Ask — Implement an office-wide system that ensures that, for every person and for every nurse encounter or clinic visit, tobacco-use status is queried and documented. Expand the vital signs to include tobacco use or use an alternative universal identification system: blood pressure, pulse, weight, temperature, respiratory rate, and tobacco use (current, former, never).
Advise — In a clear, strong, and personalized manner, urge every tobacco user to quit. Advice should be:
Clear — "I think it is important for you to quit smoking now and I can help you." "Cutting down while you are ill is not enough."
Strong — "As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you."
Personalized — Tie tobacco use to current health/illness, and/or social and economic costs, motivation level/readiness to quit, and/or the impact of tobacco use on children and others in the household.
Assess — Ask every tobacco user if he or she is willing to make a quit attempt at this time (e.g., within the next 30 days). Assess his or her willingness to quit:
• If the person is willing to make a quit attempt at this time, provide assistance.
• If he or she will participate in an intensive treatment, deliver such a treatment or refer to an intensive intervention.
• If the smoker clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention.
• If the person is a member of a special population (e.g., adolescent, pregnant smoker, racial/ethnic minority), consider providing additional information.
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Assist — Help the smoker with a quit plan.
Provide practical counseling (problem solving/training), intra-treatment social support, and a supportive clinical environment while encouraging the patient in his or her quit attempt. "My office staff and I are available to assist you."
Help the smoker obtain extra-treatment social support. Suggest the person ask spouse/partner, friends, and co-workers to support him or her in the quit attempt.
Recommend the use of approved pharmacotherapy, except in special circumstances.
Provide supplementary materials:
• Source — Federal agencies, nonprofit agencies, or local/state health departments.
• Type — Culturally/racially/educationally/age appropriate for the individual.
• Location — Readily available at every clinician's workstation. Arrange — Schedule follow-up contact, either in person or via telephone.
Timing — Follow-up contact should occur soon after the quit date, preferably during the first week. A second follow-up contact is recommended within the first month. Schedule further follow-up contacts as indicated.
Actions during follow-up contact — Congratulate success. If tobacco use has occurred, review circumstances and elicit recommitment to total abstinence. Remind patient that a lapse can be used as a learning experience. Identify problems already encountered and anticipate challenges in the immediate future. Assess pharmacotherapy use and problems. Consider use or referral to more intensive treatment.
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