Skip to main content Skip to left navigation Skip to footer
U.S. Department of Health and Human Services
Skip Left Navigation

Browse by Topic

Tobacco Smoking Cessation in Adults and Pregnant Women, Behavioral and Pharmacotherapy Interventions, 2015

* Indicates an old grade definition


Recommendations: Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults and Pregnant Women

  • Tobacco Smoking Cessation:Behavioral Interventions -- Pregnant Women
    Grade: A
    Specific Recommendations:

      The USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco.


  • Tobacco Smoking Cessation: Behavioral and Pharmacotherapy Interventions -- Adults who are not pregnant
    Grade: A
    Specific Recommendations:
      The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco.
  • Tobacco Smoking Cessation: Pharmacotherapy Interventions -- Pregnant Women
    Grade: I
    Specific Recommendations:

      The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women.


  • Tobacco Smoking Cessation: Electronic Nicotine Delivery systems (ENDS) -- All adults, including pregnant women
    Grade: I
    Specific Recommendations:
      The USPSTF concludes that the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) for tobacco cessation in adults, including pregnant women. The USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety (previously stated).
  • Rationale:

    Importance

    Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Cigarette smoking results in more than 480,000 premature deaths each year and accounts for approximately 1 in every 5 deaths.1 In pregnant women, smoking increases the risk for congenital anomalies; perinatal complications, such as preterm birth, fetal growth restriction, and placental abruption; miscarriage and stillbirth; and neonatal or pediatric complications, such as sudden infant death syndrome and impaired lung function in childhood.1-4 An estimated 42.1 million U.S. adults (nearly 18% of the population) currently smoke.5

    Recognition of Behavior

    The benefits of assessing patients’ smoking behavior are well-established. Common approaches for clinicians include recording a patient’s smoking status as a vital sign or using the 5 A’s: 1) Ask about smoking; 2) Advise to quit through clear, personalized messages; 3) Assess willingness to quit; 4) Assist in quitting; and 5) Arrange follow-up and support. Another approach is “Ask, Advise, Refer,” which encourages clinicians to ask patients about tobacco use, advise them to quit, and refer them to telephone quit lines and/or other evidence-based cessation interventions.

    Benefits of Interventions

    Nonpregnant Adults

    The USPSTF found convincing evidence that behavioral interventions (including in-person behavioral support and counseling, telephone counseling, and self-help materials) alone or combined with pharmacotherapy substantially improve achievement of tobacco cessation in nonpregnant adults who smoke. The USPSTF found convincing evidence that pharmacotherapy interventions, including nicotine replacement therapy (NRT), bupropion hydrochloride sustained-release (buproprion SR), and varenicline—with or without behavioral counseling interventions—substantially improve achievement of tobacco cessation in nonpregnant adults who smoke. The USPSTF also found convincing evidence that using 2 types of NRT moderately improves achievement of tobacco smoking cessation over using 1 type and that addition of NRT to treatment with bupropion SR provides additional benefit over use of bupropion SR alone. The USPSTF found inadequate evidence to determine the effect of ENDS on achievement of tobacco smoking cessation.

    Pregnant Women

    The USPSTF found convincing evidence that behavioral interventions substantially improve achievement of tobacco smoking abstinence in pregnant women, increase infant birthweight, and reduce risk for preterm birth. The USPSTF found inadequate evidence on the benefits of NRT and no evidence on the benefits of bupropion SR, varenicline, or ENDS to achieve tobacco cessation in pregnant women who smoke or to improve perinatal outcomes in infants.

    Harms of Interventions

    Nonpregnant Adults

    The USPSTF determined that there is adequate evidence to bound the magnitude of harms of behavioral interventions for tobacco cessation in nonpregnant adults who smoke as small to none. The USPSTF found adequate evidence that the harms of NRT, bupropion SR, or varenicline for tobacco cessation in adults who smoke are small. The USPSTF found inadequate evidence to determine the harms of ENDS.

    Pregnant Women

    The USPSTF determined that there is adequate evidence to bound the magnitude of harms of behavioral interventions for tobacco cessation in pregnant women who smoke as small to none. The USPSTF found inadequate evidence on the harms of NRT and no evidence on the harms of bupropion SR, varenicline, or ENDS for tobacco cessation in pregnant women who smoke.

    USPSTF Assessment

    The USPSTF concludes with high certainty that the net benefit of behavioral interventions and FDA-approved pharmacotherapy for tobacco cessation, alone or combined, in nonpregnant adults who smoke is substantial.The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco cessation on perinatal outcomes and smoking abstinence in pregnant women who smoke is substantial.The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco cessation in pregnant women is insufficient because of a lack of studies, and the balance of benefits and harms cannot be determined.The USPSTF concludes that the evidence on the use of ENDS for tobacco smoking cessation in adults, including pregnant women, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized, controlled trials (RCTs) on ENDS that report smoking abstinence or adverse events as a critical gap in the evidence.

Agency for Healthcare Research and Quality - Advancing Excellence in Health Care
AHRQ ePSS

You are now leaving ePSS Electronic Preventive Services Selector website and going to
This website contains links to other federal and state agencies and private organizations. The Agency for Healthcare Research and Quality (AHRQ) cannot attest to the accuracy of information provided by these nonfederal website links. Linking to nonfederal sites does not constitute an endorsement by AHRQ or any of its employees of the sponsors or the information and products presented on the sites. You will be subject to the destination site's privacy policy when you leave the AHRQ website. Thank you for visiting epss.ahrq.gov.

Continue Cancel