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2024世界卫生组织成人戒烟临床治疗指南报告（英）

医药生物2024-07-10-WHO世界卫生组织庄***

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WHO Clinical Treatment Guidelines for Tobacco Cessation in Adults

Executive Summary

Introduction: The guidelines focus on comprehensive strategies for managing tobacco cessation among adults, encompassing both clinical and community settings, digital interventions, pharmacological treatments, cessation of smokeless tobacco use, combined behavioral and pharmacological approaches, traditional therapies, system-level interventions, and policies.

Key Recommendations:

Behavioral Support: Both in clinical and community settings, continuous support is crucial, emphasizing personalized counseling and group sessions.
Digital Interventions: Utilizing technology for education, monitoring, and support enhances engagement and effectiveness.
Pharmacological Interventions: Medications like varenicline and bupropion are recommended, alongside nicotine replacement therapy (NRT).
Smokeless Tobacco Cessation: Tailored interventions are necessary, considering the unique challenges posed by smokeless tobacco.
Combined Approaches: Combining behavioral and pharmacological treatments can lead to higher success rates.
Traditional Therapies: While acknowledged, their role is limited due to insufficient evidence for efficacy.
System-Level Interventions: Policies, financial incentives, and public health campaigns are essential for widespread adoption and effectiveness.

Methods and Process

Scope Definition: Questions of interest were clearly outlined.
Evidence Reviews: Comprehensive literature reviews were conducted.
Grading of Evidence: Certainty of evidence was assessed.
Recommendation Formulation: Based on benefits, harms, values, preferences, cost-effectiveness, equity, and feasibility.

Implementation Considerations

Tailoring Approaches: Recommendations need adaptation based on local contexts and resources.
Monitoring and Evaluation: Continuous assessment is critical to ensure guidelines' effectiveness.

Research Needs

Evidence Base Expansion: More studies are needed to strengthen the evidence base for all intervention types.

Dissemination and Adoption

Guideline Adoption: Strategies for implementation in diverse settings.
Dissemination: Wide distribution to reach healthcare providers and the general public.

Conclusion

These guidelines provide a structured approach to tobacco cessation, emphasizing the importance of multifaceted strategies including behavioral support, digital tools, pharmacological interventions, and system-level policies. They aim to facilitate more effective and equitable cessation efforts worldwide.

WHOclinicaltreatmentguidelinefortobaccocessationinadults 1 30sec–3min 2 100% 3 +AI MONTH 4 Varenicline/ / bupropioncytisine NRT 5 Bupropion+ /Varenicline NRT 6 7 Varenicline / NRT 8 + 9 +? 10 11 ❶+❸X ?X YESNO ❷+❺ 12 3 4 2 5 1 6 12 7 11 8 10 9 WHOclinicaltreatmentguidelinefortobaccocessationinadults WHOclinicaltreatmentguidelinefortobaccocessationinadultsISBN978-92-4-009643-1(electronicversion) ISBN978-92-4-009644-8(printversion) ©WorldHealthOrganization2024 Somerightsreserved.ThisworkisavailableundertheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0IGOlicence(CCBY-NC-SA3.0IGO;https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Underthetermsofthislicence,youmaycopy,redistributeandadapttheworkfornon-commercialpurposes,providedtheworkisappropriatelycited,asindicatedbelow.Inanyuseofthiswork,thereshouldbenosuggestionthatWHOendorsesanyspecificorganization,productsorservices.TheuseoftheWHOlogoisnotpermitted.Ifyouadaptthework,thenyoumustlicenseyourworkunderthesameorequivalentCreativeCommonslicence.Ifyoucreateatranslationofthiswork,youshouldaddthefollowingdisclaimeralongwiththesuggestedcitation:“ThistranslationwasnotcreatedbytheWorldHealthOrganization(WHO).WHOisnotresponsibleforthecontentoraccuracyofthistranslation.TheoriginalEnglisheditionshallbethebindingandauthenticedition”. AnymediationrelatingtodisputesarisingunderthelicenceshallbeconductedinaccordancewiththemediationrulesoftheWorldIntellectualPropertyOrganization(http://www.wipo.int/amc/en/mediation/rules/). Suggestedcitation.WHOclinicaltreatmentguidelinefortobaccocessationinadults.Geneva:WorldHealthOrganization;2024.Licence:CCBY-NC-SA3.0IGO. Cataloguing-in-Publication(CIP)data.CIPdataareavailableathttps://iris.who.int/. Sales,rightsandlicensing.TopurchaseWHOpublications,seehttps://www.who.int/publications/book-orders.Tosubmitrequestsforcommercialuseandqueriesonrightsandlicensing,seehttps://www.who.int/copyright. Third-partymaterials.Ifyouwishtoreusematerialfromthisworkthatisattributedtoathirdparty,suchastables,figuresorimages,itisyourresponsibilitytodeterminewhetherpermissionisneededforthatreuseandtoobtainpermissionfromthecopyrightholder.Theriskofclaimsresultingfrominfringementofanythird-party-ownedcomponentintheworkrestssolelywiththeuser. Generaldisclaimers.ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartofWHOconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedanddashedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement. Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbyWHOinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters. AllreasonableprecautionshavebeentakenbyWHOtoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshallWHObeliablefordamagesarisingfromitsuse. i TableofContents Acknowledgementsiii Abbreviationsandacronymsv Glossaryoftermsvii Executivesummaryxi Backgroundxi Rationaleandobjectivesxi Guidelinedevelopmentprocessandmethodsxi Targetaudiencexi Summaryofrecommendationsxii Behaviouralsupportdeliveredinbothclinicalandcommunitysettingsxiii Digitaltobaccocessationinterventionsxiii Pharmacologicalinterventionsdeliveredinbothclinicalandcommunitysettingsxiii Interventionsforsmokelesstobaccousecessationxiv Combinationofbehaviouralandpharmacologicaltreatmentsxiv Traditional,complementaryandalternativetherapiesxiv System-levelinterventionsandpoliciesxiv 1.Introduction1 1.1.ExistingWHOguidelines1 1.2.Rationaleandobjectives2 1.3.Targetaudience3 2.Methods5 2.1.Scopeoftheguidelineandquestionsofinterest5 2.2.Evidencereviews6 2.3.Assessmentofevidenceanditsgrading8 2.4.Goingfromevidencetorecommendations8 3.Recommendations11 3.1.Behaviouralsupportdeliveredinbothclinicalandcommunitysettings11 3.1.1.Recommendations11 3.1.2.Overallquestions11 3.1.3.Justificationandevidence11 3.1.4.Implementationconsiderations13 3.2.Digitaltobaccocessationinterventions14 3.2.1.Recommendation14 3.2.2.Overallquestions14 3.2.3.Justificationandevidence14 3.2.4.Implementationconsiderations16 3.3.Pharmacologicalinterventionsdeliveredinbothclinicalandcommunitysettings17 3.3.1.Recommendations17 3.3.2.Overallquestions17 3.3.3.Justificationandevidence17 3.3.4.Implementationconsideration21 ii 3.4.Interventionsforsmokelesstobaccousecessation22 3.4.1.Recommendations22 3.4.2.Overallquestions22 3.4.3.Justificationandevidence22 3.4.4.Implementationconsiderations23 3.5.Combinationofbehaviouralandpharmacologicaltreatments23 3.5.1.Recommendation23 3.5.2.Overallquestions23 3.5.3.Justificationandevidence23 3.5.4.Implementationconsiderations24 3.6.Trad

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