Abstinence percentage. The percentage of smokers who achieve long-term abstinence from smoking. The most frequently used abstinence measure for this Guideline was the percentage of smokers in a group or treatment condition who were abstinent at a followup point that occurred at least 5 months after treatment.

Acupuncture. A treatment involving the placement of needles in specific areas of the body with the intent to promote abstinence from tobacco use. Acupuncture also can be accomplished using electrostimulation or laser.

Addiction. Compulsive drug use, with loss of control, the development of dependence, continued use despite negative consequences, and specific withdrawal symptoms when the drug is removed.

All-comers. Individuals included in a tobacco treatment study regardless of whether they sought to participate. For example, if treatment was delivered to all smokers visiting a primary care clinic, the treatment population would be coded as “all-comers.” Presumably, individuals who seek to participate in tobacco treatment studies (“want-to-quit” smokers) likely are more motivated to quit, and studies limited to these individuals may produce higher quit rates. All-comers can be contrasted with “want-to-quit” or self-selected populations.

Agonist. A drug action that generally mimics or enhances the effect of another drug at a neural receptor site. Nicotine is a cholinergic agonist.

Antagonist. A drug action that generally blocks or neutralizes the effect of another drug at a neural receptor site. Naltrexone and mecamylamine are examples of antagonists.

Anxiolytic. A medication used to reduce anxiety symptoms.

Assessment. All tobacco cessation interventions begin with identifying tobacco users and performing an assessment. The assessment is used to identify the most beneficial intervention for each smoker. Assessments may be specialized and may be ongoing throughout a smoking cessation program or occur at followups.

Aversive smoking. Several types of therapeutic techniques that involve smoking in an unpleasant or concentrated manner. These techniques pair smoking with negative associations or responses. Notable examples include rapid smoking, rapid puffing, focused smoking, and satiation smoking.

Behavioral therapy. A psychotherapeutic approach aimed at identifying and modifying the behaviors associated with human problems.

Benzodiazepine. Medication used as an anxiolytic. Benzodiazepines do not have an FDA indication for treating tobacco use and dependence.

Bidis. Small, thin, hand-rolled cigarettes, often consisting of flavored tobacco wrapped in tendu or temburni leaves. Bidis have a higher concentration of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. They are imported to the United States from India and other Southeast Asian countries.

Biochemical confirmation. The use of biological samples (expired air, blood, saliva, or urine) to measure tobacco-related compounds such as thiocyanate, cotinine, nicotine, and carboxyhemoglobin to verify users' reports of abstinence.

Bupropion SR (bupropion sustained-release). A non-nicotine aid for smoking cessation, originally developed and marketed as an antidepressant. It is chemically unrelated to tricyclics, tetracyclics, selective serotonin re-uptake inhibitors, or other known antidepressant medications. Its mechanism of action is presumed to be mediated through its capacity to block the re-uptake of dopamine and norepinephrine centrally.

Buspirone. A nonbenzodiazepine drug with anxiolytic properties. Buspirone does not have an FDA indication for treating tobacco use and dependence.

Coordinated intervention. Tobacco dependence treatment strategy that involves the clinician, health care administrator, insurer, and purchaser to ensure the provision of tobacco dependence treatment as an integral element of health care delivery.

Chronic disease model. Recognizes the long-term nature of tobacco dependence, with an expectation that patients may have periods of relapse and remission. The chronic disease model emphasizes the importance of continued patient education, counseling, and advice over time.

Cigarette fading/smoking reduction prequit. An intervention strategy designed to reduce the number of cigarettes smoked or nicotine intake prior to a patient's quit date. This may be accomplished through advice to cut down or to systematically restrict access to cigarettes. These interventions use computers and/or strategies to accomplish prequitting reductions in cigarette consumption or nicotine intake.

Clinician. A professional directly providing health care services.

Clinic screening system. The strategies used in clinics and medical practices for the delivery of clinical services. Clinic screening system interventions involve changes in protocols designed to enhance the identification of and intervention with patients who smoke. Examples include affixing tobacco use status stickers to patients' charts, expanding the capture of vital signs to include tobacco use, incorporating tobacco use status items into patient questionnaires, and including prompts for tobacco use monitoring in electronic medical records.

Clonidine. An alpha-2-adrenergic agonist typically used as an antihypertensive medication, but also documented in this Guideline as an effective medication for smoking cessation.

