Las Vegas – While the implementation of smoking cessation guidelines in both employee and patient settings can be encumbered by a lack of proper application, rigorous counseling models can be effective in certain clinical settings.

In one study presented at the American Association of Nurse Practitioners (AANP) 2013 National Conference, Alexandra Riley, BSN, RN, DNP-S, of the Arizona State University College of Nursing & Health Innovation used the 5A counseling model (Ask, Advise, Assess, Assist, Arrange) to evaluate its effectiveness in reducing patient smoking rates in an Arizona clinic.

The 5A model is endorsed by the Agency for Healthcare Research & Quality (AHRQ) in people who are actively trying to quit smoking.

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Nine adults were enrolled in the project, with eight who confirmed that they wanted to quit smoking. The 5A intervention took eight weeks and included counseling, pharmacotherapy advice, and referrals to local quit-line services.

The Fagerström Test for Nicotine Dependence (FTND), a six-item questionnaire, was given at baseline as well as weeks four and eight of the program.

There were significant changes in nicotine dependency and cigarette consumption between baseline and week eight, but no significant change in smoking cessation. Only one patient had abstained from smoking by week eight.

“To reinforce consistent tobacco cessation counseling, providers and staff should be educated on the 5A counseling process, including smoking cessation medications and the process for referral outside support services,” the author concluded.

In another study presented at AANP 2013, Kathleen McCoy, FNP-BC, FAANP, of Brandman University School of Nursing in Irvine, CA, implemented a system that would promote awareness of smoking cessation as well as support outreach to all employees of a regional hospital.

The project was based on the recommendation from the Joint Commission to “meet needs of nicotine-using employees to promote wellness and reduce duress of habit while at work or on grounds”.

In addition to outreach programs that were customized throughout the entire organization, the project included PR efforts such as anonymous surveys, regular email messages, and department meetings to promote awareness.

However, she found that nicotine users were “hesitant to self-disclose” their habit, reinforcing a “need for education and a culture shift toward informed compassion”.

“[There is] more resistance than expected,” she noted. “Many employees are losing patience with nicotine users, [and] extra breaks for smoking are resented.”

McCoy emphasized that these work-related issues need to be addressed for the safety and management of the hospital. In the future, she is hoping to implement the program in a way that involves non-smokers in order to foster more support.


  1. McCoy KT. Poster #224. “When Political Correctness Can Obscure Care: an NP’s role as a change agent in the Cross Fire of a Nicotine Free Lifestyle Program.”
  2. Riley A. Poster #213. “Smoking Cessation in Primary Care: A Multi-Component Intervention.”

Both presented at: American Association of Nurse Practitioners 2013 Meeting. June 19-23. Las Vegas