Ask and Advise

The 5 A's (Ask, Advise, Assess, Assist, Arrange) is a framework for providers to treat tobacco dependence and exposure. A shorter version is Ask, Advise, Refer to a quitline counselor at the California Smoker's Helpline at UC San Diego. Scroll down for script examples of the 5 A's and brief video showing how to Ask, Advise, and Refer in 2 minutes.

ASK: Timeframe is usually past 30 days. Tobacco products include smokless and e-cigarettes. Asking about non smoker exposure to smoke (passive smoker) is important because there is no safe level of exposure. 

ADVISE: Even brief advice is powerful motivator for patients. Tie in to patient's health status or concerns such as family well-being.

ASSESS: If not ready to quit, consider telling patients to make a small change such as a smoke-free home and car to protect others, or their routine. Offer referral to Helpline for educational materials

ASSIST/ARRANGE: The Helpline counselors can help discuss medication options and an individualized quit plan. The Helpline can also assist passive smokers seeking help from smokers.

Remember that light smoker = <10 cigarettes daily

Protocol for Identifying and Treating Patients Who Use Tobacco


"Practical Counseling" definition for the Joint Commission's hospital TOB-2 measure.

Definition: The components of practical counseling require interaction with the patient to address the following: recognizing danger situations, developing coping skills, and providing basic information about quitting.


How to Talk to Your Patients About Quitting Smoking

YouTube Video

In this short video, Steve Schroeder, M.D., UCSF Professor of Medicine and Director of the Smoking Cessation Leadership Center, discusses the importance of asking and advising all smokers to quit, and Dean Schillinger, M.D., Chief, Division of Internal Medicine, San Francisco General Hospital, provides a short demonstration about how to talk to patients about quitting.