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U.S. Preventive Services Task Force

Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women

Clinical Summary of U.S. Preventive Services Task Force Recommendation

This document is a summary of the 2009 recommendation of the U.S. Preventive Services Task Force (USPSTF) on counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women. This summary is intended for use by primary care clinicians.

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Population Adults Age ≥18 Years Pregnant Women of Any Age
Recommendation Ask about tobacco use.
Provide tobacco cessation interventions to those who use tobacco products.
Ask about tobacco use.
Provide augmented pregnancy-tailored counseling for women who smoke.
Grade: A Grade: A

The "5-A" framework provides a useful counseling strategy:

  1. Ask about tobacco use.
  2. Advise to quit through clear personalized messages.
  3. Assess willingness to quit.
  4. Assist to quit.
  5. Arrange follow-up and support.

Intensity of counseling matters: brief one-time counseling works; however, longer sessions or multiple sessions are more effective.

Telephone counseling "quit lines" also improve cessation rates.


Combination therapy with counseling and medications is more effective than either component alone. FDA-approved pharmacotherapy includes nicotine replacement therapy, sustained-release bupropion, and varenicline.

The USPSTF found inadequate evidence to evaluate the safety or efficacy of pharmacotherapy during pregnancy.


Successful implementation strategies for primary care practice include:

  • Instituting a tobacco user identification system.
  • Promoting clinician intervention through education, resources, and feedback.
  • Dedicating staff to provide treatment, and assessing the delivery of treatment in staff performance evaluations.
Relevant Recommendations from the USPSTF

Recommendations on other behavioral counseling topics are available at http://www.uspreventiveservicestaskforce.org.

Note: FDA = U.S. Food and Drug Administration; USPSTF = U.S. Preventive Services Task Force.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Copyright and Source Information

This document is in the public domain within the United States.

Requests for linking or to incorporate content in electronic resources should be sent via the USPSTF contact form.

AHRQ Publication No. 09-05131-EF-2
Current as of April 2009

Internet Citation:

U.S. Preventive Services Task Force. Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women: Clinical Summary. AHRQ Publication No. 09-05131-EF-2, April 2009. http://www.uspreventiveservicestaskforce.org/uspstf09/tobacco/tobaccosum2.htm


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