking cessation in adults.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of tobacco use are prepared by our editorial team based on guidelines from the American Society of Addiction Medicine (ASAM/AAAP 2024), the World Health Organization (WHO 2024), the National Lipid Association (NLA/PCNA/ASPC/ACC/AHA/ACCP 2023), the United States Department of Defense (DoD/VA 2023), the U.S. Preventive Services Task Force (USPSTF 2021,2020), the American ...
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Screening and diagnosis

Indications for screening: as per USPSTF 2021 guidelines, ask all adults about tobacco use.
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Diagnostic investigations

Assessment of willingness to quit: as per USPHS 2008 guidelines, assess the patient's willingness to quit once a tobacco user is identified and advised to quit.
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Medical management

Pharmacotherapy, indications: as per USPSTF 2021 guidelines, offer US FDA-approved pharmacotherapy for tobacco use cessation in nonpregnant adults.
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  • Pharmacotherapy (nicotine replacement therapy)

  • Pharmacotherapy (bupropion)

  • Pharmacotherapy (varenicline)

  • Pharmacotherapy (other drugs)

Nonpharmacologic interventions

Behavioral interventions, indications: as per WHO 2024 guidelines, provide brief advice (between 30 seconds and 3 minutes per encounter), delivered consistently by healthcare providers as a routine practice to all tobacco users accessing any healthcare settings.
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  • Behavioral interventions (providers)

  • Behavioral interventions (approaches)

  • Behavioral interventions (formats)

  • Behavioral interventions (intensity)

  • E-cigarettes

  • Alternative and complementary therapies

Specific circumstances

Light smokers: as per USPHS 2008 guidelines, identify light smokers, strongly urge them to quit, and provide counseling cessation interventions.
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  • Smokeless tobacco users (nonpharmacologic management)

  • Smokeless tobacco users (pharmacotherapy)

  • Non-cigarette tobacco smokers

  • Pregnant patients

  • Pediatric patients (assessment)

  • Pediatric patients (prevention)

  • Pediatric patients (management)

  • Patients with coronary artery disease

  • Patients with stimulant use disorder

  • Patients with bipolar disorder

Follow-up and surveillance

Assessment of abstinence: as per USPHS 2008 guidelines, assess all patients receiving a tobacco dependence intervention for abstinence at the completion of treatment and during subsequent contacts.
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  • Weight gain after quitting smoking

Quality improvement

Documentation: as per WHO 2024 guidelines, ensure that all healthcare facilities include tobacco use status and use of tobacco cessation interventions in their medical records (including electronic health records), to facilitate provider interaction with tobacco users and increase adoption and maintenance of evidence-based treatment interventions.
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  • Health service coverage

  • Health professional training