For those who smoke tobacco, quitting usually ranks high on the New Year’s resolution list. In fact, XX% of those who smoke in Spokane County stated in a recent survey that they wish to quit. What better time for the local medical community to recommit to supporting patients’ successes in quitting?

And who knows better than those in the medical profession that tobacco use remains the leading cause of preventable death in the U.S. and that smoking is a risk factor for heart disease, stroke, diabetes, cancer, and other common diseases. Quitting tobacco is the best thing a person can do for their health.

Right about now, patients who resolved to quit using tobacco in 2016 may need some extra help in sticking with their quit plan. It is an ideal time to ask patients about tobacco use and counsel them on quitting. Patients expect providers to ask about tobacco use, and screening for tobacco use and providing tobacco cessation counseling are positively associated with patient satisfaction[1]. They are looking to providers for help in quitting tobacco and when counseled to quit, they are about 2.5 times more likely to quit for five months or more than if they quit on their own[2].

When asking about tobacco use, the U.S. Department of Health & Human Services’ Clinical Practice Guidelines for Treating Tobacco Use and Dependence recommends a framework called the Five As:

• ASK: Ask about tobacco use. Ask every patient, at every visit, “Do you use tobacco?”

• ADVISE: Advise the patient to quit. Use a clear, strong and personalized message to tell the patient to quit.

• ASSESS: Assess the patient’s readiness for quitting. Ask the patient when they are thinking of quitting or if they have set a quit date.

• ASSIST: Assist the patient with the quit attempt. If the patient is not ready to quit, strongly advise them to quit, raise awareness of health consequences, and ask motivational questions like, “What would have to change for you to decide to quit?” or, “What might be some of the benefits of quitting now, instead of later?” Remember to demonstrate empathy, leave the decision up to the patient, and foster communication. If the patient is ready to quit, help them design a treatment plan. If they have already quit, help with relapse prevention by asking about nicotine replacement therapy dosage and counseling, and by offering support and encouragement.

• ARRANGE: Arrange follow-up care. Follow-up may be a call from a provider’s clinic to check on how the quit plan is working or it may be another appointment. It may also be a referral to counseling through the Washington state Quitline (1-800-QUIT-NOW) or providing the patient with SRHD’s cessation resource list at: srhd.org/topics/cessation.asp.

When providers assist patients in quitting, they should keep in mind the most effective way for a person to quit is to use a combination of counseling and medication, though both can be effective when used by themselves. For more information about the Five As, recommendations for health care providers, or a copy of the Guidelines for Treating Tobacco Use and Dependence, visit ahrq.gov.

If you have questions about provider training specific to cessation, resources for cessation, or what Spokane Regional Health District is doing to decrease tobacco use in Spokane County contact the Tobacco, E-Cigarette, and Marijuana Prevention program coordinator by email at pmcgowan@srhd.org or call (509) 324-1504.

[1] Barzilai et al. (2001). Prev Med 33:595-599.

[2] Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008