The 4 A’s

The Ask, Advise, Assist, Arrange protocol provides guidance in implementing both brief and intensive intervention for smoking cessation.

Minimal Smoking Cessation Intervention (lasting 1-3 minutes)

ASK: About tobacco use with all clients (e.g. “have you used any form of tobacco in the past six months?”) and assess readiness to quit. If time allows, assess the person’s level of motivation to change behavior, using motivational interviewing techniques. Document tobacco use status.

ADVISE: Every tobacco user of the importance of quitting in a non-judgmental and unambiguous manner.

ASSIST: By providing minimal intervention. Refer to support and self-help resources, community clinics and services, other healthcare providers.

ARRANGE: Follow-up or referral.

Intensive Smoking Cessation Intervention (Lasting more than 10 minutes)

ASK: About tobacco use with all clients (e.g. “have you used any form of tobacco in the past six months?”) and assess readiness to quit. If time allows, assess the person’s level of motivation to change behavior, using motivational interviewing techniques. Document tobacco use status.

ADVISE: Every tobacco user of the importance of quitting in a non-judgmental and unambiguous manner.

ASSIST: By providing intensive intervention:

• Determine and discuss the stage of change
• Discuss reasons for smoking
• Assess nicotine dependence
• Discuss strategies to quit, and treatment options
• Offer information re: pharmacotherapy options
• Set a quit date
• Review quitting history, past quit attempts and discuss these experiences
• Review potential challenges and triggers
• Encourage support of family and friends.

ARRANGE: Follow up or referral. Schedule a follow-up or refer to a community stop smoking clinic or service.