Dr. Scott Leischow, of NCI’s Tobacco Control Research Branch, discussed barriers to delivery and utilization of current tobacco cessation treatments. These include low efficacy and high relapse rate associated with current treatments, the “hassle factor” of nicotine replacement therapy (NRT) compared with the simplicity of nicotine delivery by cigarettes, the cost of NRT’s monthly supply versus the availability and cost of single packs of cigarettes, the limited access to comprehensive smoking cessation programs that incorporate behavioral therapy with pharmacological treatment, and the failure of health care organizations to provide coverage for the costs of treatment.

Dr. Saul Shiffman of the University of Pittsburgh discussed factors that might increase utilization of existing treatments. These include regulatory changes that make cigarettes more expensive, encouraging more smokers to try to quit; expanding the availability of pharmacotherapies, which now are sold primarily at pharmacies; and increased advertising, education, and promotion of current therapies.

Dr. Richard Hurt, of the Mayo Clinic’s Nicotine Dependence Center in Minneapolis, Minnesota, discussed the limitations of current clinical treatment. There are relatively few medications available, clinicians are not familiar with medications and are concerned about low efficacy of existing treatments, and patients are reluctant to initiate treatment because of embarrassment, the expense of treatment, inadequate relief from withdrawal, and the difficulty of complying with instructions for use of gum, inhalers, or nasal sprays.

Dr. Susan Curry of the University of Illinois at Chicago described the process by which insurers and other health care management organizations determine coverage of treatments, and said that tobacco use and dependence should be treated in the same way as other chronic medical conditions. Behavioral support is a key component of successful treatment, and “bundling” access to medication into community-based behavioral treatment programs will improve delivery, utilization, and effectiveness of treatment.