Ask, Advise, Assess, Assist, and Arrange - Action Steps for Clinicians

Ask all patients about tobacco use.

Identify or verify and document tobacco use status of every patient at every visit.

Advise all tobacco users to quit.

In a clear, strong, and personalized manner, urge every tobacco user to quit. “The most important thing you can do to improve your health is to quit smoking, and I can help you.” Advice should be:

Clear. “It is important that you quit smoking/using chewing tobacco now, and I can help you. Occasional or light smoking is still dangerous.”

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 symptoms and health concerns, social and economic costs, and/or the impact of tobacco use on children and others in the household. “Continuing to smoke makes your asthma worse, and quitting may dramatically improve your health. Quitting smoking may reduce the number of ear infections your child has.”

Assess willingness to quit now.

For each tobacco user, ask whether they are willing to make a quit attempt now. “Are you willing to quit within the next month if I provide help for you?”

For former tobacco users, ask how recently they have quit and whether they are experiencing any challenges to remaining abstinent.

Assist the tobacco user with a quit plan.

For the patient willing to make a quit attempt, assist with creating a quit plan, offer medication, and provide or refer the patient for counseling to help them quit. Evidence strongly suggests that the combination of medication and counseling dramatically improves the chances of quitting successfully.

Help the patient create a quit plan. As part of a patient’s preparation for quitting, encourage them to take the following steps

Set a quit date, ideally within 2 to 4 weeks.

Tell your family, friends, and coworkers about quitting and ask for their support.

Anticipate challenges, particularly during the critical first few weeks. Challenges include nicotine withdrawal symptoms.

Remove tobacco products from your environment. Prior to quitting, avoid smoking in places where you spend a lot of time (e.g., work, home, car). Make your home smoke-free.

Arrange follow-up with the patient.

All patients receiving the brief tobacco cessation intervention should receive follow-up to monitor challenges and medication adherence. Follow-up can take place at a clinic, via EHR, or via phone.