A decade ago there was great optimism about achieving national goals for reductions in the prevalence of tobacco use. This article assesses developments in integrating evidence-based tobacco dependence treatment into health care and finds enormous progress overall. The need for system-level changes to reflect knowledge about the health impact and cost effectiveness of smoking-cessation treatment has gained increased attention and inspired guidelines. Published research underscores the effectiveness of system-level strategies, such as adding smoking as a vital sign. Less clear are the effects of financial incentives and reimbursement.

Positive developments cited by the authors include:

• More frequent inclusion of coverage for evidence-based tobacco-cessation treatments in public insurance benefits;
• an increase in the number of states offering quit-lines over the past decade (from four to 45 states);
• greater availability of over-the-counter pharmacological therapies for quitting smoking; and
• more physicians routinely advising their patients to quit smoking.

Nonetheless, much remains to be done, the authors suggest. Use and demand for smoking-cessation programs remains low, especially among low-income and underserved populations where tobacco use prevalence is highest. The authors propose that smoking status should be part of electronic medical records, providers should have seamless methods for linking motivated smokers to cessation treatments, and coverage for evidence-based treatments should be an expected benefit in all health plans. They suggest that the performance in addressing the problem of tobacco dependence should be routinely tracked and publicly reported.