Smoking treatment interventions and policies to promote their use: a critical review.

Despite evidence regarding the effectiveness and cost-effectiveness of smoking cessation treatments, the involvement of health care workers in providing advice and the use of treatment is limited. Barriers to treatment access have been suggested as part of the reason physicians do not routinely provide brief interventions and smokers do not use proven cessation methods. The purpose of this paper is to review tobacco treatments and policy research, and highlight where more research is warranted to develop more effective policies at the private and public levels. Special attention is devoted to the recently released Guidelines (Fiore et al., Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: USDHHS, 2000). We also consider the policy issues faced by private and public insurers, such as cost-effectiveness, the different forms that policies could take, and potential problems in implementing those policies. The efficacy of brief interventions and cessation treatments has been well studied. Less understood, however, is their impact in population-based investigations. In particular, more information is needed on the prevalence of their use and on how treatment use depends on prior smoking, treatment history, and demographic subgroup. Public and private health policies designed to increase access to cessation treatments and information dissemination through brief interventions by health care providers also have the potential to increase cessation. Further research on the impact of these interventions on use and quit rates, particularly over longer periods of time, and how these effects depend on the form of the intervention, is warranted.