Clinician Summary

Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Interventions

January 19, 2021

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Panel 1
What does the USPSTF recommend? Nonpregnant adults:
  • Ask about tobacco use
  • Provide behavioral interventions and pharmacotherapy for cessation to those who use tobacco
Grade A
Pregnant persons:
  • Ask about tobacco use
  • Provide behavioral interventions for cessation to those who use tobacco
Grade A
Pregnant persons who use tobacco:
  • The evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy for tobacco cessation
I statement
Adults and pregnant persons who use tobacco:
  • The evidence is insufficient to assess the balance of benefits and harms of using e-cigarettes for tobacco cessation. Clinicians should direct patients to other cessation interventions with proven effectiveness and established safety
I statement
To whom does this recommendation apply? Adults 18 years or older, including pregnant persons.
What’s new? This recommendation is consistent with the 2015 USPSTF recommendation. This recommendation incorporates newer evidence and language in the field of tobacco cessation, including new evidence on the harms of e-cigarettes (ie, vaping).  
How to implement this recommendation?
    1. Ask all adults, including pregnant persons, about tobacco use, using methods such as:
      • “5 A’s”: Ask, Advise, Assess, Assist, Arrange follow-up
      • “Ask, Advise, Refer”
      • “Vital Sign”: Treat smoking status as a vital sign
    2. Provide cessation interventions to persons who use tobacco
      • For nonpregnant adults who use tobacco, provide behavioral counseling and pharmacotherapy for cessation
      • Effective behavioral counseling interventions include physician advice, nurse advice, individual counseling, group behavioral interventions, telephone counseling, and mobile phone–based interventions
      • FDA-approved pharmacotherapy for cessation includes nicotine replacement therapy, bupropion sustained-release, and varenicline
      • Combined behavioral counseling and pharmacotherapy includes at least 4 or more behavioral counseling sessions with 90 to 300 minutes of total contact time
      • For pregnant persons who use tobacco, provide behavioral counseling for cessation
        • Effective behavioral counseling includes cognitive behavioral, motivational, and supportive therapies such as counseling, health education, feedback, financial incentives, and social support
What are other relevant USPSTF recommendations? The USPSTF has made a recommendation on Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents. This recommendation is available at www.uspreventiveservicestaskforce.org.
Where to read the full recommendation statement? Visit the USPSTF Web site to read the full recommendation statement. This includes more details on the rationale of the recommendation, including benefits and harms, supporting evidence, and recommendations of others.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation.

 Abbreviation: FDA=US Food and Drug Administration.