The Ohio Partners for Smoke-Free Families

5A’s

Rhonda Huckaby – Ohio Department of Health

Katie Graham – Ohio Department of Health

Helping the Quit Process: Using the 5 A’s

Source: Clinical Practice Guideline: Treating Tobacco Use and Dependence (2008). US Dept. of Health and Human Services

Website: http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf

Helping the Quit Process

• We can help with the process of quitting smoking by targeting the way in which we do two things:

– Interact with the individual

– Ask questions

Why is it so hard to quit?

• Smoking has physiological, emotional, social and behavioral components, all of which must be addressed.

• No one picks up his or her first cigarette hoping to destroy their health – they pick it up for emotional and social reasons, and continue to smoke for these same reasons.

• These issues are usually ignored in smoking cessation.

Helping the Quit Process

• If we recognize the perspective of the person who is addicted to nicotine, it becomes easier to relate and interact.

• The types of questions we ask will allow us to have a more productive conversation.

The 5 A’s

• Brief Intervention: The 5 A’s

– Ask about current tobacco use

– Advise them to quit

– Assess willingness to make a quit attempt

– Assist the person with quitting

– Arrange for follow up

The 5 A’s

ASK

Action Step: Implement an office-wide system that ensures that, for every person, at every visit, tobacco use status is queried and documented.

Strategy: Include tobacco use as a part of the assessment process.

The 5 A’s

• How to ASK:

– Are you a current or former smoker?

– Tell me about your smoking history.

– Tell me more about your smoking.

The 5 A’s

ADVISE

Action: In a clear, strong and personalized manner, urge every tobacco user to quit.

Clear Advice: “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.”

The 5 A's

ADVISEStrong Advice:“As a healthcare professional, 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. Your healthcare professional and I will help you.”

Personalized Advice:Tie tobacco use to current health/illness, and/or its social and economic costs, motivation level/readiness to quit, and/or the impact of tobacco use on children in the household.

The 5 A's

ASSESS

Action: Ask every tobacco user if he or she is willing to make a quit attempt a this time.

Strategy: • If the individual is willing to make a quit attempt

at this time, provide assistance.• If the individual will participate in an intensive

treatment, deliver such a treatment or refer to intensive intervention.

The 5 A's

ASSESS, cont.

• If the individual clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention.

• If the individual is a member of a special population consider providing additional information.

The 5 A's

ASSIST

Actions:• Help the individual find resources to quit

• Provide practical counseling and problem solving/skills training

• Provide social support

The 5 A's

ASSIST continued…

Actions:• Help individuals obtain treatment and social support

• Recommend approved providers and tobacco cessation programs and services

• Provide supplementary materials

The 5 A'sARRANGE

Action: • Schedule follow-up contact, either in person or via

telephone.

Strategy: • Timing: At your next home visit or clinic visit ask the

individual about their smoking status, encourage if they are in quit process, assess and refer if still smoking.

Things to Remember

You may need to repeat this process several times before the individual finally quits.

You may not get through all 5 A’s at every visit and that is O.K.

This process is also helpful when dealing with someone who has relapsed.

Resources

Ohio Partners for Smoke Free Families: 5 A’s Intervention Record

Smoke-Free Pledge

Ohio Tobacco Quit Linehttps://ohio.quitlogix.org/

• Served populations• Pregnant women• Uninsured• Medicaid fee-for-service• Members of Ohio Tobacco Collaborative

• Services delivered• Intake call• Five outgoing coaching calls• Unlimited inbound calls• Two week course of nicotine patches or lozenges (if eligible)• Pregnancy Protocol • Text messaging• Online cessation program:Quitlogix• Warm Transfers

Quit Line Pregnancy Protocol• The program offers special rewards to pregnant

callers, including:

• A $5 rewards card after the first call

• A $5 rewards card per completed call during

pregnancy (up to $25)

• A $10 rewards card per completed call after

childbirth (up to $40)

Other Benefits…

• Text messaging options• Nicotine replacement therapy (if applicable

and approved)• Online counseling and individual, telephone

counseling• Most importantly: a healthy, tobacco-free

future for mothers and babies!

Thank You!