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.


Protocol for Identifying and Treating Patients Who Use Tobacco

Remember that light smoker = <10 cigarettes daily

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.

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

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

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.


Information on Electronic Cigarettes

Campaign for Tobacco Free Kids and Centers for Disease Control has more information about electronic tobacco products that look like flash drives. These products’ small cartridges have fruit and candy flavor and nicotine levels equal to a pack of cigarettes


"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.


To learn more about E-cigarettes visit the E-liquid Database

In recent years, e-cigarette use among adolescents and young adults has been rising. “E-cigarettes are now the most commonly used tobacco product among youth in the United States.” Furthermore, the director of the Centers for Disease Control and Prevention (CDC) has stated, “Tobacco use among youth and young adults in any form, including e-cigarettes, is not safe”.

E-cigarettes produce a cloud-like vapor by heating what is known as e-liquid. E-liquid is a viscous fluid composed of propylene glycol (PG), vegetable glycerin (VG), flavorings, and other chemical additives such as nicotine. Many of these flavorings and chemical additives contained in the e-liquid have never been tested on the lungs and their effects are largely unknown.

About the E-liquid Database:One of fourteen recently funded Tobacco Centers of Regulatory Science (TCORS) designed to advance the public's knowledge of tobacco products please read more about the E-liquid data here .


For more information on e-Cigarettes please access the link below:

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.

How to Talk to Your Patients About Quitting Smoking