AUG/SEP 2006
Volume 12 - No. 3
SRNT Newsletter
August/September 2006, Volume 12, Number 3
Updates Underway for the
US Public Health Service Clinical Practice
Guidelines: Treating Tobacco Use and Dependence
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Michael C. Fiore, MD, MPH, Professor of Medicine, University of Wisconsin School of Medicine and Public Health, & Director of the UW Center for Tobacco Research and Intervention |
The current guideline, published in 2000, is an extremely important link between research and medical practice. It is also the most widely used and distributed guideline ever released by the US Public Health Service, with over five million copies and related products distributed. Since the 2000 edition, the guideline has been recognized as the standard of care for treating tobacco use in the United States. It has also given rise to a number of additional aids, including an online continuing medical education program and a quick reference guide. The updated 2008 edition will be the third guideline (the first two were published in 1996 and 2000) and will focus on topics for which there is new research.
"We want the information at clinicians' fingertips to be as current as possible," said UW-CTRI's Michael Fiore, Panel Chair for the update. "The scope and focus of tobacco dependence treatment research have changed significantly, and we want the updated guide to accurately reflect all that is new and effective."
The task of reviewing all available scientific data on tobacco dependence is an arduous one. The previous update, conducted between 1998 and 2000, evaluated over 6,000 articles researching tobacco treatments. This effort will be an update, focusing on topic areas where there is a significant change in the evidence.
Since the publication of the last update in 2000, there has been a dramatic increase in our knowledge about tobacco cessation counseling and treatment, including newer counseling approaches such as quitlines and subpopulations such as pregnant women, older smokers and minorities, to name a few. The FDA has also approved two new pharmacotherapies and at least two more are undergoing testing. These events represent a significant advancement in combating tobacco dependence and are sure to be given consideration in the 2008-updated guideline.
The process began in July with topics solicited for consideration from the tobacco dependence community. These submissions, as well as those identified in the previous guideline as promising, will then be screened and narrowed to up to ten topics worthy of update – based on new research. Although the focus of the update project is topics not dealt with in previous editions,
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The panel represents a wide variety of constituencies including clinicians, academics, dentists, nurses, and public health professionals. Additional members have been added to represent previously under-represented areas such as adolescent smoking cessation. The guideline update will be funded by several organizations including the Agency for Health Research and Quality, the National Cancer Institute, the American Legacy Foundation, the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, the National Institute on Drug Abuse, the National Heart, Lung, and Blood Institute, and the University of Wisconsin Center for Tobacco Research and Intervention.
As we know, 70 percent of smokers visit a primary care clinician each year. The guideline update will increase the likelihood that those encounters end with smokers receiving evidence based cessation treatments. According to the American Journal of Preventive Medicine, evidence-based interventions have been increasing every year. For example, an August 2005 study shows that 90 percent of smokers were asked about smoking during their appointment, and 71 percent were asked to quit by their clinician. The other components of the 5 A's intervention (assess, assist and arrange) were less often employed.
"A visit to a clinician is one of the best opportunities to intervene," Fiore said. "We hope that once the update is completed, healthcare providers will have even more tools at their disposal to effectively intervene with their patients who smoke."
About the Author: Bruce Christiansen, Ph.D., is the project manager for updating the Guideline. In addition to his work on the Guideline update, his more general interests include individual and population-wide behavioral change strategies. He can be reached at bc1@ctri.medicine.wisc.edu .