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Tobacco Use or Secondhand Exposure: Assessment and Interventions - Adult/Pediatric - Inpatient/Ambulatory

Tobacco Use or Secondhand Exposure: Assessment and Interventions - Adult/Pediatric - Inpatient/Ambulatory - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Alcohol and Tobacco


Tobacco Use or Secondhand Exposure– Adult/Pediatric – Inpatient/Ambulatory
Guideline Summary
Target Population: Pediatric, adolescent (11-17 years), and adults (18+ years) who use or are exposed to tobacco/nicotine products (excludes pregnant/postpartum patients).
Link to Full Guideline: Tobacco Use or Secondhand Exposure: Assessment and Interventions —Adult/Pediatric—Inpatient/Ambulatory
Screening by Age

Key Practice Recommendations
1. Assess every adolescent and adult patient at every clinical encounter.
2. Assess parental/caregiver use during pediatric visits and address dependence as necessary.
3. Secondhand smoke exposure is harmful to all patients; ask about tobacco smoke exposure.
4. Every tobacco user should be offered minimal or intensive intervention.
5. Counseling and medication combined is the most effective for smoking cessation.
6. Counseling and Nicotine Replacement Therapy (NRT) are recommended 4-8 weeks prior to
surgery to reduce surgical complication rates and increase long-term abstinence.
7. Patients should be encouraged to quit smoking abruptly versus gradually.
8. The choice of medication should be dependent upon patient preferences and prior experi-
ences identified via a discussion with the provider.
9. Clinicians should use motivational techniques and health education to encourage smokers
not currently willing to quit to consider making a quit attempt in the future.
Counseling using Quit Plan Components: STARS
Set a quit date (ideally within 2-3 weeks).
Tell others and ask for support (i.e., coworkers, family, and friends).
Anticipate and plan for challenges (including withdrawal symptoms).
Remove all tobacco products from home, car, and work environments.
Stress total abstinence and sticking with treatment even if a slip or lapse.
Brief Advice and Assessment of Willingness to Quit
1. Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates.
2. The 5 A’s model: ASK, ADVISE, ASSESS, ASSIST, ARRANGE
3. Are you willing to make a quit attempt at this time or in the next 30 days?
Suggested Question (Age 0-10 years)
Is this patient regularly exposed to tobacco smoke (e.g., at home, in a car, at work)?
Suggested Questions (Age 11-17 years)
Have you ever tried tobacco or nicotine products (e-cigarettes, e-hookah, hookah, vape or chew)?
Are you regularly exposed to tobacco smoke (e.g., at home, in a car, at work)?
Suggested Questions (Age 18 years or older)
Do you currently use or have you used tobacco or nicotine products within the last month?
Are you regularly exposed to tobacco smoke (e.g., at home, in a car, at work)?
Evidence-Based Quit Line and Text-Based Tobacco Cessation Resources
National
1-800-QUIT-NOW (1-800-784-8669)
SmokefreeTXT (text QUIT to 47848 from a mobile phone)
www.smokefree.gov (operated by the National Cancer Institute)
Wisconsin
1-800-QUIT-NOW (1-800-784-8669)
Ambulatory Clinics: HealthLink eReferral to Quit Line
UW- Center for Tobacco Research and Intervention
Illinois
1-866-QUIT-YES (1-866-784-8937)
www.quityes.org (operated by the American Lung Association)
Care for Those Not Willing To Quit
A patient unwilling to quit may respond to motivational interventions following the “5 Rs” especially when physician time or training does not permit motivational interviewing:
RELEVANCE, RISK, REWARD, ROAD-BLOCKS, REPETITION
Pharmacotherapy
Pediatrics: No medications are currently FDA approved for tobacco cessation.
Adults: FDA approved and guideline endorsed medications:
ξ Varenicline
ξ Bupropion
ξ Nicotine Replacement Therapy (NRT)
Nicotine gum
Nicotine patch
Nicotine lozenge
Nicotine inhaler
Nicotine nasal spray
For information on drug
choice and dosing, refer
to the medication tables
or the full guideline.
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org