1. The Ohio Partners for Smoke-Free Families 5A’s
Rhonda Huckaby – Ohio Department of Health
Katie Graham – Ohio Department of Health

2. 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:

3. 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

4. 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.

5. Why It’s So Hard to Quit – Craving Comes From Brain Chemistry1
*Note to facilitator: Build Slide (6)
When you smoke a cigarette:
Nicotine is sent to your brain in a few seconds1
Nicotine starts a series of biochemical reactions in your brain that ultimately cause the release of dopamine. Dopamine gives you a feeling of pleasure and calm2
The level of dopamine drops between cigarettes, and you start to feel jumpy1
Your brain craves the nicotine so that more dopamine will be released to make you feel calm again1
And the cycle goes on of craving, smoking, calming, and craving
References:
Schroeder SA. What to do with a patient who smokes. JAMA. 2005;294(4):
Reuter M, Netter P, Rogausch A, et al. The role of cortisol suppression on craving for and satisfaction from nicotine in high and low impulsive subjects. Hum Psychopharmacol Clin Exp. 2002;17(5):

6. 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.

7. 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

8. 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.

9. 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.
Interject role play here

10. 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.”
Interject role play here

11. The 5 A's ADVISE Strong 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.
Role play

12. 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.
Assess client’s willingness to quit within the next 30 days
If client is ready to quit, proceed with the 5A’s
If client is not ready to quit, then ask why and use the five R’s to try to increase motivation:
Relevance
Risks
Rewards
Roadblocks
Repetition

13. 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.
Special Population: Pregnant or of childbearing age
Parent
Health Problems including COPD

14. The 5 A's ASSIST • Help the individual find resources to quit Actions:
• Provide practical counseling and problem solving/skills training
• Provide social support
Anticipate problems, provide strategies
Sign a contract
Address most pressing concerns and then refer her to the materials
A slip is not a failure

15. 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

16. The 5 A's
ARRANGE
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.
Refer client to cessation center or specialists if available
Refer client to the Ohio Tobacco Quitline QUIT-NOW
Emphasize that client services are free
SET A FOLLOW-UP APPT.!

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

18. Resources

19. Ohio Partners for Smoke Free Families: 5 A’s Intervention Record
Every agency should have a copy of this form. This is called the FAIR form (Five A’s Intervention Record) including 5A’s smoking entry codes.

20. Smoke-Free Pledge

21. Ohio Tobacco Quit Line https://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

22. 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)

23. 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!

24. Thank You!