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Level I – Tobacco Use Screening and Brief Intervention

Level I Services: Preventive services for which clinicians and health systems must assess the need. These services must be recommended to each patient, as they have the highest value and are worthy of attention at every opportunity.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.”
  2. “The USPSTF recommends that clinicians ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling for those who smoke.”
(USPSTF Last Revised 2009 – Update in Progress)
Grade of Recommendation:
  1. A
  2. A

Level of Certainty:

  1. High
  2. High
“Benefits:
In non-pregnant adults, the USPSTF found convincing evidence that smoking cessation interventions, including brief behavioral counseling sessions (< 10 minutes) and pharmacotherapy delivered in primary care settings, are effective in increasing the proportion of smokers who successfully quit and remain abstinent for one year. Although less effective than longer interventions, even minimal interventions (< 3 minutes) have been found to increase quit rates. Go to the Clinical Considerations section for a discussion of complementary services to which primary care clinicians may refer patients.
The USPSTF found convincing evidence that smoking cessation decreases the risk for heart disease, stroke and lung disease.
In pregnant women, the USPSTF found convincing evidence that smoking cessation-counseling sessions, augmented with messages and self-help materials tailored for pregnant smokers, increases abstinence rates during pregnancy compared with brief, generic counseling interventions alone. Tobacco cessation at any point during pregnancy yields substantial health benefits for the expectant mother and baby. The USPSTF found inadequate evidence to evaluate the safety or efficacy of pharmacotherapy during pregnancy.
Harms:
Finding no published studies that describe harms of counseling to prevent tobacco use in adults or pregnant women, the USPSTF judged the magnitude of these harms to be no greater than small. Harms of pharmacotherapy are dependent on the specific medication used. In non-pregnant adults, the USPSTF judged these harms to be small.
Benefits-Harms Assessment:
The USPSTF concludes that there is high certainty that the net benefit of tobacco cessation interventions in adults is substantial.
The USPSTF also concludes that there is high certainty that the net benefit of augmented, pregnancy-tailored counseling in pregnant women is substantial.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/uspstf09/tobacco/tobaccors2.htm
ICSI Supplemental Information:
For additional resources refer to Call it Quits Minnesota