Varenicline first, and combined nicotine replacement over one product, in a tobacco guideline

The edition in brief

The 2026 US Veterans Affairs and Department of Defense guideline on tobacco treatment makes 32 recommendations. Its strongest are motivational interviewing to bring people into treatment, approved pharmacotherapy for everyone trying to stop smoking, varenicline in preference to any single other agent, and combination nicotine replacement (a patch plus a short-acting form) over a single product. It also recommends varenicline for smokeless tobacco, and weakly supports offering nicotine replacement or varenicline to people not yet ready to quit. A Japanese case-control study of 21,724 working-age adults with heatstroke found the link between heat and heatstroke grew stronger with each added chronic or lifestyle condition: at a wet-bulb globe temperature of 33°C the odds were about twice baseline with no conditions and 2.7 times with four. In the PACER trial, 375 emergency patients with low-risk chest pain and at least moderate anxiety improved in all arms, but peer-supported internet CBT reduced anxiety scores 1.2 points more than a primary care referral over a year, with larger gains in those with severe anxiety.