A Guide for Clinicians
"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
Select for print
version (PDF File, 190 KB). PDF Help.
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:
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
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