Realignment of the nation’s tobacco agenda: The need to treat tobacco dependence

Background. Tobacco use remains the leading cause of preventable death in the United States. Although comprehensive tobacco control has a number of essential components, support for cessation services can yield the largest short-term public health benefit. While effective treatments for tobacco dependence do exist, they are not currently available to many of the tobacco users who want and need them. Finding cost-effective, science-based strategies for reducing tobacco dependence in the United States should be a national priority. Methods. Late in 1997 a group of experts in the science of tobacco control was convened by the Center for the Advancement of Health to develop recommendations regarding the use of federal funds for treating tobacco dependence. These recommendations were prepared based on the priority of the actions and the estimated cost and effort required to implement them. Following the Master Settlement Agreement in 1998, the recommendations were adapted to address the needs of state policy makers. Results. Effective treatments for tobacco dependence do exist; however, our nation currently lacks the capacity to deliver these services to the many millions who require them. There is a compelling need for funding from a variety of sources to create this capacity. Conclusions. The priority must be to develop the systems, competencies, and resources needed to deliver, and to monitor the delivery of, evidence-based treatments to tobacco users. Treatment must be delivered in an integrated manner, consistent with the needs of tobacco users. Additionally, financial barriers to treatment must be reduced, and consistent, high-quality treatment services must be ensured for all tobacco users who seek them.