 The
Five R's
Implementation: Ask every tobacco user if she is willing to make a
cessation attempt at this time.
If the client is not willing to quit at this time, then implement the Five R's to motivate your client and let
her know that you are available to help when she is ready.
 Relevance
Encourage the client to indicate why she does not wish to quit at this time, ask
her to be as specific as possible. This will assist you in finding motivational materials to supply your client that are relevant to
her needs. Motivational information and pamphlets have the greatest impact if they are relevant to a
client's needs, beliefs, social situation, age, gender, and family situation.
 Risks
As a health care provider ask your client if she understands the negative health consequences of smoking and the potential dangers to
her unborn child. Be sure to emphasize that smoking low tar/low nicotine cigarettes or use of other forms of tobacco products will not eliminate the health consequences to
her nor to her unborn child.
 Acute risks:
- Shortness of breath
- Exacerbation of asthma
- Harm to pregnancy
- Infertility
- Increased serum carbon monoxide
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Long-term risks:
- Heart attacks and strokes
- Lung and other forms of cancers
- Chronic obstructive pulmonary diseases
- Long-term disability
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Environmental risks
for children and spouses of smokers:
- Increased risk of lung and other cancers
- Heart disease
- Higher rates of smoking among children of smokers
- Increased risk of low birth weight infants
- Increased risk for SIDS
- Asthma
- Middle ear disease
- Increased respiratory infections
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 Rewards
Identify some possible benefits of a smoke-free life style with your client. Make sure to emphasize those benefits that are most relevant to your client using the list created with your client during the Relevance stage (R-1).
 Roadblocks
As a health care provider ask the client to identify some possible roadblocks or barriers to quitting smoking that are preventing
her from attempting to quit at this time.
Potential roadblocks:
- Withdrawal symptoms
- Fear of failure
- Weight gain
- Lack of support
- Depression
- Enjoyment of tobacco products
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 Some
rewards:
- Improved health
- Food will taste and smell better
- Save money
- Improved self-esteem
- Set a good example for her children
- Have healthier children
- Improved physical health
- Increased performance in physical activity
- Reduce premature aging
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 Repetition
The motivational interventions should be repeated every time an unmotivated client is seen in the office during her pregnancy and then during regular office visits for non-pregnant
clients. Remind clients who have relapsed after past attempts to quit that many people will relapse in the process of quitting smoking, but that temporary relapse should not prevent them from
trying again.
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