Tobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.

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Cet article des Editions Lavoisier est disponible en acces libre et gratuit sur sda.revuesonline.com SCIENCES DES ALIMENTS, 24(2004) 451-462 © Lavoisier -La photocopie non autorisée est un délit Les stratégies de santé publique autour de l'alcool

El consumo de productos del tabaco es causa de muchas enfermedades. La exposición al aire contaminado por humo de tabaco (ACHT) se considera también causante de varias enfermedades, incluso durante el embarazo. Sobre esta materia se han publicado al menos 14 informes, el primero de ellos aparecido en 1986. La mayoría proceden de los Estados Unidos de América (EEUU), el Reino Unido e Irlanda del Norte y Australia. No obstante, en el resto de Europa la cuestión no se ha descuidado. En Francia, por ejemplo, el Comité National Contre le Tabagisme 1 publicó un informe sobre este tema. Es importante señalar que algunas instituciones como el National Institute on Occupational Safety and Health (NIOSH) de EE.UU. o la California Environmental Protection Agency (Cal-EPA) incluyen al humo del tabaco entre los agentes canceríge