The 5A process (Ask, Advise, Assess, Assist, Arrange) is the result of the most comprehensive evaluation yet available on the delivery of smoking cessation services recommended by the USPHS, according to a study published in the August issue of the American Journal of Preventive Medicine.

Physicians Asked to Take the Lead

In contrast to commonly held beliefs, most smokers want their doctors to address the issue of smoking and are more satisfied with their health plan when they receive help with quitting, the study indicates.

Often, however, even when smokers are motivated to quit, they do not ask their physician for help. The USPHS plan is designed to reach even the most reticent patients.

"Limiting tobacco treatment to smokers who ask for help overlooks many who are interested in quitting but are unaware of the services available from their health providers, notes study author Virginia P. Quinn, PhD.

"Effective tobacco control requires offering cessation services to all smokers. Even light smoking carries substantial health risks, and lighter smokers may be less aware of this danger," she added.

"Health plans may be able to increase the effectiveness of their tobacco control efforts by encouraging smokers to ask their physicians for help," Quinn pointed out. " This should provide encouragement to physicians to treat smokers and an incentive to healthcare organizations to support delivery of tobacco-cessation services."

No. 1 Cause of Early Death

Cigarette smoking continues to be the principal cause of premature death in the nation and a major cause of medical expenditures and lost productivity.

Of the 46.5 million adults in the United States who smoke, about 70% will see a primary care provider at least once a year.

The USPHS recommends that physicians take the following steps:

1. Ask every patient about tobacco use.

2. Advise all smokers to quit.

3. Assess smokers' willingness to make a quit-attempt.

4. Assist smokers with treatment and referrals.

5. Arrange follow-up contacts for patients.