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    “The USPSTF [U.S. Preventive Services Task Force] recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.” Level A recommendation1


    • Quit rates increase with the intensity of counseling (i.e. frequency and length) up to about 90 minutes of total counseling time.1
    • However, brief counseling (3 minutes or less) has been shown to be effective at increasing tobacco abstinence.1-3

    2 A’s + R Model

    • Ask about tobacco use2
    • Advise tobacco users to quit2
    • Refer them to cessation services (e.g. 1-800-QUIT-NOW)2
    5 A’s Model
    Ask about tobacco use2,3
  • Advise tobacco users to quit2,3
  • Assess willingness to attempt quitting2,3
  • Assist in quit attempt2,3
  • Arrange for follow-up2,3
  • Motivational Interviewing

    • A directive, patient-centered counseling technique that helps patients recognize thoughts and feelings that lead to their continuation of unhealthy behaviors and helps them alter thought patterns to assist behavior change.4
    • The goal of motivational interviewing is to help patients move through the stages of readiness for change:he goal of motivational interviewing is to help patients move through the stages of readiness for change:
      • Precontemplation: The patient does not acknowledge a problem.4
      • Contemplation: The patient recognizes a problem and is thinking about treatment or behavior modification.4
      • Action: The patient starts treatment or behavior modification.4
      • Maintenance: The patient integrates new behavior into everyday life.4
      • Relapse: The patient falls back to the undesired behavior.4 


    1. Final Recommendation Statement: Tobacco Use in Adults and Pregnant Women: Counseling and Interventions. Retrieved October 7, 2014 from U.S. Preventive Services Task Force Website:  http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions.
    2. Counseling About Smoking Cessation. Retrieved October 3, 2014 from American Academy of Pediatrics: Julius B. Richmond Center of Excellence Website: http://www2.aap.org/richmondcenter/CounselingAboutSmokingCessation.html.
    3. American College of Obstetricians and Gynecologists. (2011). ACOG Committee Opinion 503: Tobacco Use and Women’s Health. Washington, DC:  American College of Obstetricians and Gynecologists.  Available Online: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co503.pdf?dmc=1&ts=20141016T2150223316. 
    4. American College of Obstetricians and Gynecologist. (2009). ACOG Committee Opinion 423: Motivational Interviewing: A Tool for Behavior Change. Washington, DC: American College of Obstetricians and Gynecologist. Available Online: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/co423.pdf?dmc=1&ts=20141016T2154558634.
    October 2014