 The
Five A's: #1 - Ask
Identify every client's tobacco status at each visit. For current smokers and those that have quit in the past year, smoking status should be updated regularly (NZ
guideline completed).
Implementation: Implement an office wide system that ensures that every client is asked at each visit about their smoking status and that information is documented.
One way to ensure that all office staff are asking about smoking status is to expand your vital signs
'chart to include a
question about her tobacco status.
Vital Signs
| Blood Pressure: |
| Pulse: Weight: |
| Temperature: |
| Respiratory Rate: |
| Tobacco Use (circle one): current former never |
Other Questions to ask that will allow you to gather background smoking habit information are (Synopsis for Physicians):
- Do you smoke?
- How many cigarettes do you smoke a day, a week?
- Are you interested in quitting your smoking habit?
- Have you ever tried to quit smoking in the past? If so, when and how?
In the Ask step you are simply trying to identify if the
client is a current smoker, in the process of quitting smoking, ex-smoker, or non-smoker. Some clients who are smokers will want to quit with your assistance, others will be resistant to considering smoking cessation. If a client is defensive to the suggestion of quitting smoking, the goal becomes to identify why the
client is hesitant to quit. After you have identified why the client is unwilling to attempt quitting smoking at this time, try to brainstorm some possible motivators for your client to attempt to quit smoking with your assistance.
Some reasons a client may be defensive toward suggestions to quit
are:
- Discouraged with unsuccessful attempts
- Lack of awareness about consequences
- Enjoyment of smoking
- Belief she is too addicted to quit
- Feels that she has not suffered any serious health consequences from her addiction
 Activity:
Brainstorm with your client possible reasons for quitting her addiction to tobacco addiction. This will allow you to identify a motivator for change.
A client who is health conscious
or has a family history of disease
might be motivated by...
- Women who stop smoking before becoming pregnant or during the first trimester reduce their risk of miscarriage and low birth weight deliveries
compared to those of a non-smoker.
- Smoking increases the risk of spontaneous abortion.
- Infants of women who smoke have low birth weight, increased risk of SIDS and morbidity.
- Smokers have 2X the risk of dying of a heart attack compared to non-smokers.
- Women over 35 who smoke and use the "pill" are at high risk for heart attack, stroke, and blood clots.
- After 15 years without smoking, risk of disease drops to that of a non-smoker.
A client who is concerned with her outward appearance
might be motivated by...
- A pack a day smoker who pays $3.00 a pack will save
$1,095.00
in one year.
- Smokers may find their opportunities for dating or romantic involvement limited to other smokers,
who comprise only ¼ of the population.
- Smoking will make clothes smell bad.
- Smoking causes yellowing of the fingers, as well as making them smell bad.
- Smoking causes premature wrinkling of the skin.
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