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Evidence Base for Systems

Reducing the prevalence of tobacco use is an important national goal for improving public health. The dangers of tobacco use are well known and policies restricting tobacco use are widespread. But access to evidence-based treatment is still limited. To improve access, the Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence, Revised 2008 strongly emphasizes the role that health care policies, administrative procedures, and health care delivery systems can play in addressing tobacco use during every encounter in the health care system.


The 2008 PHS Clinical Practice Guideline (Revised 2008) Treating Tobacco Use and Dependence recommends five system-level strategies.

  • Systems Strategy 1: Implementing a tobacco user identification system in every clinic. 
  • Systems Strategy 2: Providing adequate training, resources, and feedback to ensure that providers consistently deliver effective treatments.
  • Systems Strategy 3: Dedicating staff to provide tobacco dependence treatment and assessing the delivery of this treatment in staff performance evaluations.  
  • Systems Strategy 4: Promoting hospital policies that support and provide tobacco dependence services.
  • Systems Strategy 5: Including tobacco dependence treatments (both counseling and medication) identified as effective in this Guideline as paid or covered services for all subscribers or members of health insurance packages.

A National Action Plan for Tobacco Cessation recommends that comprehensive cessation assistance be made available to all smokers who want to quit. Key evidence includes:

  • Effective tobacco dependence treatments now exist.
  • Such treatments more than double a smoker’s likelihood of achieving long-term abstinence.
  • Such treatments are highly cost-effective.
  • Effective counseling and medications for smoking cessation have been found to be among the most cost-effective healthcare practices.

Evidence-based policy interventions can dramatically reduce tobacco use by promoting smoking cessation. These include:

  • Reducing patient out of-pocket costs for effective treatments, especially through public and private insurance coverage with low or no-co pays.
  • Systems-level changes within healthcare delivery to enhance the identification of and Intervention with tobacco user.

CDC Best Practices for cessation include:

  • Proactive quitlines and quitlines integrated in healthcare.
  • Making health care systems changes recommended by the PHS Guideline (revised 2008).
  • Covering treatment for tobacco use under both public and private insurance, including individual, group, and telephone counseling and all FDA-approved medications.
  • Eliminating cost and other barriers to treatment for underserved populations, particularly the uninsured and populations disproportionately affected by tobacco.


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