healthprovidersMost smokers see a health care provider at least once a year. Clinicians are in a position to intervene with patients who use tobacco.  Smokers cite a physician’s advice to them to quit is an important motivator for them to attempt to stop using tobacco.  Clinicians have high credibility with smokers; and can capitalize on office visits to identify tobacco users and intervene.

Seventy percent of tobacco users report that they want to quit and almost two-thirds who relapse want to try quitting again within 30 days. This can be done by following the 5 “a’s”or in other words, conduct a brief intervention that takes less than 10 minutes. As simple as physicians advising their patients to quit smoking can produce cessation rates of 5% to 10% per year. More intensive interventions, combining behavioral counseling and pharmacologic treatment, can produce 20% to 25% quit rates in one year.

The “5 A’s” model for treating tobacco use and dependence

1. Ask about tobacco use!

   Identify and document tobacco use status for every patient at every visit.

2. Advise to quit!

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

3. Assess willingness to make a quit attempt!

   Is the tobacco user willing to make a quit attempt at this time?

4. Assist in quit attempt!

   For the patient willing to make a quit attempt, offer medication and provide or refer for counseling

   or additional treatment to help the patient quit. Refer patient to the CT Quitline using the fax

   referral form link below.

   For patients unwilling to quit at this time, provide interventions designed to increase 

   future quit Attempts.  (see table for 5 R’s)

5. Arrange! follow-up

   For the patient willing to make a quit attempt, arrange for follow-up contacts, beginning within the

   first week after the quit date.

   For patients unwilling to make a quit attempt at this time, address tobacco dependence and

   willingness to quit at their next clinic visit.

Help your patients quit packets - pcp packet & rt/pulmonology packet

protect your patients from second hand smoke packet - for pediatricians

Patient not ready to make an attempt right now
Once a clinician has assessed a patient’s willingness to quit and the patient is not ready to make an attempt at this time, use brief intervention or Motivational Interviewing (MI) designed to educate and motivate the patient. MI techniques focus on exploring and resolving a tobacco user’s reasons for using and not wanting to attempt to quit tobacco. The content areas that should be addressed in a MI counseling intervention can be found in the “5R’s” table below.  For specific strategies of MI review the US Department of Health and Human Services Recommended Guidelines for Treating Tobacco Use.


The “5 R’s” for enhancing motivation to quit tobacco


Encourage the patient to indicate why quitting is personally relevant- being as specific as possible. How does it relate to the patient’s disease status or risk, family or social situation (e.g. children at home), health concerns, age, gender and other characteristics important to the patient.


Ask the Tobacco user to identify potential negative consequences of tobacco use.  Suggest and highlight those that seem most relevant to the patient.


Ask the patient to identify potential benefits of stopping tobacco use.  Suggest and highlight those that seem most relevant to the patient.


Ask the tobacco user to identify barriers to quitting and suggest treatments that could address those barriers.  Common barriers are withdrawal symptoms, fear of failure, weight gain, lack of support, and enjoyment of tobacco.


MI should be repeated every time the unmotivated patient visits the clinic setting.  Tobacco users who failed in a previous quit attempt should be told that most people make repeated attempts before they are successful.












  • Lung & Bronchus cancer ranks 3rd in types of cancer for all races and ethnicities. It ranks 2nd in Asian/Pacific Islander. (Connecticut)
  • The incidence for lung & bronchus in Connecticut is higher than the national average.
  • New Haven, New London, Windham and Middlesex counties have the highest incidence of lung & bronchus cancer for all races combined.

National Cancer Institute, National Vital Statistics System data from 2009-2013

Talk to your patients that are current smokers or have been smokers in the past about getting a lung cancer screening.  Studies have shown that a Low Dose CT Scan (LDCT) which scans the body using low dose radiation to make detailed pictures of the lungs, can help detect lung cancer at an early stage when it's most treatable, decreasing the risk of dying from lung cancer.

The US Preventive Task Force recommends yearly lung cancer screening with LDCT for people whom meet the following criteria:

  • Have a history of smoking 30 pack years or more (a pack year is smoking an average of one pack of cigarettes per day for one year).
  • Currently smoking, or have quit within the past 15 years.
  • Between the ages of 55 and 80 years old

Exposure to Household Radon Information - Can Cause Lung Cancer

Criteria for referring patients for a Low Dose CT scan and patient resources can be accessed from The American Lung Association. This site incudes an interactive web screening tool that can be helpful for patient and provider decision making.

The Low Dose CT Scan is covered by Medicare. Computed Technology (CT) Scan is covered by Connecticut Medicaid Husky program.

Lung Cancer Screening Guidelines and Recommendations

List of Lung Cancer Screening Centers

DPH Comprehensive Cancer Program

State Cancer Rates (2013)



Algorithm for Treating Tobacco Use

Quitline Flyer for Healthcare Professionals

What Happens When I Call the Quitline

CT Quitline brochure

CT Quitline Fax Referral Form ( English)

CT Quitline Fax Referral Form (Spanish)

Local Community Cessation Programs

Tobacco Control Program - 860-509-8251