section on dual use in Chapter 5). The committee has insufficient evidence to make any recommendations with respect to the use of smokeless tobacco as an alternative to smoked tobacco. There is an evidence base that supports the use of nicotine-replacement therapies (NRTs) on an extended basis as a form of harm reduction if a person is trying to quit or has made a quit effort and is sustaining abstinence. The Public Health Service (PHS) Clinical Practice Guideline—Treating Tobacco Use and Dependence: 2008 Update (Fiore et al., 2008) indicates that prolonged use of NRTs (for more than 14 weeks) is effective in increasing abstinence.

In the sections below, the committee examines the evidence base on various tobacco-cessation interventions, including medications and behavioral therapies. It then identifies the most effective practices for providing those treatments to the targeted audiences.

Evidence-Based Interventions

Tobacco users today have access to a variety of evidence-based interventions that, if used appropriately, can significantly increase the likelihood that they will achieve long-term abstinence. There is abundant evidence on effective tobacco-cessation interventions, and numerous groups have provided detailed and consistent recommendations for individual-level interventions. For example, the 2008 PHS guideline (Fiore et al., 2008), the Task Force on Community Preventive Services Recommendations Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke (Hopkins, 2001), and the 2007 IOM report Ending the Tobacco Problem: A Blueprint for the Nation all conclude that the most effective way to achieve smoking cessation is to combine behavioral interventions that include person-to-person treatment with Food and Drug Administration (FDA)–approved pharmacologic treatments. Effective behavioral interventions include brief advice and assistance from a health-care provider during routine health-care visits, multisession outreach telephone counseling, and face-to-face group and individual counseling. Although all those interventions are effective, there is a dose–response relationship in behavioral treatments: multisession intensive treatments achieve significantly higher quit rates than minimal-contact interventions. The use of FDA-approved tobacco-cessation medications, alone or in conjunction with behavioral interventions, is effective in maintaining long-term abstinence.

Behavioral Interventions

Behavioral interventions focus on providing tobacco users with specific skills and supports to modify their tobacco use. Building from



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