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Cited by 512Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force, Krist, Alex H., Davidson, Karina W., Mangione, Carol M., Barry, Michael J., Cabana, Michael, Caughey, Aaron B., Donahue, Katrina +9 more·2021·JAMA
DOI 10.1001/jama.2020.25019
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Abstract

IMPORTANCE: Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2014, it was estimated that 480 000 deaths annually are attributed to cigarette smoking, including second hand smoke exposure. Smoking during pregnancy can increase the risk of numerous adverse pregnancy outcomes (eg, miscarriage and congenital anomalies) and complications in the offspring (including sudden infant death syndrome and impaired lung function in childhood). In 2019, an estimated 50.6 million US adults (20.8% of the adult population) used tobacco; 14.0% of the US adult population currently smoked cigarettes and 4.5% of the adult population used electronic cigarettes (e-cigarettes). Among pregnant US women who gave birth in 2016, 7.2% reported smoking cigarettes while pregnant. OBJECTIVE: To update its 2015 recommendation, the USPSTF commissioned a review to evaluate the benefits and harms of primary care interventions on tobacco use cessation in adults, including pregnant persons. POPULATION: This recommendation statement applies to adults 18 years or older, including pregnant persons. EVIDENCE ASSESSMENT: The USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated (FDA)-approved pharmacotherapy for tobacco smoking 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 smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence. RECOMMENDATIONS: The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (A recommendation) The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. (A recommendation) 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 persons. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of e-cigarettes for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety. (I statement).

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Authors
US Preventive Services Task Force, Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Donahue, K., Doubeni, C. A., Epling, J. W., Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B.
Affiliations
  • Virginia Commonwealth University (US)
  • Northwell Health (US)
  • Harvard University (US)
  • Oregon Health & Science University (US)
  • University of North Carolina at Chapel Hill (US)
  • Mayo Clinic (US)
  • George Mason University (US)
  • University of Massachusetts Chan Medical School (US)
  • Boston University (US)
  • Northwestern University (US)
  • University of Hawaiʻi at Mānoa (US)
  • Tufts University (US)
Corresponding author
Krist, Alex H.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2021-01-19
Volume
325
Issue
3
Pages
265
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2020.25019
OpenAlex
W3126088119
Cited by
512
References
94
Citations by year
2026: 79 · 2025: 91 · 2024: 102 · 2023: 91 · 2022: 88 · 2021: 60 · 2012: 1
FWCI
54.12
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
tobacco smoking cessation, pregnant persons, behavioral interventions, pharmacotherapy, electronic cigarettes, perinatal outcomes, passive smoking, primary care, smoking during pregnancy, smoking cessation counseling, smoking abstinence, adverse pregnancy outcomes, sudden infant death syndrome, congenital malformations, tobacco use screening, nicotine replacement therapy
MeSH terms
Smoking Cessation Agents, Adult, Behavior Therapy, Combined Modality Therapy, Female, Humans, Male, Pregnancy, Primary Health Care, Tobacco Use Disorder, Smoking Cessation, Tobacco Use Cessation, Tobacco Use Cessation Devices, Electronic Nicotine Delivery Systems

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