The World Health Organization (WHO) has published a clinical treatment guideline for tobacco cessation in adults to provide technical guidance on tobacco cessation in adults. The guideline aims to support the use of evidence-based behavioural interventions and pharmacological treatments for tobacco cessation as part of a comprehensive tobacco control approach. The guideline was developed following WHO processes and methods, with oversight from the WHO Guidelines Review Committee.
Tobacco Use: A Global Health Threat
Tobacco use is a significant global public health concern, resulting in over 8 million deaths annually. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides recommendations for countries to reduce the harms caused by tobacco. Article 14 of the WHO FCTC highlights the importance of supporting tobacco users to quit. More than 60% of the world’s 1.25 billion adult tobacco users desire to quit, but many lack access to comprehensive cessation services. This guideline aims to address this gap and provide guidance for supporting adult tobacco users in quitting various tobacco products, including cigarettes, waterpipe tobacco, and smokeless tobacco products.
Guideline Development and Target Audience
Developed through a rigorous process involving a Steering Group (SG), Guideline Development Group (GDG), and External Review Group (ERG), the guideline relies on evidence from existing and newly commissioned systematic reviews. The primary audience for this guideline includes healthcare providers in clinical and community settings, as well as policymakers and health service managers.
Key Recommendations
The guideline presents strong recommendations for several interventions:
- Brief Advice: Healthcare providers should consistently provide brief advice (30 seconds to 3 minutes) to all tobacco users accessing any healthcare setting.
- Intensive Behavioural Support: More intensive behavioural support should be offered to all tobacco users interested in quitting. This can include individual face-to-face counselling, group counselling, or telephone counselling.
- Pharmacotherapy: The guideline strongly recommends combining pharmacotherapy and behavioural interventions for tobacco users interested in quitting. Recommended first-line medications include nicotine replacement therapy (NRT), bupropion, and varenicline.
- Smokeless Tobacco Cessation: For smokeless tobacco users, behavioural counselling and pharmacological interventions, specifically NRT and varenicline, are recommended.
- System-Level Interventions: The guideline advocates for system-level interventions and policies to facilitate tobacco cessation, including:
- Including tobacco use status and cessation interventions in medical records.
- Training all healthcare providers on delivering evidence-based cessation interventions.
- Providing tobacco cessation interventions at no or reduced cost.
Implementation Considerations
The guideline emphasises the importance of a multifaceted approach to guideline implementation, including promoting awareness among healthcare providers and tobacco users, integrating cessation support into existing healthcare systems, and ensuring cost coverage for cessation interventions. The guideline acknowledges the need to tailor interventions to specific populations and settings, including considering the needs of vulnerable groups. Continuous monitoring and evaluation are crucial to assess the guideline’s impact and identify areas for improvement.
Research Needs
Recognising the need for continuous improvement, the guideline highlights areas for future research:
- Investigating strategies to encourage more quit attempts.
- Identifying effective strategies to prioritise tobacco cessation in policy.
- Assessing the effectiveness of community health worker-delivered tobacco cessation interventions.
- Researching smartphone apps, AI-based interventions, and internet-based interventions for tobacco cessation.
- Examining effective strategies to increase medication use and explore different dosing and durations.
- Quantifying nicotine concentrations in different tobacco products and exploring cessation strategies for adolescents, pregnant individuals, and e-cigarette users.
The guideline concludes by emphasising the importance of dissemination, implementation, and evaluation to ensure its widespread adoption and effectiveness in reducing the global burden of tobacco use.
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