Annals of Internal Medicine· 2026Q1· Guideline
Tobacco Use Treatment: Synopsis of the 2026 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline
- 1citations
- Q1SCImago
- 2026year
Short summary
A new clinical practice guideline from the VA and DoD strongly recommends motivational interviewing and FDA-approved pharmacotherapies, specifically varenicline over other monotherapies and combination NRT over single-agent NRT, to increase abstinence from combustible tobacco.
AI-generated from the title and abstract; the full text is not read.
Key points
- The 2026 VA/DoD guideline includes 32 recommendations for tobacco and nicotine use treatment.
- Motivational interviewing is strongly recommended to increase engagement in tobacco cessation treatment.
- Varenicline is strongly recommended over other monotherapy pharmacotherapies for combustible tobacco abstinence.
- Combination nicotine replacement therapy (NRT) is strongly recommended over single-agent NRT.
- The guideline also provides recommendations for smokeless tobacco, electronic nicotine delivery systems, and patients not ready to quit.
AI-generated from the title and abstract; the full text is not read.
Abstract
DESCRIPTION: A work group representing the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) prepared a new VA/DoD clinical practice guideline (CPG) for tobacco use treatment. This article provides a synopsis of the 2026 CPG, which addresses use of commercially available tobacco and nicotine products. METHODS: A multidisciplinary work group developed 19 key questions on clinical topics of highest priority for the VA and DoD populations. Published literature from 1 January 2014 to 10 December 2024 was systematically reviewed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. Recommendations were made by consensus and informed by evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, which assesses quality of evidence and balances benefits and harms, patient preferences, and feasibility. The final document incorporated input from peer review by an external group of experts. RECOMMENDATIONS: The 2026 guideline includes 32 recommendations across 10 topic areas. Key recommendations for increasing abstinence from combustible tobacco include recommending motivational interviewing to increase engagement in treatment of tobacco and nicotine use (strong) and use of U.S. Food and Drug Administration-approved pharmacotherapies (strong), with varenicline recommended over monotherapy with other agents (strong), combination nicotine replacement therapy ([NRT] for example, patch plus lozenge) recommended over NRT monotherapy (single agent) (strong), and extending use of bupropion sustained release beyond 12 weeks (weak). Other key recommendations include varenicline for increasing abstinence from smokeless tobacco (strong) and electronic nicotine delivery systems (weak) and use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days (weak).
The authors' abstract, as published at the source. Annals of Internal Medicine, 2026 · DOI ↗
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