A Pilot Study on Inducement of Smoking Cessation by a Simple 5A (Asking, Advice, Assess, Assist, and Arrange) Approach at  Outpatient Clinics


Asking smokers about their smoking status, followed by advice to quit smoking, assessing the intention to quit , ‍assistance with cessation, and arrange of follow-up (5A) is recommended for induction of smoking cessation. To ‍obtain preliminary data on effects of “5A” , we investigated the smoking cessation rate with two modes in the phase ‍I: 1) self-administered questionnaire and 2) doctor’s interview at respiratory disease clinics of three general hospitals ‍in Japan, and another mode in phase II: 3) doctor’s interview with an additional pamphlet at one of the three ‍hospitals. The interviews for smokers were conducted by doctors in charge of treatment. Subject smoking habits ‍were followed up by postal surveys three months after the enrollment. In phase I, 359 outpatients were recruited and ‍189 smokers responded, among whom 27 patients (7.5% of 359 outpatients) had quit smoking at the three months ‍after the enrollment. The cessation rate of the self-administered questionnaire group (8.4% of 238 smokers) did not ‍differ significantly from that of doctors’ interview group (5.8% of 121 smokers). Age and intention to quit at enrollment ‍were found to be independent predictors of smoking cessation. Patients aged 50 years or older (odds ratio=5.05, 95% ‍confidence interval 1.89-13.54), and participants with an intention to quit (odds ratio=6.78, 95% confidence interval ‍2.66-17.30) were more likely to be successful in quitting. In phase II, another 212 smokers of one hospital were ‍interviewed by doctors in charge and provided with an additional pamphlet describing how to practice to dislike ‍smoking. No significant difference in the cessation rate was observed between phase I and phase II (5.8% vs. 8.0%). ‍In conclusion, there were no differences among the three modes of “5A”, but 7.7% of the 571 outpatients visiting ‍respiratory divisions quit smoking with this simple “5A”. The findings may indicate that this simple practice at ‍clinics is useful for smoking cessation strategy, although randomized trials are now required.