Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons

Abstract

IMPORTANCE Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2014, it was estimated that 480 000 deaths annually are attributed to cigarette smoking, including second hand smoke exposure. Smoking during pregnancy can increase the risk of numerous adverse pregnancy outcomes (eg, miscarriage and congenital anomalies) and complications in the offspring (including sudden infant death syndrome and impaired lung function in childhood). In 2019, an estimated 50.6 million US adults (20.8% of the adult population) used tobacco; 14.0% of the US adult population currently smoked cigarettes and 4.5% of the adult population used electronic cigarettes (e-cigarettes). Among pregnant US women who gave birth in 2016, 7.2% reported smoking cigarettes while pregnant.OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a review to evaluate the benefits and harms of primary care interventions on tobacco use cessation in adults, including pregnant persons.POPULATION This recommendation statement applies to adults 18 years or older, including pregnant persons. EVIDENCE ASSESSMENTThe USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated (FDA)-approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial. The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence. RECOMMENDATIONSThe USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (A recommendation) The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. (A recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of e-cigarettes for tobacco cessation in adults, including pregnant ...

Balancing Consideration of the Risks and Benefits of E-Cigarettes

“…57 However, the US Preventive Services Task Force's smoking cessation practice guideline did not find the evidence convincing. 58…”

Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review

“…In Western countries, the prevalence of maternal tobacco smoking during pregnancy is estimated to be 8%, including around three-quarters of daily smokers, and with a high heterogeneity between countries [ 1 ]. Hence, despite an overall decrease in trends in tobacco smoking [ 2 ], the prevalence of tobacco use remains elevated in women in the general population (e.g., 30% in France, 25% in Germany, 16% in the United Kingdom, or 15% in the United States of America) [ 3 ] and in pregnant women (e.g., 16% in France, 9% in Germany, 12% in the United Kingdom, or 7% in the United States of America) [ 4 , 5 , 6 ]. According to a nation-wide study conducted in a representative population of women giving birth in France in 2016 [ 7 ], among women who smoked before pregnancy, 46% managed to quit during pregnancy and 45% reduced their consumption of tobacco.…”

Incorporating Post-Cessation Weight-Control Coaching into Smoking Cessation Therapy to Reduce Type 2 Diabetes Risk

“…The FIT2 program was a 16-week program that combined pharmacotherapy for smoking cessation with individualized counseling focused on both smoking cessation and weight-control techniques. Behavioral counseling in tobacco cessation techniques were delivered to every FIT2 participant involving one session per week [ 18 ]. The pharmacotherapy in the FIT2 program was a 16-week varenicline course, which conforms to real-practice government regulations in Taiwan.…”