The Five A's of Smoking Counseling

What every physician must remember to do:

  1. Ask whether the patient smokes.

  2. Advise them to stop.
  3. Brief advice to quit smoking from a clinician increases cessation rates by 30%.
  4. Assess their readiness to quit.
  5. Assist them in quitting.
  6. The goal is to educate about the importance of quitting smoking. You needn't provide all of the elements of this counseling; that can be done by referral to a cessation program. Just get the process started.
  7. Arrange follow-up care.

Of all the evidence-based guidelines in preventive healthcare, this is perhaps the most important.


Five Major Steps to Intervention (The "5A's")
Surgeon General

Clinical Practice Guideline: Treating Tobacco Use and Dependence
Fiore MC, Bailey WC, Cohen SJ, et al.; Rockville, MD: US Department of Health and Human Services, Public Health Service; 2000.

Management of Nicotine Addiction, Fact Sheet
US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000.

Policy recommendations for smoking cessation and treatment of tobacco dependence
World Health Organization. Geneva, Switzerland; 2003.