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©2013 UpToDate ® Print Email Six "A's" to prevent smoking initiation or support smoking cessation among adolescents Intervention Technique Anticipate Routinely ask parents about smoking and discuss the health effects of tobacco use. Discuss the possibility of smoking onset in pre-teen and adolescent children, and the need for consistent messages from parents to prevent smoking initiation. Ask For all adolescents at every visit, ask about tobacco use without the parents in the room. For pre-teen children also inquire about tobacco use in an age-appropriate manner (eg, whether they have ever "tried" smoking or thought about trying). Also inquire about tobacco use among peers, as this may predict smoking initiation. Advise Strongly urge all tobacco users to quit in a clear, strong, personalized manner. Advise all non-users to remain tobacco-free. Advice should be: Clear - "I think it is important for you to quit smoking now and I can help you." "Cutting down is not enough." "If you wait until you feel bad effects of smoking it will be too late." Strong - "As your doctor, I want you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. I will help you quit." Personalized - Tie tobacco use to current and future health and athletic performance, its social and economic costs, motivation level/readiness to quit, and the impact of tobacco use on siblings and others in the household. Remind parents of their responsibility as role models. Assess Determine the patient's willingness to quit smoking within the next 30 days: If the patient is willing to make a quit attempt at this time, provide assistance. If the patient will participate in an intensive treatment, deliver such a treatment or refer to an intensive intervention. If the patient clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention. If the patient is a member of a special population (eg, pregnant smoker, racial or ethnic minority), consider providing additional information relevant to this population. Assist Provide aid for the patient to quit (eg, set a quit date, provide counseling and self-help materials, refer to a quit line). Arrange

If the patient clearly states he or she is unwilling to make a quit attempt at this time, provide a motivational intervention. If the patient is a member of a special population (eg, pregnant smoker, racial or ethnic minority), consider providing additional information relevant to this population. Assist Provide aid for the patient to quit (eg, set a quit date, provide counseling and self-help materials, refer to a quit line). Arrange Schedule follow-up contact, either in person or by telephone. Follow-up contact should occur soon after the quit date, preferably during the first week. A second follow-up contact is recommended within the first month. Schedule further follow-up contacts as indicated. Congratulate success during each follow-up. If tobacco use has occurred, review circumstances and elicit recommitment to total abstinence. Remind the patient that a lapse can be used as a learning experience. Identify problems already encountered and anticipate challenges in the immediate future. Assess pharmacotherapy use and problems. Consider use or referral to more intensive treatment. Adapted from: Fiore, MC, Bailey, WC, Cohen, SJ, et al. Treating Tobacco Use and Dependence. Quick Reference Guide for Clinicians. Rockville, MD: US Department of Health and Human Services. Public Health Service. October 2000 and Sims, TH. Pediatrics 2009; 124:e1045.