The Fagerström Test is useful for determining a patient's level of nicotine addiction. The test assesses the extent to which nicotine controls the behavior. Healthcare providers working with smokers may download and print the test from the Related Resources section, and then have their patients complete the form and determine their own scores prior to counseling. Add the points acquired from each question. The total determines whether the patient is dependent on nicotine. Withdrawal symptoms are more likely with a higher score and are likely to be stronger.

Assess the patient's stage in the quitting process. Quitting smoking is a process of change with several stages. People typically move through stages of change in a nonlinear, cyclical fashion (Prochaska and DiClemente 1982; Prochaska and Velicer 1997). Most successful former smokers have attempted to quit many times, repeating the cycle over and over. Hover over each step to get more information.

Assess the patient's interest in quitting by asking questions such as the following:

"Do you want to quit?" "Do you feel you need to quit?" "Are you ready to quit?"

It is important to understand how the tobacco user feels about quitting in order to determine what type of assistance to provide. Many smokers are not ready to quit but know enough about adverse health effects to know that they should quit. Others are ready to quit and can be provided assistance. Even if a smoker is not actively interested in quitting, it is still important to provide an intervention appropriate for his or her current frame of mind. Regular discussions about quitting can be effective.

A health professional's advice is respected. Patients want to believe their doctor's advice. Therefore, they must know you have an opinion about tobacco use.

Make a clear but caring statement, such as:

"As someone who is interested in your health and well-being, I think you should stop using tobacco, and very soon."

Even brief advice can significantly increase patient quit rates and long-term abstinence rates. As little as 3 minutes of advice has been shown to be effective (Fiore et al. 2008). Likewise, advise nonsmokers not to start using tobacco.

Establishing every patient's tobacco use status is like determining any other vital sign. As an alternative to a questionnaire completed by the patient, smoking status of patients can be assessed while vital signs are measured. The results may be entered in the patient record with the other vital signs. Making tobacco use queries a part of vital signs increases the likelihood of clinician intervention (Fiore et al. 2008)

Smoking Status Incorporated Into the Chart

Or Added to a Vital Signs Sticker

Tobacco use status information must be readily available to healthcare providers and clinic staff. Mark tobacco use status on the patient record. The clinic receptionist or records manager can put a tobacco use identifying mark on each patient's chart -- "Free From Tobacco" or "Tobacco User" -- in a discrete area of the record to protect patient confidentiality. Absence of the tobacco use marker indicates a patient has not been asked about tobacco use. Making record identification a part of clinic routine increases the likelihood of clinician intervention (Fiore et al. 2008)

Some other ideas for where to store patient tobacco use information include the following:

• With identification stickers on the patient record
• With the vital signs
• In electronic records
• With an alternative universal identification system

(Fiore et al. 2008).

Some computer reminder systems may be customized to prompt you to enter this information.