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+. =. BrISCK. Patient using tobacco. Happy, healthy, tobacco-free patient. Brief Intervention Smoking Cessation Kit (BrISCK).

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Patient using tobacco

Happy, healthy, tobacco-free patient

Brief Intervention Smoking Cessation Kit (BrISCK)

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  • Minimal interventions (<3min) and low intensity interventions (3-10min) increase overall tobacco abstinence rates [OR(95%CI): 1.3(1.01-1.6); 1.6(1.2-2.0)] with a strong dose-response relation between the session length and counseling therapies.

Quick Facts

  • Death

    • Cigarette smoking is #1 cause of preventable death in U.S.

    • In U.S., tobacco kills more a Americans than auto accidents, homicide, AIDS, durgs, and fires combine

      • 137,979 CV related deaths/year

      • 101,454 respiratory disease deaths/year including pneumonia, bronchitis, emphysema

      • 123,836 airway cancer death/year including lung, trachea, and bronchus cancer

      • Every 6.5 seconds, someone in the world dies from a smoking–related disease

      • Smoking during pregnancy results in 900 infant deaths/year

      • Cigarettes will leave 12,000 kids motherless/year (33 mothers/day)

  • Secondhand Smoke

    • 50,000 deaths/year from secondhand smoke-related diseases

    • 3000 deaths/year from secondhand smoke-related lung cancer

  • Quitting

    • 63% of high school smokers say they want to quit

    • 61.4% of people below the poverty level want to quit

    • 47.3% of women who have ever smoked have quit

    • 70% of smokers say they want to quit

    • Each year 41% of smokers quit for at least a day

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5 A’s Tobacco Intervention

ASK(about tobacco use at every visit)

- ensure that tobacco use status is asked during your interview

- ensure that tobacco use is documented on every chart

- cigarettes: pack years = #ppd x years

- cigars: # per day, years

- smokeless tobacco: amount/day, years

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5 A’s Tobacco Intervention

ADVISE(all tobacco users to quit)

- “I strongly advise you to quit smoking and I can help you”

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5 A’s Tobacco Intervention

ASSESS (readiness to quit)

- ask every tobacco user if s/he is willing to make a quit attempt at this time

Yes: provide assistance

No: provide motivational intervention

- Calculator, Changes, Resources

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5 A’s Tobacco Intervention

ASSIST(tobacco users in quitting)

1. Provide brief counseling:

- reasons to quit, especially contribution to patient’s health or morbidity, and effect on family and friends

- barriers to quitting

- lessons from previous quit attempts, or other overcoming other lifetime adversities

- set a definitive quit date, if ready

- enlist social support (family, friends, support network)

2. Recommend use of pharmacotherapy or alternative therapies

- Pharmacotherapy, Contraindications, Resources

3. Provide supplementary educational materials

- Resources,Changes

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5 A’s Tobacco Intervention


- Refer using Resources

- On subsequent visit, review progress. Congratulate Success. Encourage maintenance.

- If tobacco use has occurred: ask for recommitment, review circumstances, use lapse as learning experience, assess proper therapy

- Consider referral using Resources

- Fill out Patient Information with every intervention and mail when complete (please, please, please!)

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In Review

  • Ask about smoking with every interview

  • Advise all tobacco users to quit

  • Assess readiness to quit; utilizing Calculator, Changes, and Resources for encouragement

  • Assist in finding appropriate therapies (Pharmacotherapy/Contraindications) and educational services (Resources)

  • Arrange referral (Resources)

  • Fill-out Patient Information with every intervention and mail when complete

  • Hand out the Resources and Changes to every patient, DO NOT HAND OUT THE NEONSTICKERS

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C. Everett Koop Institute

- Dr. C. Everett Koop, Susan Wills, Holly Johnson, Kate Van Brunt


- Dr. Seddon Savage, Mary Batchelder


- Lonnie Larrow, Dr. Joe Odonnell, Dr. Don West, Noah Hoffman


- Rick Wold