Version May 2024
| Intervention | Technique |
| Anticipate | Routinely ask parents about whether they smoke or vape and discuss the health effects of both. Discuss the possibility that preteen and adolescent children might start smoking or vaping and emphasize the need for consistent messages from parents to prevent initiation. |
| Ask | For all adolescents at every visit, ask about tobacco and vaping use without the parents in the room. For preteen children, also inquire about tobacco and vaping use in an age-appropriate manner (eg, whether they have ever "tried" smoking or vaping 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 nonusers to remain tobacco-free. For patients who report vaping, advise regarding the potential health risks, including promoting nicotine addiction. |
| 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 or vaping 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 they are 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). Consider nicotine replacement or other cessation pharmacotherapy if the patient seems likely to have nicotine withdrawal symptoms. |
| 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 the patient has used tobacco or vaping, review the 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. |
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