Cochrane Review. A service of the Cochrane Collaboration, an international nonprofit and independent organization (www.cochrane.org/index.htm) that regularly publishes evidence-based reviews about health care interventions.

Cognitive behavioral therapy (CBT). A psychotherapeutic approach aimed at identifying and modifying faulty or distorted negative thinking styles and the maladaptive behaviors associated with those thinking styles.

Combination medications. Treatment that combines two or more nicotine-containing medications or a nicotine-containing medication with another tobacco treatment medication such as bupropion SR.

Community-level interventions. Interventions for the primary prevention or treatment of tobacco use that usually are not implemented in primary care practice settings. These interventions most often are implemented through mass media campaigns.

Comorbidity. Coexistence of tobacco use with other medical diseases/illnesses, including mental illnesses.

Confidence intervals. Estimated range of values, which is likely to include an unknown population parameter. The estimated range is calculated from a given set of sample data.

Contingency contracting/instrumental contingencies. Interventions that incorporate the use of tangible rewards for cigarette abstinence and/or costs for smoking. For the purposes of analysis, simple agreements about a quit date, or other agreements between treatment providers and patients without specifiable consequences, as well as deposits refunded based on study attendance and/or other incentives that were not contingent on smoking abstinence or relapse were not considered examples of contingency contracting.

Continuous abstinence. A measure of tobacco abstinence based on whether subjects are continuously abstinent from smoking/tobacco use from their quit day to a designated outcome point (e.g., end of treatment, 6 months after the quit day).

Cost effectiveness. Quantified analysis of tobacco dependence program costs relative to tobacco use related costs.

Diazepam. A benzodiazepine medication intended to reduce anxiety.

Discrepancy. A strategy used in motivational interviewing to highlight how a patient's expressed priorities, values, and goals may conflict with the use of tobacco.

Efficacy and effectiveness.Efficacy is the outcome achieved from a treatment provided under near-ideal circumstances of control (typically, in a research study). Efficacy studies involve recruitment of motivated participants, random assignment, intensive assessment, and methods designed to keep participants in treatment. Effectiveness is the outcome achieved from a treatment provided in a “real-world setting” (in a clinic or community setting). Such studies typically involve participants who do not seek out the study or treatment, and the treatment is delivered in a manner consistent with its likely use in real-world settings. This 2008 clinical update uses the term “effectiveness” exclusively, recognizing that the majority of the studies summarized here reflect efficacy research that requires random assignment and a high degree of experimental control. This was done for purposes of clarity for its intended clinical audience.

Environmental tobacco smoke (ETS). Also known as “secondhand smoke” (SHS). The smoke inhaled by an individual not actively engaged in smoking, but who is exposed to smoke from the lit end of a cigarette and the smoke exhaled by the smoker.

Exercise/fitness component. Refers to an intervention that contains a component related to exercise/fitness. The intensity of interventions falling within this category varies from the mere provision of information/advice about exercise/fitness to exercise classes.

Extratreatment social support component. Interventions or elements of an intervention in which patients are provided with tools or assistance in obtaining social support outside the treatment environment. This category is distinct from intratreatment social support, in which social support is delivered directly by treatment staff.

Fax-to-quit. Patient referral in which the patient and health care provider fill out a form with pertinent patient information, which is faxed to a quitline for followup.

Food and Drug Administration (FDA). Federal regulatory agency that has control over the safety and release of drugs marketed in the United States.

First-line medications. First-line medications have been found to be safe and effective for tobacco dependence treatment and have been approved by the FDA for this use. First-line medications have an established empirical record of efficacy and should be considered first as part of tobacco dependence treatment, except in cases of contraindications.

Fluoxetine. A selective serotonin re-uptake inhibitor used as a treatment for depression. Fluoxetine does not have an FDA indication for treating tobacco use and dependence.

Formats. Refers to tobacco dependence intervention delivery strategies that include self-help, proactive telephone counseling, computerized or e-health services, individual counseling, and group counseling.

Healthcare Effectiveness Data and Information Set (HEDIS). Serves as a “report card” for providing information on quality, utilization, enrollee access and satisfaction, and finances for managed care organizations and other health care delivery entities.

Higher intensity counseling. Refers to interventions that involve extended contact between clinicians and patients. It is coded based on the length of contact between clinicians and patients (greater than 10 minutes). If that information is unavailable, it is coded based on the content of the contact between clinicians and patients.

Hookah. A smoking pipe designed with a long tube passing through an urn of water that cools the smoke as it is drawn through. Also called “waterpipe,” “hubble-bubble,” “narghile,” “shisha.”

