counseling, might be effective, but more study is needed (Carr and Ebbert, 2006; Ebbert et al., 2007a; Klesges et al., 2006). The 2008 PHS guideline also indicates that counseling is effective for smokeless-tobacco cessation, although the evidence for cessation medications is insufficient (Fiore et al., 2008). A review of behavioral and pharmacologic interventions for smokeless-tobacco use found similar results (Severson, 2003). Cessation counseling during a dental visit was more effective in increasing 12-month abstinence than group support sessions in a tobacco-cessation clinic or self-help materials with brief counseling. The use of NRT gum, NRT patch, or bupropion did not improve cessation in smokeless-tobacco users.

Hospitalized Tobacco Users

Several studies of tobacco cessation in hospitalized smokers are included in the above discussion of tobacco users with comorbidities (Barth et al., 2008; Prochaska et al., 2004b; Sundblad et al., 2008). In addition, a Cochrane review assessed smoking-cessation treatments for hospitalized patients (Rigotti et al., 2007). Hospitalized tobacco users benefit from tobacco-cessation treatments, particularly intensive cognitive-behavioral therapy combined with NRT (Simon et al., 2003). Smokers who received a multicomponent cessation intervention consisting of face-to-face in-hospital counseling, a videotape, self-help literature, NRT, and 3 months of telephone follow-up after noncardiac surgery had higher biochemically confirmed abstinence rates at 12 months than those who received only self-help literature and brief counseling (relative risk, 2.0; p = 0.04) (Simon et al., 1997). A meta-analysis of treatment of hospitalized patients shows that intensive therapy begun in the hospital and continuing with at least 1 month of follow-up after discharge appears to result in the best cessation rate; the addition of cessation medications does not increase the rate (Rigotti et al., 2007).

Other Tobacco Users

The 2008 PHS guideline assesses tobacco cessation in several special populations, including those with low socioeconomic status (SES) and little formal education, older smokers, and racial and ethnic minorities (Fiore et al., 2008). There is a paucity of studies on the effectiveness of tobacco-cessation treatments in each of those populations. Tobacco users with low SES and little formal education benefit from the use of nicotine patches in combination with counseling, including proactive telephone counseling and motivational messages with or without telephone counseling (Fiore et al. 2008). Older smokers



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