Tobacco education posters, tabletop signs, and other visible messages can help prepare patients for the intervention. The Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence recommends medical offices to include tobacco use as a vital sign to ensure proper documentation of tobacco use and intervention on the patient's medical record.

ADVISE
 
In a clear, strong, and personalized manner, urge every tobacco user to quit.
 
Examples:

• "I think it is important for you to quit smoking now and I can help you. Cutting down while you are ill is not enough."
  
  
• "As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you."
  
  
• Tie tobacco use to current health/illness, and/or its social and economic costs, motivation level/readiness to quit, and/or the impact of tobacco use on children and others in the household.
  
  
• "Ms. Jones, if you quit smoking now, I'm sure that your child will have to be seen less frequently in the emergency room for his asthma. The clinic staff and I will help you."
  
  
• "Tobacco is very expensive! Right now you are smoking one pack a day. At around $4 a pack, you could save over $1,400 a year if you quit."

ASSESS

Ask every tobacco user if he or she is willing to make a quit attempt at this time
(for example, within the next 30 days).

ASSIST

Assist the patient in quitting.
If the patient is willing to make a quit attempt, assist the patient with a Quit Plan. The core components of a Quit Plan include:

• Setting a quit date
  
• Identifying social support
  
• Providing specific problem-solving suggestions
  
• Recommending the use of approved pharmacotherapy, except in special circumstances
  
• Providing self-help materials, as appropriate to particular populations (for example, adolescent, pregnant/postpartum, racial/ethnic minority)
  
• Referring to intensive services, if appropriate

If the patient clearly states an unwillingness to make a quit attempt at the present time, provide assistance through a motivational intervention using the Five R's. It is NOT necessary (or even helpful) to try to talk an unwilling patient into quitting. People who are unwilling or not ready to make a quit attempt at the time of the intervention may be ready the next time. With these individuals:

• Avoid being judgmental or trying to pressure the tobacco user into quitting.
  
• Provide a brief motivational intervention using the "5 R's:" Relevance, Risks, Rewards, Roadblocks, and Repetition.
  
• Offer self-help materials or literature that emphasizes the benefits of quitting tobacco.

ARRANGE

Arrange for follow-up contact, either in person or via telephone.
Follow-up may be arranged for a specific time, such as when a patient returns to a dental clinic. Follow-up may be as simple as an invitation to talk about quitting in the future. It is particularly important to arrange follow-up contact with a tobacco user who is making a quit attempt. Whenever possible, arrange the follow-up within a week after the individual's quit date. During the follow-up contact:

• Ask about tobacco status.
• Congratulate individuals who are tobacco-free and support them in staying quit.
• Support those who have relapsed and assist them in making a new quit attempt