Hotline/helpline. A reactive telephone line dedicated to over-the-phone smoking intervention. Hotline/helpline treatment occurs when a hotline/helpline number is provided to a patient, or a referral to a hotline/helpline is made. The key distinction between a hotline/helpline and proactive telephone counseling is that, in the former, the patient must initiate each clinical contact.

Hypnosis. A treatment by which a clinician induces an altered attention state and heightened suggestibility in a tobacco user for the purpose of promoting abstinence from tobacco use. Also referred to as hypnotherapy.

Individualized interventions. Refers to tailoring an intervention to fit the needs of a particular smoker. For example, relapse prevention can be individualized based on information obtained about problems the patient has encountered in maintaining abstinence. See also Tailored Interventions.

Intent-to-treat. Treatment outcome analyses that determine abstinence percentages based on all subjects randomized to treatment conditions, rather than on just those subjects who completed the intervention or those who could be contacted at followup.

Intensive interventions. Comprehensive treatments that may occur over multiple visits for long periods of time and may be provided by more than one clinician.

Internet (Web-based) interventions. Interventions delivered through the use of a computer. The smoker may navigate within a specific Web site to access general treatment and treatment information, or the smoker may interact with a program that delivers a tailored intervention.

Intervention. An action or program that aims to bring about identifiable outcomes. In tobacco dependence treatment, the intervention generally is clinical in nature and may consist of counseling and the use of medications. Also referred to as “treatment.”

Intratreatment social support. Refers to an intervention component that is intended to provide encouragement, a sense of concern, and empathic listening as part of the treatment.

Light smoker. The field of tobacco dependence research has not achieved consensus regarding the definition of a light smoker. For this publication, it refers to anyone who smokes between 1 and 10 cigarettes per day.

Literature review. A critical analysis of the research conducted on a particular topic or question in the field of science.

Logistic regression. Statistical technique to determine the statistical association or relation between/among two or more variables, in which the dependent variable is dichotomous (has only two levels of magnitude, e.g., abstinent vs. smoking).

Low-intensity counseling. Low-intensity counseling refers to interventions that involve contact between clinicians and patients that last between 3 and 10 minutes. If the information on length of contact is unavailable, it is coded based on the description of content of the clinical intervention.

Managed care organizations (MCOs). Any group implementing health care using managed care concepts, such as preauthorization of treatment, utilization review, system-wide quality improvement strategies, and a network of providers.

Mecamylamine. A nicotine antagonist used as an antihypertensive agent. Mecamylamine does not have an FDA indication for treating tobacco use and dependence.

Meta-analysis. A statistical technique that estimates the impact of a treatment or variable across a set of related studies, publications, or investigations.

Minimal counseling. Minimal counseling refers to interventions that involve very brief contact between clinicians and patients. It is coded based on the length of contact between clinicians and patients (3 minutes or less). If that information is unavailable, it is coded based on the content of the clinical intervention.

Motivation. Refers to a patient's intent or resolve to quit. Motivation can be bolstered through actions, such as setting a quit date, using a contract with a specified quit date, reinforcing correspondence (letters mailed from clinical/study staff congratulating the patient on his or her decision to quit or on early success), and providing information about the health risks of smoking.

Motivational intervention. An intervention designed to increase the smoker's motivation to quit.

Motivational interviewing (MI). A directive and patient-centered counseling method used to increase motivation and facilitate change.

Naltrexone. An opioid receptor antagonist used in substance abuse treatment. Naltrexone does not have an FDA indication for treating tobacco use and dependence.

National Committee for Quality Assurance (NCQA). Reviews and accredits managed care organizations, develops processes for measuring health plan performance, and disseminates information about quality so consumers can make informed choices (e.g., through “report cards,” such as HEDIS).

Negative affect/depression intervention. A type of intervention designed to train patients to cope with negative affect after smoking cessation. The intensity of the interventions in this category may vary from prolonged counseling to the provision of information about coping with negative moods. To receive this code, interventions target depressed mood, not simply stress. Interventions aimed at teaching subjects to cope with stressors are coded as problemsolving. When it is unclear whether an intervention is directed at negative affect/depression or at psychosocial stress, problemsolving is used as the default code.

Neuroteratogenic. The capability of some substances to cause abnormal development of the nervous system in the fetus.

Neurotoxicity. The capablility of some substances to cause damage to the nervous system.

