Prevention Matters

Yesterday, the U.S. Navy announced a change in policy – smoking will be banned aboard all submarines. Obviously, prohibiting smoking in such confined spaces makes sense. The question for me was “Why did it take so long?” One can reason that both smoking and non-smoking sailors would be exposed to unacceptable levels of secondhand smoke. Although prior Surgeons General and tobacco control advocates have presented evidence of the health consequences of second-hand smoke, it wasn’t until a 2009 study by the Naval Submarine Medical Research Laboratory confirmed risk to nonsmoking submariners that a policy change was successful.

Accompanying the smoking ban will be tobacco cessation education and access to nicotine replacement therapy products. Kudos to the Navy for recognizing that forcing submarine sailors to go “cold turkey” would not be a smart move. Hopefully, the cessation programs will be expanded to adhere to the Public Health Service Guidelines’ comprehensive mix of counseling and medications.

Diane M. Canova
Vice President, Policy & Programs

A number of new tools have been added to The US Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence since it was released in June 2008. At the same time, some additional guideline-related information is now available online. As with all guideline materials and information, they are in the public domain and can be used without obtaining permission from the US PHS. These new materials and tools include:

1) A 20-page “quick reference guide” for clinicians that summarizes key guideline findings in a short, easy-to-use guide.

2) A PowerPoint presentation containing every data table and recommendation in the 2008 guideline to aid policymakers, researchers and others who may need this information for presentations.

3) A 30-40 minute PowerPoint presentation that summarizes key findings in the 2008 guideline for people who wish to give a presentation on the guideline.

4) A tool for health systems that are interested in incorporating the guideline recommendations into clinical practice, summarizing key strategies and opportunities.

5) An updated poster for clinician offices.

6) A new Guideline addition and corrections section. This new section now provides clinicians with a link to the recent update by the FDA on the use of bupropion and varenicline and a correction to Table 6.22 from page 102.

These new tools and other materials, including the full Guideline and references, are available online at: http://www.ahrq.gov/path/tobacco.htm#Clinic  and http://www.surgeongeneral.gov/tobacco/. While all of the materials are on the AHRQ website, some of these materials are still being added to the Surgeon General’s website.

Additionally, a free, one-hour CME program sponsored by the University of Wisconsin School of Medicine and Public Health on treating tobacco dependence has been updated based on the 2008 guideline. The program is currently accredited for physicians (up to Category 1 CME credit), nurses (one ANCC contact hour), and pharmacists (one ACPE contact hour). The CME program is available on Medscape at http://cme.medscape.com/viewprogram/17710 .

Finally, the Guideline panel wants to alert you to two recent publications. First, the U.S. Preventive Services Task Force recently reaffirmed its recommendation that using evidence-based cessation interventions in adults and pregnant women can lead many to quit using tobacco products and improve their health. The Task Force’s recommendations were published in the April 21, 2009 issue of the Annals of Internal Medicine and are available on the AHRQ Web site at http://www.preventiveservices.ahrq.gov/. Second, John Hughes has recently published an article in Addiction that describes the high rate of concordance between two independent entities that have examined the smoking cessation literature: the 2008 PHS Guideline and relevant Cochrane Collaboration analyses (Hughes JR. "How confident should we be that smoking cessation treatments work?" Addiction 2009; published online August 4, 2009 (http://www3.interscience.wiley.com/cgi-bin/fulltext/122538766/HTMLSTART  ).