What Works to Boost Tobacco Cessation?

Are you looking for evidence-based programs and policies to support tobacco cessation? If so, consider three recently released Community Preventive Services Task Force (Task Force) recommendations:

• The Task Force recommends quitline interventions, particularly proactive quitlines (i.e., those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting. Three interventions effective at increasing use of quitlines are:
  1. Mass-reach health communications that combine cessation messages with the quitline phone number
  2. Free evidence-based cessation medications for those who want to quit
  3. Quitline referral interventions for health care systems and providers.

The economic evidence indicates that quitline services are cost-effective across a range of different treatments and promotional approaches.

• The Task Force recommends policies and programs to reduce tobacco users’ out-of-pocket costs for evidence-based cessation treatments based on strong evidence of effectiveness in increasing the number of tobacco users who quit. The economic evidence indicates that interventions to reduce out-of-pocket costs for evidence-based cessation treatments are cost-effective and may provide net savings to the implementer.
• The Task Force recommends mass-reach health communication interventions based on strong evidence of effectiveness in:
  1. Decreasing the prevalence of tobacco use
  2. Increasing cessation and use of available services such as quitlines
  3. Decreasing initiation of tobacco use among young people.

The economic evidence shows mass-reach health communication interventions are cost-effective, and savings from averted healthcare costs exceed intervention costs.

The recommendations are based on systematic reviews of the scientific literature conducted with oversight from the Task Force by scientists and subject matter experts from the Centers for Disease Control and Prevention (CDC) in collaboration with a wide range of government, academic, policy, and practice-based partners. Peer-reviewed articles of the systematic reviews are not yet published; however you can find summaries and supporting materials at www.thecommunityguide.org.

What are quitlines, reducing out-of-pocket costs, and mass reach?

• Quitlines use the telephone to provide evidence-based behavioral counseling and support to help tobacco users who want to quit. Counseling is provided by trained cessation specialists who follow standardized protocols that may include several sessions delivered over one or more months.
• Reducing tobacco users’ out-of-pocket costs involves policy or program changes that make evidence-based treatments, including counseling and medication, more affordable. Optimal insurance coverage for tobacco cessation is comprehensive, covering all evidence-based cessation treatments, including counseling and both over-the-counter and prescription medications. It also eliminates or minimizes barriers to accessing these treatments such as copayments, coinsurance, deductibles, or annual or lifetime dollar limits. To achieve this, new benefits may be provided or changes may be made to the level of benefits offered. It is important that these cessation benefits be communicated to tobacco users and health care providers to increase awareness, interest in quitting, and use of evidence-based treatments.
• Mass-reach health communication interventions target large audiences through television and radio broadcasts, print media (e.g., newspaper), out-of-home placements (e.g., billboards, movie theaters, point-of-sale), and digital media to change knowledge, beliefs, attitudes, and behaviors affecting tobacco use. Messages are typically developed through formative testing and aim to reduce initiation of tobacco use among young people, increase quit efforts by tobacco users of all ages, and inform individual and public attitudes on tobacco use and secondhand smoke.

Why are the Task Force recommendations important?

• Tobacco use is the largest preventable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million live with a serious illness caused by smoking (CDC, 2009).
• Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers (U.S. Department of Health and Human Services, 2004; 2006; National Cancer Institute, 1998).
• Secondhand smoke exposure causes serious disease and death, including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. An estimated 88 million nonsmoking Americans, including 54% of children aged 3 11 years, are exposed to secondhand smoke (World Health Organization, 2007).
• Coupled with the enormous health toll is the significant economic burden of tobacco use more than $96 billion a year in medical costs and another $97 billion a year from lost productivity (CDC, 2009).

What are the Task Force and The Community Guide?

• The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, uncompensated panel of public health and prevention experts. The Task Force works to improve the health of all Americans by providing evidence-based recommendations about community preventive programs, services, and policies to improve health. Its members represent a broad range of research, practice, and policy expertise in community prevention services, public health, health promotion, and disease prevention.
• The Guide to Community Preventive Services (The Community Guide) is a website that is a collection of all the evidence-based findings and recommendations of the Community Preventive Services Task Force.

For More Information

• The Community Guide
  • Reducing Tobacco Use and Secondhand Smoke Exposure
  • What Works Fact Sheet: Tobacco Use [PDF – 765 KB]
• CDC, Office on Smoking and Health
• Best Practices for Comprehensive Tobacco Control Programs
• A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update (Public Health Service sponsored)
• Surgeon General’s Reports on Smoking and Health
• National Cancer Institute Smoking and Tobacco Control Monographs

References

CDC. State-specific smoking-attributable mortality and years of potential life lost United States, 2000 2004. MMWR 2009;58(2):29-33.

National Cancer Institute. Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9. Bethesda (MD): U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1998.

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

World Health Organization. Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines. International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 89. Lyon, (France): World Health Organization, International Agency for Research on Cancer, 2007. Available at URL: http://monographs.iarc.fr/ENG/Monographs/vol89/mono89.pdf.