American Public Health Association
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Principles to Practice


Given 70% of smoking patients report that physicians can be important motivators to quitting The Five A’s have been effectively used by physicians and other medical professionals as a brief-treatment tool in order to help patients stop tobacco use.  These guidelines can be used as a tool to assist physicians in addressing tobacco use with youth and their parents.


The Five A’s

1. Ask about exposure to tobacco smoke and tobacco use at each visit and willingness to quit.

2.  Assess by asking patient if they are ready to quit.

3.  Advise all smoking parents to stop and all children not to use tobacco products.

4.  Assist children and youth in resisting tobacco use; assist tobacco users in quitting.

5.  Arrange follow-up visits as required


The Five A’s




Ask about exposure to tobacco smoke and tobacco use at each visit and willingness to quit.  Tobacco use should be documented at each visit.





Determine readiness by asking your patient if he/she is ready to quit.


  • Administer a questionnaire
  • Document smoking as a part of your vital signs documentation
  • Suggest interventions appropriately based on patients readiness to quit
    • Nonsmoker- behavior should be reinforced
    • Smoker –should be educated about cessation and treatment options




Smoking parents should be advised to stop any tobacco use and all children should be encouraged not to use tobacco products. Present the realities of tobacco use and the health consequences associated with this behavior.


Prevention for nonsmokers


  • Advise and educate youth not to begin use
  • Congratulate and encourage nonsmokers to continue non use
  • Emphasize short term negative consequences
  • Help youth develop refusal skills
  • Discuss benefits of not using tobacco


Cessation for smokers

o         Advise that it is easier to stop now than later.

o         Discuss the benefits of not using tobacco or reasons for quitting.

o         Emphasize short-term negative consequences

o         Show visuals of what tobacco use does to the body




Assist youth/parents in resisting tobacco use or quitting by equipping them with the appropriate tools and knowledge.


Cessation for smokers

o         Assist youth in stress management.

o         Consider a ‘stop smoking’ contract.

o         Set a quite date.

o         Provide self-help manuals.

o         Encourage relapsed smokers to try again

o         Promote problem-solving skills, goal setting and decision making programs.

o         Encourage exercise and social activities incompatible with tobacco use.

o         Prescribe nicotine replacement therapy.




Schedule follow-up visits as necessary to track cessation efforts or progress made.


Cessation for smokers

o         Arrange follow-up visits within 1-2 weeks of quit date.

o         Discuss progress, barriers, and cigarette use at the first follow-up visit.

o         Arrange a second follow-up visit at 1-2 months.

o         Discuss progress and problems.

Relapse prevention

o         Discuss potential health benefits

o         Converse about successes in quitting

o         Discuss problems encountered and/or anticipate threats


An alternate A (Anticipate) is sometimes used by others in the field of smoking prevention to assist physicians with patients who use tobacco products:



Physicians should be aware of certain aspects that contribute to smoking/tobacco us and anticipate methods to provide a teachable moment.

o         Be aware of risk factors of your adolescent patient.

o         Engage in discussion.

o         Encourage parental guidance.

o         Provide information on the ills of tobacco use