Nicotine gum. Nicotine-containing gum, a smoking cessation aid, that delivers nicotine through the oral mucosa. It is available without a prescription.

Nicotine inhaler. Nicotine-containing inhaler, a smoking cessation aid, that delivers nicotine in a vapor that is absorbed through the oral mucosa. It is available by prescription only.

Nicotine lozenge. Nicotine-containing hard lozenge, a smoking cessation aid, that delivers nicotine through the oral mucosa. It is available without a prescription.

Nicotine nasal spray. Nicotine-containing spray, a smoking cessation aid, that delivers nicotine in a mist that is absorbed in the nasal passages. It is available by prescription only.

Nicotine patch. A nicotine-containing patch, a smoking cessation aid, that delivers nicotine through the skin; available with or without a prescription.

Nicotine replacement therapy (NRT). Refers to medications containing nicotine that are intended to promote smoking cessation. There are five NRT delivery systems currently approved for use in the United States. These include nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, and nicotine patch.

Nortriptyline. A tricyclic antidepressant identified by the Guideline Panel as a second-line medication for smoking cessation. Nortriptyline does not have an FDA indication for treating tobacco use and dependence.

Odds ratio. The odds of an outcome on one variable, given the certain status of another variable(s). This ratio expresses the increase in risk of a given outcome if a specific variable is present.

Opioid antagonists. A class of medications that block action at opiate receptor sites. Naltrexone is one type of opioid antagonist. No opioid antagonist has an FDA indication for treating tobacco use and dependence.

Oral mucosa. The mucous membranes that line the mouth.

Over-the-counter (OTC). Drug or medication for which a prescription is not needed.

Pay for performance. An incentive program in which a health care purchaser provides additional payments or other rewards usually to a clinic or provider if a specified goal is met.

Person-to-person intervention. In-person or face-to-face contact between a clinician and a patient for the purpose of tobacco use intervention or assessment.

Physiological monitoring/biological marker feedback. A treatment by which a clinician provides to a tobacco user biological information, such as spirometry readings, carbon monoxide readings, or genetic susceptibility information, for the purpose of increasing abstinence from tobacco use.

Placebo. An inactive, harmless substance with no known direct beneficial effects. Usually used in clinical studies as a comparison to the effectiveness of an experimental drug or regimen.

Point prevalence. A measure of tobacco abstinence based on smoking/tobacco use occurrence within a set period (usually 7 days), prior to a followup assessment.

Potential reduced exposure products (PREP). Products designed to reduce levels of tobacco intoxicants including: (1) modified tobacco products, (2) tobacco products that are heated rather than burned, (3) oral, low-nitrosamine tobacco products, and (4) medicinal nicotine products (e.g., NRTs). With the exception of NRTs, little research has been conducted to evaluate PREPs.

Practical counseling (problemsolving/skills training). Refers to a tobacco use treatment in which tobacco users are trained to identify and cope with events or problems that increase the likelihood of their tobacco use. For example, quitters might be trained to anticipate stressful events and to use coping skills, such as distraction or deep breathing, to cope with an urge to smoke. Related interventions are coping skill training, relapse prevention, and stress management.

Primary care clinician. A clinician (e.g., in medicine; nursing; psychology; pharmacology; dentistry/oral health; physical, occupational, and respiratory therapy) who provides basic health care services for problems other than tobacco use per se. Primary care providers are encouraged to identify tobacco users and to intervene, regardless of whether tobacco use is the patient's presenting problem.

Proactive telephone counseling. A quitline that responds to incoming calls and makes outbound followup calls. Following an initial request by the smoker or via a fax-to-quit program, the clinician initiates telephone contact to counsel the patient (see Hotline/Helpline).

Propranolol. A beta-adrenergic blocker often used as an antihypertensive medication. Propranolol does not have an FDA indication for treating tobacco use and dependence.

Psychosocial interventions. Refers to intervention strategies that are designed to increase tobacco abstinence rates due to psychological or social support mechanisms. These interventions comprise counseling, self-help, and behavioral treatment, such as rapid smoking and contingency contracting.

Purchaser. A corporation, company, Government agency, or other consortium that purchases health care benefits for a group of individuals.

Quality-adjusted life years (QALY). Measure of both the quality and the quantity of life lived. Used as a means of quantifying the benefits of a medical intervention.

Quit day. The day of a given cessation attempt during which a patient tries to abstain totally from tobacco use. Also refers to a motivational intervention, whereby a patient commits to quit tobacco use on a specified day.

