Helping Smokers Quit

A Guide for Clinicians

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"Even brief tobacco dependence treatment is effective and should be offered to every patient who uses tobacco."
—Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update

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Ask

Ask about tobacco use at every visit.

Implement a system in your clinic that ensures that tobacco-use status is obtained and recorded at every patient visit.

Vital Signs Blood Pressure: __________________________________________ Pulse: __________________   Weight: __________________ Temperature: ____________________________________________ Respiratory Rate: ________________________________________ Tobacco Use:        Current        Former        Never        (circle one)

Advise

Advise all tobacco users to quit.

Use clear, strong, and personalized language. For example:

"Quitting tobacco is the most important thing you can do to protect your health."

Assess

Assess readiness to quit.

Ask every tobacco user if he/she is willing to quit at this time.

• If willing to quit, provide resources and assistance (go to Assist section).
• If unwilling to quit at this time, help motivate the patient:
  • Identify reasons to quit in a supportive manner.
  • Build patient's confidence about quitting.

Assist

Assist tobacco users with a quit plan.

Assist the smoker to:

• Set a quit date, ideally within 2 weeks.
• Remove tobacco products from their environment.
• Get support from family, friends, and coworkers.
• Review past quit attempts—what helped, what led to relapse.
• Anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal.
• Identify reasons for quitting and benefits of quitting.

Give advice on successful quitting:

• Total abstinence is essential—not even a single puff.
• Drinking alcohol is strongly associated with relapse.
• Allowing others to smoke in the household hinders successful quitting.

Encourage use of medication:

• Recommend use of over-the-counter nicotine patch, gum, or lozenge; or give prescription for varenicline, bupropion SR, nicotine inhaler, or nasal spray, unless contraindicated.

Select for Suggestions for the Clinical Use of Medications for Tobacco Dependence Treatment.

Provide resources:

• Recommend toll free 1-800-QUIT NOW (784-8669), the national access number to State-based quitline services.

Refer to Web sites for free materials:

• Agency for Healthcare Research and Quality:
  www.ahrq.gov/path/tobacco.htm
• U.S. Department of Health and Human Services:
  www.smokefree.gov

Arrange

Arrange followup visits.

Schedule followup visits to review progress toward quitting.

If a relapse occurs, encourage repeat quit attempt.

• Review circumstances that caused relapse. Use relapse as a learning experience.
• Review medication use and problems.
• Refer to 1-800-QUIT NOW (784-8669).

For more information on prescribing, precautions, and side effects, go to the Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update, www.ahrq.gov/path/tobacco.htm.

U.S. Department of Health and Human Services
Public Health Service

Current as of May 2008

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Internet Citation:

Helping Smokers Quit: A Guide for Clinicians. Revised May 2008. Agency for Healthcare Research and Quality. Rockville, MD. http://www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm

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