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Jun 25, 2015

Action, Not Advice, Helps Smokers Quit

Creating a quit plan and providing tools for ongoing support is more effective than education alone in helping smokers quit.

Smoking cessation tools are more effective than advice alone when it comes to helping smokers quit, according to a study recently published in JAMA Internal Medicine.

Smoking is the No. 1 preventable cause of death in the United States. That’s why it’s considered best practice for primary care doctors to discuss smoking status with patients at each and every visit.

To increase a smoker’s likelihood of quitting during this conversation, guidelines recommend that doctors cover each of these “5A’s”—ask, advise, assess, assist and arrange follow-up.

By hitting all five points, doctors can educate patients about the dangers of smoking and boost their chances of quitting.

Here are the “5A’s”:


  • ASK about patients’ smoking habits.
  • ADVISE patients about the dangers of smoking and benefits of quitting.
  • ASSESS patients’ willingness to quit smoking.
  • ASSIST with creating a quit plan, complete with smoking cessation tools and resources.
  • ARRANGE for follow-up and support to help a patient quit for good.

But just how effective is this approach? To see how often doctors use the 5A’s and how effective these steps are in helping smokers quit, researchers analyzed data from the National Lung Screening Trial. The study included more than 3,300 patients, all of whom were between the ages of 55 and 74 and had smoked for at least 30 years.

During the five-and-a-half year study, participants underwent lung cancer screenings and discussed smoking cessation with their primary care doctor. For each patient who successfully quit at any point in the study, researchers matched them with a participant who remained a smoker throughout the entire trial.

After analysis, researchers found that three out of four patients were “asked” about their smoking habits and “advised” about quitting during their doctors visit. Additionally, doctors “assessed” patients’ willingness to quit about 63% of the time. However, these three “A’s” had no significant impact on a patient’s likelihood of quitting.

The good news is that having doctors “assisting” and “arranging” in the quitting process increased a patient’s chances of quitting by up to 46%. However,  analysis showed that only half of doctors actually assisted patients with a quit plan and just 10% arranged for follow-up support.

Based on study findings, authors conclude that education-based interventions are less effective than action-based steps in helping smokers quit. Not only does this study confirm the benefits of creating a concrete action plan for quitting, it highlights the need for doctors to provide these services more readily.

Questions for You to Consider

  • Are the health effects of smoking irreversible?

  • Absolutely not. Smokers experience many benefits by quitting, some of which begin just minutes after stopping smoking. Twenty minutes after quitting, blood pressure and heart rate will drop, and the benefits continue to improve over time. One year after quitting, risk of heart disease will be half that of a smoker; within years, risk for stroke, heart disease and other health conditions can equal that of a non-smoker.
  • What smoking cessation aids exist to help smokers quit?

  • A variety of tools exist to help smokers quit. Aside from quitting cold turkey without the use of aids, adults can be prescribed smoking cessation drugs that help to fight nicotine withdrawal and tobacco cravings. There are also various types of nicotine replacement therapy, including patches, inhalers, lozenges, gum and nasal spray that can help wean smokers off of cigarettes.

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