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I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click here

Physicians now have a variety of proven options to help persons stop smoking including counseling, medication, and targeted interventions, reports a recent commentary in the Journal of the American Medical Association.

The commentary followed the release of new, updated U.S. Public Health Service clinical practice guidelines about tobacco use and dependence intended to help physicians assist smokers to quit.

Dr. Michael Fiore, U. of Wisconsin-Madison and Dr. Carlos Jaen, U. of Texas-San Antonio, note that for the first time since records have been kept there are more former smokers than current smokers in the U.S.

Drs. Fiore and Jaen add that smoking today is perceived more appropriately as a chronic disease rather than a habit. They note that within the past decade, the percent of managed health plans that cover tobacco dependence jumped from 25 to 90 percent.

Also, they report about 75 percent of U.S. states now have Medicaid coverage for tobacco dependence treatment and the Joint Commission, which accredits about 15,000 hospitals and health care programs, now suggests tobacco dependence treatment as a standard of care for patients with some heart conditions and pneumonia.

Nevertheless, the authors report 45 million American adults smoke tobacco and more than 20 million will die prematurely from a disease caused by tobacco use if they do not quit. MedlinePlus' quitting smoking health topic page also reminds us that tobacco use remains the most preventable cause of death.

As the authors explain in JAMA (and we quote), 'it is difficult to identify any other condition that presents such as mix of lethality, prevalence, and neglect, despite effective and readily available interventions' (end of quote). 

Some of the available, tested, options to quit include: individual, group, and telephone counseling. In a finding that surprised us, the authors note the effectiveness of telephone counseling -- and they recommended a hotline (1-800-QUIT NOW) that is available throughout the U.S.. The authors add that counseling seems to work for patients who are ready to stop smoking as well as persons who may not be ready (because involvement boosts their motivation to stop).

In addition, there are now seven different smoking cessation medications approved by the U.S. Food and Drug Administration. In other words, seven medications have been clinically tested and demonstrated to help intended users stop smoking. The authors report there are two non-nicotine based medications and five nicotine replacements, that include a gum, patch, nasal spray, inhaler, and lozenge. There also is new evidence that a combination of a low dose non-nicotine and nicotine based medications are more effective than a nicotine patch by itself in helping persons quit.

Some simple, helpful, and very inexpensive interventions by doctors, nurses, and others also are effective regardless of a smoker's intention to quit. These simple interventions include: asking persons about smoking, advising them about their options, assessing a person's overall health and life situation, assisting them, and helping arrange helpful treatment options. The five As, as they are called (ask, advise, assess, assist, and arrange) are a straightforward approach to encourage a smoker to ponder alternatives and head down a tobacco-free path.

Moreover, the authors note there is increasing evidence that the combination of counseling, medications, and interventions work regardless of background, gender, income, education, race, and ethnicity. The authors acknowledge there is less evidence that medications are effective to treat teen smokers and pregnant women, light smokers, (less than 10 cigarettes a day) and smokeless tobacco users.

Besides simple interventions, counseling and medications, the authors explain that changes in health policy make a difference in curbing smoking. Some helpful policy steps include:

• Providing tobacco dependence treatment as a covered insurance benefit
• Offering training to physicians and nurses to encourage them to counsel patients
• Improving the ability of physicians to document and receive reimbursement for tobacco interventions.

Overall, the authors are optimistic that a trend towards reducing the number of Americans who smoke will continue. They close with a reminder that reversing tobacco use is now grounded in clinical evidence, which should give physicians and patients new confidence to take steps to quit.

In addition, MedlinePlus.gov's health topic page on quitting smoking covers and updates all the issues discussed in the JAMA commentary and provides additional, helpful information.

For counseling information, MedlinePlus' health topic page provides a 'go local' link that provides you the names of clinical centers in 29 areas nationwide.

For medication and product information, there is a page provided by the Mayo Foundation for Medication Education and Research that provides well-written pros and cons about products that help you quit smoking. The site, called 'stop-smoking products to help you quit' is found in the 'treatment' section of MedlinePlus'gov's quitting smoking health topic page.

For intervention information and plans, there are several good sites that provide assistance, including a quit smoking plan provided by the American Lung Association that is found in the 'related issues' section.

Other resources on MedlinePlus' quitting smoking health topic page include: health check tools, financial issues related to treatment, the latest research on smoking cessation, clinical trials, directories of experts and organizations, and national statistics.

To find MedlinePlus' quitting smoking health topic page, simply type 'quitting smoking' in the search box on MedlinePlus.gov's home page. Then, click on 'smoking cessation (National Library of Medicine).

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