Counseling About Smoking Cessation

A clinician can make a significant impact on a tobacco user. Clinicians can address the social, financial, and emotional issues surrounding tobacco use, in addition to the health impacts associated with use. Find information about why it's important to counsel tobacco users, as well as when and how to do so. 
 
Get the why, when, and how of helping patients quit in this infographic. 

• Supporting Youth who are Addicted to Nicotine: Advice for Pediatricians 
  This factsheet provides information for pediatricians about how to support adolescents who are addicted to nicotine from cigarettes, vaping, or other tobacco products. The content includes tips for screening, counseling, and helping youth with a cessation attempt. This factsheet is also available in Spanish  
• Nicotine Replacement Therapy and Adolescent Patients: Information for Pediatricians 
  This document provides information for pediatricians about how to use nicotine replacement therapy (NRT) to support adolescents who are addicted to nicotine from cigarettes, vaping, or other tobacco products. 

Note: Though the information below talks mostly about smoking, the information can be helpful for users of other tobacco products as well. 
 
Why Should You Counsel for Smoking Cessation? 

• Parental smoking is the main source of children's secondhand smoke exposure. 
• When parents quit smoking, adolescents are less likely to start. 
• Pediatric clinicians have direct contact with roughly 25% of the nation's smokers through child health visits. 
• Parental counseling by the child's physician increases rates of parents' attempts to quit. 
• Most parents see their child's provider more frequently than their own, with an average of 10 visits in the first two years of a child's life. 
• While many children are covered by Medicaid, their parents may be uninsured, so pediatric clinicians may be their only available source of counseling. 

When Should You Counsel for Smoking Cessation? 

• If adolescents and/or parents are smoking, counsel them to quit tobacco use. 
• If parents or other family members are smoking, counsel them to prevent and reduce children's exposure to secondhand smoke. 
• If a new parent is a current or former smoker, assist them in their efforts to avoid relapse following pregnancy. 
• If a pre-adolescent or adolescent patient is not a smoker, counsel them to prevent initiation of tobacco use. 

How Should You Counsel for Smoking Cessation? 

• Brief counseling, delivered in as little as three minutes, can be effective. 
• Focus on the child as a primary beneficiary of smoking cessation. 

Counseling Techniques 

• 2 As + R 
  Physicians can help patients who smoke to quit through an effective 30-second intervention, 2 As + R (Ask, Assist, Refer): Physicians Ask patients if they smoke, Assist them in their quit attempt, and Refer them to cessation services (1-800-QUIT NOW or to community/ internet quit resources). 
   
  Information on the 2 As + R strategy can be found in the presentations listed on the Downloadable PowerPoint Presentations page. 
• 5 As 
  The US Agency for Healthcare Research and Quality has developed five major steps to intervention (the "5 As") for clinicians to provide counseling to tobacco users who want to quit. 
• Motivational Interviewing 
  This website provides information on motivational interviewing. It includes details about this approach, other links, training resources and current research. 
   
  Motivational Interviewing videos – Effective Physician 
  Motivational Interviewing videos – Ineffective Physician 
• Talk To Your Patients 
  Don't Be Silent About Smoking is a social marketing campaign to encourage clinicians to take an active role in helping their smoking patients quit. This site includes counseling tips and advice.