Tobacco use screening and cessation

USPSTF2021Grade A

Ask all adults about tobacco use; advise quitting; offer behavioral interventions plus FDA-approved pharmacotherapy (NRT, bupropion SR, varenicline) for nonpregnant adults (Grade A). Pregnant persons: ask, advise, behavioral interventions (Grade A); evidence insufficient for pharmacotherapy in pregnancy and for e-cigarettes (Grade I).

ATS2020

For pharmacologic treatment, varenicline preferred over nicotine patch and over bupropion (strong). Start varenicline even in those not ready to quit rather than waiting (strong). Varenicline plus nicotine patch over varenicline alone (conditional). Use extended duration over 12 weeks over standard 6 to 12 weeks (strong).

VA/DoD2026Grade Strong for / Weak for

Offer FDA-approved pharmacotherapy (varenicline, NRT, bupropion SR) to all who smoke (strong for). Varenicline over other single agents, and combination NRT (patch plus short-acting) over single NRT (strong for). At least 4 counseling encounters over less intensive counseling (strong for). Not ready to quit: suggest NRT or varenicline to increase quit attempts. Suggests against e-cigarettes for cessation; varenicline or NRT to help stop vaping.