Quitline. A telephone counseling service that can provide both proactive telephone counseling and reactive telephone counseling (see Proactive Telephone Counseling and Reactive Telephone Counseling).

Randomized controlled trial. A study in which subjects are assigned to conditions on the basis of chance, and where at least one of the conditions is a control or comparison condition.

Random effects modeling. A model in which both study sampling errors (variance) and between-study variation are included in the assessment of the uncertainty (confidence interval) of the results of a meta-analysis. If there is significant heterogeneity among the results of included studies, random effects models will give wider confidence intervals than fixed effect models.

Rapid puffing/smoking. A smoking cessation technique that involves the pairing of concentrated smoking with negative associations or responses (e.g., nausea).

Reactive telephone counseling. Telephone counseling that provides an immediate response to a patient-initiated call for assistance. It is a quitline intended to respond only to incoming calls (see Hotline/Helpline).

Reference group. In meta-analyses, refers to the group against which other groups are compared (i.e., a comparison or control group).

Relapse. Return to regular smoking by someone who has quit. A distinction is sometimes made between “relapse” and a “lapse” (or a “slip”), which is a return to reduced smoking or brief smoking after quitting that falls short of a return to regular smoking (see also Slip).

Relapse prevention. Various intervention strategies intended to prevent a recent quitter from returning to regular smoking.

Relaxation/breathing. An intervention strategy in which patients are trained in relaxation techniques, such as meditation and breathing exercises. This intervention should be distinguished from “problemsolving,” which includes a much wider range of stress-reduction/management strategies.

Restricted environmental stimulation therapy (REST). A treatment involving the use of sensory deprivation to promote abstinence from tobacco use.

Return on investment (ROI). Amount of money gained or lost, including money that would have been spent for health care, in relation to the amount of money needed to provide the treatment.

Screening. See Clinic Screening System.

Secondhand smoke. Also known as environmental tobacco smoke (ETS). The smoke inhaled by an individual not actively engaged in smoking, but who is exposed to smoke from the lit end of a cigarette and the smoke exhaled by the smoker.

Second-line medications. Second-line medications are medications for which there is evidence of efficacy for treating tobacco dependence. They have a more limited role than first-line medications because: (1) the FDA has not approved them for a tobacco dependence treatment indication, and (2) there are more concerns about potential side effects than exist with first-line medications. Second-line treatments should be considered for use on a case-by-case basis after first-line treatments have been used or considered.

Selective Serotonin Re-uptake Inhibitors (SSRIs). A class of antidepressant used in the treatment of clinical depression that has been studied for use in tobacco dependence treatment. No SSRI has an FDA indication for treating tobacco use and dependence.

Self-efficacy. One's beliefs about his/her capability to successfully act to achieve specific goals or influence events that affect one's life.

Self-help. An intervention strategy in which the patient uses a nonpharmacologic physical aid to achieve abstinence from tobacco. Self-help strategies typically involve little contact with a clinician, although some strategies (e.g., reactive hotline/helpline) involve patient-initiated contact. Types of self-help materials include: pamphlets/booklets/mailings/manuals; videos; audios; referrals to 12-step programs; mass media, community-level interventions; lists of community programs; reactive telephone hotlines/helplines; and computer programs/Internet.

Self-reported abstinence. Abstinence based on the patient's claim, which may or may not be verified clinically by biochemical confirmation.

Sertraline. A selective serotonin re-uptake inhibitor. Sertraline does not have an FDA indication for treating tobacco use and dependence.

Serum nicotine. Level of nicotine in the blood. This often is used to assess a patient's tobacco/nicotine self-administration prior to quitting, and to confirm abstinence self-reports during followup. Nicotine commonly is measured in urine and saliva.

Serum nicotine/cotinine levels. Level of nicotine/cotinine in the blood. Cotinine is nicotine's major metabolite, which has a significantly longer half-life than nicotine. This often is used to estimate a patient's tobacco/nicotine self-administration prior to quitting, and to confirm abstinence self-reports during followup. Cotinine commonly is measured in urine and saliva.

Side effects. Undesired actions or effects of a drug used in tobacco use treatment, such as insomnia or dry mouth.

Silver acetate. Silver acetate reacts with cigarette smoke to produce an unpleasant taste and has been investigated as a smoking deterrent. It is not approved by the FDA for this use.

