2008 Clinical Practice Guideline Update: Treating Tobacco Use And Dependence.pdf

The 2008 update to the U.S. Public Health Service's Clinical Practice Guideline for treating tobacco use and dependence introduces several key changes based on new evidence:

New Recommendations:

Enhanced Quit Line Counseling: Effective across diverse populations, with callers four times more likely to quit with this support compared to unaided attempts.
Combination Therapy: Combining counseling and medication significantly improves quit rates; both should be offered when feasible, but medication is contraindicated for pregnant women, light smokers, adolescents, and smokeless tobacco users.
New Medications: Seven FDA-approved medications for tobacco dependence treatment are highlighted, including nicotine lozenges and varenicline.
Effective Combinations: Nicotine patch plus other nicotine replacement therapies (gum, spray, inhaler) and nicotine patch plus bupropion SR shown to be effective.

New Emphasis:

Chronic Condition: Tobacco dependence is viewed as a chronic condition requiring repeated interventions for long-term abstinence.
Targeted Counseling: Strengthened recommendations for counseling pregnant smokers, adolescents, spit tobacco users, and light smokers (under 10 cigarettes/day), though medication is not advised for these groups.
Diverse Populations: The guideline emphasizes effectiveness across racial and ethnic minorities, individuals with limited education or finances, medical or psychiatric co-morbidities, and LGBT patients.
Policy Interventions: Healthcare policies covering tobacco dependence treatment, clinician training, and charting systems can significantly reduce barriers to access and improve quit rates.
* Motivational Strategies: New approaches are outlined to engage patients who are currently unwilling to quit.