Brief Tobacco Intervention for Referral Partners

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Step 1: Ask

Healthcare providers and employers can play a significant role in helping their patients, clients, or employees address tobacco use. In the Ask step in the Ask-Advise-Refer framework, the goal is to gather an understanding of an individual’s attitudes and feelings about tobacco use, as well as their willingness to quit.

Interventions as brief as three minutes can increase cessation rates significantly. 1

The flowchart below serves as a concise overview of the outcomes of Brief Tobacco Intervention, but not all conversations may look like this. You can, and should, tailor questions to be relevant to the individual you are speaking with. Remember – individuals may have unique experiences, attitudes, and perceptions towards tobacco and nicotine products. These factors may influence their willingness to quit.

If an individual has ambivalent feelings about using or quitting tobacco products, asking open-ended questions may help them uncover their feelings and attitudes and may serve as a motivator throughout their journey to quit for good.  In doing so, you may help individuals develop the self-efficacy and internal motivation to quit.

The 5 R’s is a widely used tool designed to help motivate tobacco users who are unwilling to quit. Click on each of the five R’s below to see suggested language you can use when asking an individual about their feelings and attitudes towards quitting tobacco. 2

“How would you describe the role of tobacco in your life currently”

“How is quitting personally relevant to you?”

Encourage your patient, client, or employee to think about the many different ways that quitting may have an impact on their life. Motivational information has the greatest impact if it is relevant to an individual’s health concerns, family or social situation (e.g. having children in the home), age, gender, and other lived experiences (e.g. prior quitting experience, personal barriers to cessation). Aim to explore the individual’s perception of the relevance of tobacco use in their life and the motivations behind considering quitting.

“Can you describe any of the potential risks of continued tobacco use?”

“Do you know how tobacco use can affect the health of those around you, including family members and children?”

“Have you noticed any changes in your physical health since you started using tobacco?”

“Can you describe any potential benefits of quitting?”

“Have you experienced any positive outcomes when attempting to quit or reduce tobacco use in the past?”

“What challenges or obstacles have you encountered when trying to quit or cut back on tobacco use?”

What strategies can you use to overcome these challenges and obstacles?”

“Have you tried to quit before?”

“What worked and what didn’t work in your previous quit attempt?”

Have you noticed any patterns or triggers that lead to repeated cycles of tobacco use?

Quitting is a process, not a single event. On average, it takes 8-11 attempts before an individual is successful in quitting for good. Slip-ups – having a puff or smoking one or two cigarettes – are common but don’t mean that a quitter has failed. The important thing is that they keep trying to quit. A slip isn’t the same as a relapse. 3