This Clinician's Guide is based on the Clinical Practice Guideline on Smoking Cessation, Number 18. It was prepared by a panel of experts convened by the Agency for Health Care Policy and Research, and reflects a thorough review of evidence from clinical studies spanning 1978 to 1994.

Helping Smokers Quit

1. Every person who smokes should be offered smoking cessation treatment at every office visit.
2. Clinicians should ask about and record the tobacco-use status of every patient.
3. Cessation treatment even as brief as 3 minutes a visit is effective.
4. The more intense the treatment, the more effective it is in producing long-term abstinence from tobacco.
5. Nicotine replacement therapy (nicotine patches or gum), social support, and skills training are effective components of smoking cessation treatment.
6. Health care systems should be modified to routinely identify and intervene with all tobacco users at every visit.

Ask, Advise, Assist

Ask about smoking

Implement an officewide system that ensures that tobacco-use status is obtained and recorded for every patient at every office visit.

Include tobacco use in vital signs data collected. Or place tobacco-use status stickers on all patient charts or indicate smoking status using computer reminder systems.

Advise tobacco users to quit

• In a clear, strong, and personalized manner, urge every smoker to quit.

• Be clear. ("I think it is important for you to quit smoking now, and I will help you.")

• Speak strongly. ("As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your current and future health.")

• Personalize your advice. ("You've already had one heart attack.") Mention the impact of smoking on children or others in the household. ("You know your children need you.")

Assist the patient with a quit plan

Advise the smoker to:

• Set a quit date, ideally within 2 weeks.

• Inform friends, family, and coworkers of plans to quit, and ask for support.

• Remove cigarettes from home, car, and workplace and avoid smoking in these places.

• Review previous quit attempts—what helped, what led to relapse.

• Anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal.

Give advice on successful quitting:

• Total abstinence is essential—not even a single puff.

• Drinking alcohol is strongly associated with relapse.

• Having other smokers in the household hinders successful quitting.

Encourage use of nicotine replacement therapy (for more information on prescribing, precautions, and side effects, see the Clinical Practice Guideline):