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Tobacco use

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 National Lipid Association (NLA/PCNA/ASPC/ACC/AHA/ACCP 2023), the U.S. Preventive Services Task Force (USPSTF 2021; 2020), the American Thoracic Society (ATS 2020), and the United States Public Health Service (USPHS 2008).
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Guidelines

1.Screening and diagnosis

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

Assessment of willingness to quit: assess the patient's willingness to quit once a tobacco user is identified and advised to quit.
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3.Medical management

Pharmacotherapy, indications, USPSTF: 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)

4.Nonpharmacologic interventions

Behavioral interventions, indications: advise all adult tobacco users to stop using tobacco and provide behavioral interventions.
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  • Behavioral interventions (providers)

  • Behavioral interventions (approaches)

  • Behavioral interventions (formats)

  • Behavioral interventions (intensity)

  • E-cigarettes

5.Specific circumstances

Light smokers: identify light smokers, strongly urge them to quit, and provide counseling cessation interventions.
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  • Smokeless tobacco users

  • Non-cigarette tobacco smokers

  • Pregnant patients

  • Pediatric patients (assessment)

  • Pediatric patients (prevention)

  • Pediatric patients (management)

  • Patients with coronary artery disease

6.Follow-up and surveillance

Assessment of abstinence: 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

7.Quality improvement

Health service coverage: include treatments proved to be effective for smoking cessation as covered services in public and private health benefit plans as providing tobacco dependence treatments (both medication and counseling) as a paid or covered benefit by health insurance plans has been shown to increase the proportion of smokers proceeding to cessation treatment, attempting to quit and successfully quitting.
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  • Health professional training