Table 3.

The “five As” strategic model for treating tobacco use and dependence, for the patient willing to quit

Strategy	“As”	Action
A1	Ask	Systematically identify all tobacco users at every visit Current | former| never
A2	Advise	Strongly urge all tobacco users to quit “Continuing to smoke makes your asthma worse, and quitting may dramatically improve your health” “Quitting smoking may reduce the number of ear infections (and asthma attacks) your child has”
A3	Assess	Determine willingness to make a quit attempt Determine stage of changea “How do you feel about your smoking at the moment?” “Are you ready to stop smoking now?”
A4	Assist	Aid the patient in quitting (provide medication and counseling) Help the patient with a quit plan Recommend the use of approved medication except when contraindicated or the evidence is insufficient Provide practical counseling (total abstinence, make the home smoke free, build positively on past quit experiences, avoid alcohol, and other triggers) Provide supplementary materials (National Quitline network)
A5	Arrange	Ensure follow-up contact, within a week of the quit date

Note: Adapted from Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; 2008.^{62 a}The Australian Clinical Guidelines now emphasize the “stages of change”, as opposed to “readiness to quit”.⁶¹