Skills training. Refers to a tobacco use treatment in which tobacco users are trained to identify and cope with events or problems that may increase the risk of tobacco use. For example, quitters might be trained to anticipate stressful events and to use coping skills, such as distraction or deep breathing, to cope with an urge to smoke. Related interventions are practical counseling, relapse prevention, and stress management.

Slip. A brief or reduced return to smoking after quitting. Also referred to as a “lapse” (see Relapse).

Smokeless tobacco. Any form of unburned tobacco, including chewing tobacco, snus, and snuff. Use of smokeless tobacco is as addictive as smoking and can cause cancer of the gum, cheek, lip, mouth, tongue, throat, and pancreas.

Social support. Nonmedicinal support for the smoking cessation patient that provides personal encouragement and empathetic listening. Tobacco dependence treatments include two types of social supports: intratreatment social support and extratreatment social support.

Socioeconomic status (SES). Position of an individual or group in a population or society, usually based on income, education, or occupational categories.

Specialized assessments. Refers to assessment of patient characteristics, such as nicotine dependence and motivation for quitting, that may allow clinicians to tailor interventions to the needs of the individual patient.

Stepped-care. The practice of initiating treatment with a low-intensity intervention and then exposing treatment failures to successively more intense interventions.

Sudden Infant Death Syndrome (SIDS). Unexpected and sudden death of an apparently healthy infant during sleep with no autopsic evidence of disease. It is the leading cause of death in infants between 2 weeks and 1 year of age. The cause is unknown, but certain risk factors have been identified, such as prematurity; low birth-weight; birth in winter months; and mothers who are very young, smoke, are addicted to a drug, or have had a recent upper respiratory infection. Also called “cot death” and “crib death.”

Tailored interventions. Tailored interventions are based on a dimension or a subset of dimensions of the individual (i.e., weight concerns, dependency, etc.). See also Individualized Interventions.

The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Healthcare Organizations, JCAHO). An independent, not-for-profit organization that evaluates and accredits more than 19,500 health care organizations in the United States, including hospitals, health care networks, managed care organizations, and health care organizations that provide home care, long-term care, behavioral health care, and laboratory and ambulatory care services.

Tobacco dependence. Dependence on any form of tobacco, including, but not exclusive to, cigarettes, pipes, cigars, and chewing tobacco.

Tobacco treatment specialists. These specialists typically provide intensive tobacco interventions. Specialists are not defined by their professional affiliation or by the field in which they trained. Rather, specialists view tobacco dependence treatment as a primary professional role. Specialists possess the skills, knowledge, and training to provide effective interventions across a range of intensities, and often are affiliated with programs offering intensive treatment interventions or services.

Tobacco user. A person addicted to one or more forms of tobacco products.

Transdermal. Refers to delivery of a substance by absorption through the skin. Transdermal nicotine often is used as a synonym for “nicotine patch.”

Treatment matching. Differential assignment of a patient to treatment based on the patient's pretreatment characteristics. Treatment matching is based on the notion that particular types of tobacco users are most likely to benefit from particular types of treatments.

Treatment. An action or program that aims to bring about identifiable outcomes. For tobacco dependence, the treatment generally is clinical in nature and may consist of counseling and the use of medications. Also may be referred to as “intervention.”

Unaided quit attempts. Quit attempts made by patients, without the assistance of any clinical intervention or medications. Also known as “quitting cold turkey.”

Varenicline. FDA-approved, non-nicotine recommended smoking cessation medication. Its mechanism of action is thought to be a function of its ability to serve both as a partial nicotine receptor agonist and a nicotine receptor antagonist. Available by prescription only.

Vital signs. Standard patient measurements to assess the critical body functions, including blood pressure, pulse, weight, temperature, and respiratory rate. The first step (i.e., the first “A”) to providing smoking cessation interventions is identifying smokers. Vital signs should be expanded to include tobacco use status (current, former, never) or an alternative universal identification system in patient records.

Web-based interventions. See Internet Interventions.

Weight/diet/nutrition. An intervention strategy designed to address weight gain or concerns about weight gain. Interventions that teach weight/diet/nutrition management strategies, incorporate daily/weekly weight monitoring (for reasons other than routine data collection), require or suggest energy intake maintenance/reduction, and/or convey nutritional information/tips/counseling receive this code.

Withdrawal symptoms. A variety of unpleasant symptoms (e.g., difficulty concentrating, irritability, anxiety, anger, depressed mood, sleep disturbance, and craving) that occur after use of an addictive drug is reduced or stopped. Withdrawal symptoms are thought to increase the risk for relapse.