Treating tobacco use in clinical practice

Tobacco use is the leading cause of preventable death, yet cigarette-smoking rates in the USA have stagnated just below 20 %. With the signing of the Affordable Care Act came increased coverage for evidence-based tobacco cessation treatment, providing a wide range of effective cessation options that can now be offered to all tobacco-using patients, especially cigarette smokers. Health-care providers should be familiar with pharmacotherapy recommendations and counseling strategies for smoking patients at all stages of quitting. We discuss practical cessation approaches for patients ready to quit, unwilling to quit right away, and those who have recently quit. Certain groups, especially tobacco users with comorbid medical and/or psychiatric conditions, remain high tobacco burden populations that have not demonstrated declining rates of tobacco use as have been observed in the general population. Despite their higher tobacco burden status, treatments are effective for these populations and are especially important to include in their routine medical care. We end with a discussion of the emerging issues relevant for cessation treatment, including the increasing use of other tobacco and smoking products (such as e-cigarettes, hookah, and chewing tobacco) and their impact on smoking cessation efforts and the Affordable Care Act, keeping in mind that the exact parameters have not yet been set.