Practice Tools to Address Tobacco Use and Secondhand Smoke Exposure

• American Academy of Pediatrics Section on Nicotine and Tobacco Prevention and Treatment (SONTPT) – This AAP section provides information about effective clinical interventions for tobacco prevention and dependence. The SONTPT's network of clinicians responds to and advocates for policies that reduce exposure to tobacco smoke. 
• Supporting Youth who are Addicted to Nicotine: Advice for Pediatricians – This factsheet provides information for pediatricians about how to support adolescents who are addicted to nicotine from cigarettes, vaping, or other tobacco products. The content includes tips for screening, counseling, and helping youth with a cessation attempt. This factsheet is also available in Spanish  
• Nicotine Replacement Therapy and Adolescent Patients: Information for Pediatricians – This document provides information for pediatricians about how to use nicotine replacement therapy (NRT) to support adolescents who are addicted to nicotine from cigarettes, vaping, or other tobacco products 
• Talking to Teens about Tobacco: Clinician Fact Sheet – Created by the AAP Section on Tobacco Control, this fact sheet provides an easy reference guide to help clinicians utilize the 5As screening and counseling technique with teens. 
• Become A Quitter Infographic – Created by the AAP Richmond Center, this infographic covers different ways to quit (such as the quitline, texting programs, and nicoti​ne replacement therapy), and can be shared directly with patients and families. 
• Coding and Payment for Tobacco and Secondhand Smoke-Related Counseling – Information to ensure that you and your office staff are compensated accordingly for time spent discussing tobacco use and/or exposure to secondhand smoke during patient encounters. 
• ENDS Fact Sheet​ – This fact sheet, based on common recommendations from the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, and the American Medical Association, discusses the facts about and harms of electronic nicotine delivery systems (ENDS) and stresses the use of evidence-based cessation resources for those who want to quit smoking. 
• Hooked on Nicotine Checklist – The Hooked on Nicotine Checklist (HONC) is a brief instrument that is designed to assess nicotine dependence in adolescents. It was developed by researchers at the University of Massachusetts Medical School, and is available for public use. The HONC has been adapted for use with both cigarette users and e-cigarette users.

To access the vaping/e-cigarette version of the HONC, click here. 

To access the cigarette version of the HONC, click here.  

• Modified Verson of the Fagerstrom Tolerance Questionnaire – The Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ) is a brief instrument that is designed to assess nicotine dependence in adolescents. It was adapted by researchers at the MD Anderson Cancer Center, and is available for public use. 
• E-Cigarette Dependence Scale – The E-Cigarette Dependence Scale (EDS) is a measure of nicotine dependence that has been adapted for use with adults and adolescents. It was adapted by researchers at Oberlin College and Yale School of Medicine. To access the 4-item version of the EDS for adolescents, click here. 
• Fingertip Formulary – A tool that provides an easy way to determine formulary drug status for different health plans in your local area. This tool is also available as an app for mobile devices. 
• Helping Patients Quit Infographic – Get the why, when, and how of helping patients quit in this AAP Richmond Center infographic. 
• Smoking Cessation Leadership Center – The Smoking Cessation Leadership Center offers tools and resources for clinical teams who want to assist tobacco users in the practice setting. 
• Solving the Puzzle: A Guide to Pediatric Tobacco Control – This guide, created by the Richmond Center, includes resources for health care clinicians, guidance on working with youth and families, cessation materials, and strategies to keep communities smoke-free on multiple levels. 
• Strengthening Health Systems for Treating Tobacco Dependence in Primary Care – This training package aims to assist countries in taking one of their first steps towards providing comprehensive tobacco dependence treatment to all tobacco users by integrating brief tobacco interventions (brief advice) into primary care. 
• Working with Specific Populations​ – Links to resources created especially for specific populations. These resources may be helpful for you and your team, and may be helpful for your patients to get additional support. 

• Addressing Tobacco in Dental Settings (AAP Factsheet) – This factsheet from the American Academy of Pediatrics and Campaign for Dental Health outlines strategies for addressing tobacco in dental settings, and includes information on the ways that tobacco harms oral health. The factsheet also includes a one-page resource that can be distributed to patients and families. 
• American Academy of Pediatric Dentistry: Policy on Tobacco Use – A helpful resource for pediatric dentists, this document offers guidelines on tobacco in its various forms.
• American College of Chest Physicians: Tobacco Dependence Treatment Toolkit (free login required) – This toolkit offers effective tools, treatment algorithms, and compensation strategies for tobacco-dependence treatment services. 
• American Society of Clinical Oncology: Tobacco Cessation and Control Policy – This statement updates the information originally presented in 2003, and is aimed at physicians involved with cancer treatment and research. 
• A Prescription for Health: Tobacco Free Pharmacies – Courtesy of ChangeLab Solutions, this fact sheet outlines the health concerns associated with allowing tobacco sales at pharmacies and shows what local policymakers can do in their communities. 
• Tobacco Dependence Treatment Manuals – With a manual for both mental health professionals and for Alcohol and Other Drug Abuse (AODA) professionals, these materials help integrate evidence-based tobacco dependence treatment into daily patient interactions. 
• Tobacco-free Nurses – The goal of Tobacco Free Nurses is to build capacity among nurses to equip them to assist patients with tobacco dependence and to become more involved in tobacco control efforts. 
• Tobacco Treatment Toolkit for Dental Office Team – The toolkit covers guidelines on treating tobacco dependence in dental practices. The information in the toolkit is specific to the state of Wisconsin, but has very good general information as well, including coding guidelines. 

Sponsored by the US Public Health Service, the 2008 update to the clinical practice guidelines on treating tobacco use and dependence can be helpful to both you as a clinician and your clinical practice team. 

• Read the full guidelines in English 
• Download materials to help tobacco users quit 

1. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence. 
2. It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting. 
3. Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in the Guideline. 
4. Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in the Guideline. 
5. Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt: 
   1. Practical counseling (problem solving/skills training) 
   2. Social support delivered as part of treatment 
6. Numerous effective medications are available for tobacco dependence, and clinicians should encourage their use by all patients attempting to quit smoking — except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). 
   • Seven first-line medications reliably increase long-term smoking abstinence rates: 
     • Bupropion SR 
     • Varenicline 
     • Nicotine gum 
     • Nicotine inhaler 
     • Nicotine lozenge 
     • Nicotine nasal spray 
     • Nicotine patch 
   • Clinicians also should consider the use of certain combinations of medications identified as effective in the Guideline. 
7. Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication. 
8. Telephone quitline counseling is effective with diverse populations and has broad reach. Therefore, clinicians and health care delivery systems should both ensure patient access to quitlines and promote quitline use. 
9. If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational treatments shown in the Guideline to be effective in increasing future quit attempts. 
10. Tobacco dependence treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication identified as effective in the Guideline as covered benefits. 

• Systems Change: Treating Tobacco Use and Dependence  – Strategies that arose from the 2008 update on treating tobacco use and dependence. 
• Clinical Effort Against Secondhand Smoke Exposure (CEASE) – The CEASE program was developed by child health care clinicians to help other child health care clinicians adjust their office setting to address parental tobacco use in a routine and effective manner. 
  • View the CEASE website​ 
  • Visit CEASE on Facebook 

Watch a video of AAP Expert Karen Wilson, MD, MPH, FAAP, giving advice to clinicians on how to begin conversations with patients and families about quitting.

For adults​ – Information on how to quit, how to help someone else quit, and keeping homes and cars smoke free 
 
For kids and teens​ – Teen- and youth-specific materials including handouts and other resources on tobacco prevention and cessation