Substance Abuse: Smoking                                                

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How to help your patients quit smoking . . .

The 5As:

1. Ask:  Ask the patient to choose the statement, from among some feasible answers, that best describes her smoking status. The multiple-choice format has been shown to enhance accurate self-reporting.

2. Advise:  In a clear, strong, personalized manner, advise the patient to quit. Give specific information at this time about health risks to both the woman and her future children.

Smoking increases risk of placenta previa, abruptio placentae, IUGR, and preterm rupture of membranes in pregnancy.

There is a clear association between maternal smoking and perinatal morbidity and mortality. Maternal smoking causes fetal hypoxia and decreased blood flow to the uterus, placenta, and fetus. This combined with the direct effects of cigarette smoke ingredients put the baby at increased risk for low birth weight, orofacial clefts, SIDS, neurodevelopmental abnormalities, asthma, colic, and generally increased perinatal mortality.

3. Assess:  Assess the willingness of the patient to quit within the next 30 days.

4. Assist:  Give patient resources (located at the end of this section), provide social support, suggest problem-solving methods such as eliminating triggers, etc.

5. Arrange:  Arrange follow up and assess smoking status at all subsequent visits.