However, the evidence on pharmaco- therapy for tobacco cessation in pregnant women is insufficient; the balance of benefits and harms cannot be determined. Among hospitalized adults who use tobacco, intensive counseling with con- tinued supportive follow-up contacts for at least one month after discharge is recommended.S4.5-22 ENDS are not recommended as a tobacco treatment method. The evidence is unclear about Recommendations for Treatment of Tobacco Use (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES whether ENDS are useful or effective for tobacco treatment, and they may be potentially harm- ful. The evidence on the use of ENDS as a smok- ing-cessation tool in adults (including pregnant women) and adolescents is insufficientS4.5-23 or The USPSTF recommends that clini- cians direct patients who smoke tobacco to other cessation interventions with established effective- ness and safety. 4. Cigarette smoking remains a strong, indepen- dent risk factor for ASCVD events and premature Even among older adults, tobacco ces- sation is beneficial in reducing excess risk.S4.5-5 The risk of heart failure and death for most for- mer smokers is similar to that of never smokers after >15 years of tobacco cessation.S4.5-25 In the National Health Interview Survey, smoking was strongly associated with ASCVD in young people after adjustment for multiple risk factors,S4.5-26 which is why abstinence from an early age is recommended. 5. Tobacco use dependence is a chronic disease that requires highly skilled chronic disease man- agement. It is a reasonable expectation that every health system or practice should dedicate trained staff to tobacco treatment. 