Use the “Five A’s” of Counseling Service Members to Quit Tobacco
As you know, counseling Service members to quit tobacco is a complex process and involves more than handing them reading materials or offering a nicotine patch. Begin your tobacco cessation approach with the “5 A’s”. They are easy to remember and useful for all patient encounters.
- Ask each patient at every visit if they use tobacco products [PDF 610KB]. Be specific and ask about all products including cigarettes, smokeless tobacco (dip or chew), hookah, and e-cigarettes such as JUUL. (Remember, Service members may not consider themselves to be a tobacco user if they are using e-cigarettes or JUUL. It’s important to ask about these specifically.)
- Advise every tobacco user to quit. As a health professional, your advice carries authority.
- Assess if the tobacco user is willing to make a quit attempt.
- Assist the Service member who wants to quit by talking about counseling, available cessation services and nicotine and non-nicotine medications that can help them quit.
- Arrange a follow-up contact by you or your staff preferably in the first week after the quit date. Make sure you ask the patient the best way to do this such as secure messaging on the TRICARE Patient Portal or telephone. This accountability will help Service members follow through with their quit attempt.
Follow the Clinical Practice Guideline Recommendations
Below are recommendations that have been adapted from the Department of Health and Human Services Clinical Practice Guidelines, along with resources to help you provide specialized support for Service members.
- Identify and document tobacco use status every time a patient is seen.
- Ask all patients at every visit if they use tobacco and make sure their status is documented clearly in their medical record. Try not to put their tobacco use status only in the S/O or notes section of the record because it may get lost.
- Always utilize brief tobacco dependence treatment if time is limited.
- Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least brief treatments such as:
- Self-help materials/pamphlets.
- Referral to a tobacco cessation program.
- A short-period (less than 10 minutes) of counseling.
- For tobacco users who are currently unwilling to make a quit attempt, employ brief motivational treatments by using Motivational Interviewing.
- Encourage local intensive cessations treatments.
- Tobacco dependence treatments (individual, group and telephone) are effective across a broad range of populations. Effectiveness increases with treatment intensity.
- Refer patients to installation tobacco cessation programs in health promotion, behavioral health or pharmacy, if available.
- Make patients aware of state quitline services that may be available to them.
- Two components of counseling are especially effective for patients making a quit attempt:
- When appropriate, combine counseling and medication treatments.
- The combination of counseling and medication can be more effective than either alone. Numerous FDA-approved medications are available for tobacco dependence. Clinicians should encourage their use by all patients attempting to quit tobacco—except when medically contraindicated or with specific populations (i.e., pregnant women, adolescents and Service members).
- For more information on medications for quitting tobacco please see the “Medicines to Help You Quit Tobacco” page of the YouCanQuit2 website.
- For more details on TRICARE coverage, visit the TRICARE Tobacco Cessation Services page.
- As a provider, encourage your military treatment facility to decrease barriers to accessing these medications, if possible. Common barriers include allowing only certain providers to prescribe the medications or requiring patients to try other first-line medications first.
- Promote telephone quitline smoking support.
- Telephone quitline support is effective with diverse populations, has broad reach and is not time consuming. For free quit smoking support, including quit coaching and educational materials, share the following quitlines with your patients:
- Remind your patients that quitting tobacco is hard and making multiple quit attempts is normal.
- Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.
- Direct your patients to the “Stay Quit” section of the YouCanQuit2 website for additional tips and techniques for tobacco users in this stage of their quit journey.
These recommendations were adapted from the Clinical Practice Guidelines. The Guidelines were developed by the U.S. Department of Health and Human Services and are published in the Treating Tobacco Use and Dependence: 2008 Update.
Additional Provider Trainings and Resources
The following links include tobacco specific trainings, prevention techniques and guidance on safely reporting tobacco products.
- Additional Resources: