interventions—such as hypnosis, acupuncture, and financial incentives—have been assessed in a few studies, but there is insufficient information on their effectiveness in achieving long-term tobacco cessation.

DELIVERY OF INTERVENTIONS

An integral aspect of tobacco control is generating a desire and willingness in people to quit using tobacco. Motivation to quit may spring from encouragement from family and friends, increased awareness of the hazards of tobacco use because of public-education campaigns, in response to increased prices for tobacco products or restrictions to areas where they may be used, or advice from a healthcare provider. A comprehensive tobacco-control program ensures that many sources of encouragement and support are made available.

Individual interventions to promote tobacco-use cessation are effective and can help many people achieve and maintain abstinence, but if tobacco users are not aware of the treatments, cannot easily access them, cannot afford them, or do not use them when they are available, the effectiveness of the treatment is irrelevant. All of these barriers may prevent tobacco users from seeking or receiving treatment when they are motivated to quit. Inasmuch as most people who make a quit attempt relapse within 48 hours, removing barriers to treatment is paramount to maintaining abstinence. Provision of tobacco-cessation services can occur in many settings and formats. Health-care providers can inform patients about the health effects of tobacco use and counsel them about treatment options for quitting, patients can be referred to proactive or reactive telephone quitlines that provide cessation counseling and often medications, and patients can access computer-based cessation programs that offer counseling, support, and medications—although the evidence base on the latter is lacking. In this section, the committee considers the evidence base on those approaches for delivering tobacco-cessation services and the training needs of health-care professionals that provide them.

The committee finds that a combination of in-person and other forms of program-delivery formats are likely to be the most effective in reaching the largest audience. A number of tobacco-cessation programs are used by health-care organizations (see Box 4-1), but they have not all been evaluated formally for their effectiveness.



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