Implement a facility or office wide system that ensures that, for EVERY patient at EVERY clinical visit, tobacco use status is queried & documented.

• Expand vital signs to include tobacco use.
• Ask about past & present history of tobacco use.
• Ask about type & amount of tobacco used.

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

• Tie tobacco use to systemic and/or oral health conditions specific to the patient.
• Discuss its social/economic costs or impact on children & others in the household.

Ask every tobacco user if he or she is willing to make a quit attempt at this time (e.g., within the next 30 days).

• If the patient is willing to quit, assist (see below).
• If the patient clearly states he/she is unwilling to quit at this time, provide a motivational intervention.
• 5 R's Relevance, Risks, Rewards, Roadblocks, Repetition.

For the patient willing to make a quit attempt:

• Help the patient with a quit plan & set a quit date (ideally in <2 weeks).
• Provide practical counseling (problem solving).
• Provide a supportive physical environment.
• Review and/or recommend appropriate pharmacotherapy.
• Provide appropriate referrals for intensive therapy, & inform patients of community resources such as NYS tobacco-cessation hotline.

Schedule follow-up contact, preferably within the first week after the quit date.

• Congratulate success & encourage commitment to continue.
• If tobacco use has occurred, review circumstances & elicit recommitment to abstinence.
• Schedule future follow-up.