Boosting population quits through evidence-based cessation treatment and policy

Abstract

Only large increases in adult cessation will rapidly reduce population smoking prevalence. Evidence-based smoking-cessation treatments and treatment policies exist but are underutilized. More needs to be done to coordinate the widespread, efficient dissemination and implementation of effective treatments and policies. This paper is the first in a series of three to demonstrate the impact of an integrated, comprehensive systems approach to cessation treatment and policy. This paper provides an analytic framework and selected literature review that guide the two subsequent computer simulation modeling papers to show how critical leverage points may have an impact on reductions in smoking prevalence. Evidence is reviewed from the U.S. Public Health Service 2008 clinical practice guideline and other sources regarding the impact of five cessation treatment policies on quit attempts, use of evidence-based treatment, and quit rates. Cessation treatment policies would: (1) expand cessation treatment coverage and provider reimbursement; (2) mandate adequate funding for the use and promotion of evidence-based state-sponsored telephone quitlines; (3) support healthcare systems changes to prompt, guide, and incentivize tobacco treatment; (4) support and promote evidence-based treatment via the Internet; and (5) improve individually tailored, stepped-care approaches and the long-term effectiveness of evidence-based treatments. This series of papers provides an analytic framework to inform heuristic simulation models in order to take a new look at ways to markedly increase population smoking cessation by implementing a defined set of treatments and treatment-related policies with the potential to improve motivation to quit, evidence-based treatment use, and long-term effectiveness.

Figure 1. Impact of treatment-related policies on various components of the population

^aTx Use is the proportion of smokers using each category of treatment in their quit attempt. ^bTx Eff is the percentage of those using a given treatment modality that can be expected to have quit successfully at 12 months. ^cPQR is the proportion of the population that is expected to have successfully quit at the end of 1 year, computed from the proportion of smokers making a quit attempt and the expected effectiveness rate for each form of treatment used. BT, behavioral treatment; E-B Tx, evidence-based treatment; PT, pharmacologic treatment; Tx, treatment