U.S. Preventive Services Task Force

Counseling: Tobacco Use

Release Date: November 2003

Summary of Recommendations / Supporting Documents

Summary of Recommendations

• The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products.

  Rating: A Recommendation.

  Rationale: The USPSTF found good evidence that brief smoking cessation interventions, including screening, brief behavioral counseling (less than 3 minutes), and pharmacotherapy delivered in primary care settings, are effective in increasing the proportion of smokers who successfully quit smoking and remain abstinent after 1 year. Although most smoking cessation trials do not provide direct evidence of health benefits, the USPSTF found good evidence that smoking cessation lowers the risk for heart disease, stroke, and lung disease. The USPSTF concluded that there is good indirect evidence that even small increases in the quit rates from tobacco cessation counseling would produce important health benefits, and that the benefits of counseling interventions substantially outweigh any potential harms.

• The USPSTF strongly recommends that clinicians screen all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke.

  Rating: A Recommendation.

  Rationale: The USPSTF found good evidence that extended or augmented smoking cessation counseling (5-15 minutes) using messages and self-help materials tailored for pregnant smokers, compared with brief generic counseling interventions alone, substantially increases abstinence rates during pregnancy, and leads to increased birth weights. Although relapse rates are high in the post-partum period, the USPSTF concluded that reducing smoking during pregnancy is likely to have substantial health benefits for both the baby and the expectant mother. The USPSTF concluded that the benefits of smoking cessation counseling outweigh any potential harms.

• The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents.

  Rating: I Recommendation.

  Rationale: The USPSTF found limited evidence that screening and counseling children and adolescents in the primary care setting are effective in either preventing initiation or promoting cessation of tobacco use. As a result, the USPSTF could not determine the balance of benefits and harms of tobacco prevention or cessation interventions in the clinical setting for children or adolescents.

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Supporting Documents

Counseling to Prevent Tobacco Use and Tobacco-Caused Disease, 2003

Recommendation Statement (PDF File, 200 KB)

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Related Resources

Centers for Disease Control and Prevention

Morbidity and Mortality Weekly Report Recommendations and Reports
  Go to: http://www.cdc.gov/mmwr/mmwr_rr.html
Guide to Community Preventive Services
  Go to: http://www.thecommunityguide.org

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