Using Stages of Change "Tool" to Promote
Tobacco-Free Living

Beginning the client intervention:

Part of my job as a health professional is to promote a healthy lifestyle with all my clients. Following a healthy lifestyle can lessen the chance of developing many chronic diseases.

Take tobacco-free living for example:
Tobacco use and exposure to second-hand smoke causes many health problems. Quitting smoking reduces the risks for several chronic diseases.

ASK about the client’s use of tobacco:

Suggestions:

• Have you used any tobacco products in the last 6 months?
• Have you ever tried to quit? How did it go?
• Have you ever used anything to help you quit like medications or nicotine replacement like the patch or gum?

ASK the following staging question: Have you thought about quitting smoking? NO YES

If YES ADVISE the client about quitting smoking:

Suggestions:

• The most important advice I can give you is to stop smoking.
• There are immediate health benefits when you quit.
• Sometimes it takes more than one quit attempt to stay quit.
• You learn something new about your smoking habit that will help you next time if you start again.
• Turn to “In a Nutshell Tobacco-Free Living” for additional points that may help you.

Click on the appropriate stage below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Help client think about quitting.

Intervention Options:

ASK, ADVISE & ASSIST:

• Ask, advise and assist client to think critically about smoking.
  How does smoking fit in to a typical day?
  What is the role of smoking in your life?
  How do you feel about smoking? Pros and cons.
  What things influence your decision about whether or not you will smoke?

Resource options (Click to order):

• One Step At A Time Program Booklet - For Smokers Who Don't Want to Quit
  A booklet for people who smoke and do not want to quit. Provides information and support without pressure. Promotes understanding their smoking habit and how it affects people around them. For people in Precontemplation stage.
• Be smoke-free Protect your family's health
  Highlights tobacco and cancer facts and statistics. Outlines some of the toxic chemicals in cigarettes and the risks of second-hand smoke. Stresses that it is never too late to quit and experience health benefits! Promotes the Smokers' Helpline. For people in the precontemplation and contemplation stages of quitting smoking.
  
• Eating Well with Canada’s Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  
• Canada’s Physical Activity Guide to Healthy Active Living
  Includes benefits of regular physical activity, explains how much and the kind of activity you need to stay healthy and provides tips for getting started. Encouraging activity a home, at school, at work, at play and on the way! Useful for people in the precontemplation through maintenance stages of quitting smoking.
• Smoke-free Homes pamphlet
  Provides info about poisonous chemicals found in second-hand smoke; offers 2 decals (welcome to our smoke-free home & car); health effects of second-hand smoke; tips to make your home smoke-free. Useful for people in the precontemplation through maintenance stages of quitting smoking.

Future intervention: At next interaction with client, ask again.

ASK:

Have you thought about quitting smoking since we talked last?

NO		Still PRECONTEMPLATION
YES		CONTEMPLATION

Click on Contemplation (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goals for Client Intervention:

• Encourage the examination of personal pros and cons of quitting smoking.
• Promote confidence in their ability to quit smoking.
• Help client move towards quitting within the next 6 months.

Intervention Options:

ASK:

• Ask about pros & cons.
  What are some of the good things about smoking/quitting?
  What are some of the not-so-good things about smoking/quitting?

ADVISE:

• Advise client to explore cut back potential.
  Have you considered making your home or car smoke free?

ASSIST:

• Assist the client in fostering a positive belief in their ability to do it.
  Smokers’ often try to quit more than once before they succeed. With each of your quit attempts your likelihood of remaining smoke-free improves.

• Provide information.
  This resource will provide you with information to think more about reasons to quit smoking.

Resource options (Click to order):

• One Step At A Time Program Booklet - For Smokers Who Want to Quit
  A booklet to help a person who smokes and wants to quit, examine their smoking habit, their ideas and attitudes about quitting. Walks them through making a plan. Useful for people in the Contemplation, Preparation, Action or Maintenance (including slips and relapses) stages.
  
• Be smoke-free Protect your family's health
  Highlights tobacco and cancer facts and statistics. Outlines some of the toxic chemicals in cigarettes and the risks of second-hand smoke. Stresses that it is never too late to quit and experience health benefits! Promotes the Smokers' Helpline. For people in the precontemplation and contemplation stages of quitting smoking.
  
• Thinking about Quitting
  Smokers' Helpline pamphlet provides info about how to obtain one-to-one confidential counselling, support and advice by providing phone number and hours of Smoker’s Helpline. For people in the contemplation through maintenance stages of quitting smoking.
  
• Eating Well with Canada’s Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  
• Canada’s Physical Activity Guide to Healthy Active Living
  Includes benefits of regular physical activity, explains how much and the kind of activity you need to stay healthy and provides tips for getting started. Encouraging activity a home, at school, at work, at play and on the way! Useful for people in the precontemplation through maintenance stages of quitting smoking.
• Smoke-free Homes pamphlet
  Provides info about poisonous chemicals found in second-hand smoke; offers 2 decals (welcome to our smoke-free home & car); health effects of second-hand smoke; tips to make your home smoke-free. Useful for people in the precontemplation through maintenance stages of quitting smoking.

Future Intervention: At next interaction with client, ask again.

ASK:

Have you thought about quitting smoking since we talked last?

NO		Still CONTEMPLATION
YES		PREPARATION

Click on Preparation (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Help client develop quitting skills.

Intervention Options:

  ADVISE:

• Advise the client to identify barriers to quitting and possible solutions.
  What do you think is stopping you from quitting?
  What do you think you can do about that?

ASSIST:

• Assist the client to think about setting a quit date, and developing a plan on how they will deal with cravings, temptations, and triggers.
  What do you see as being your next steps to take to quit smoking?
  When would be a good time for you to quit smoking?
  What do you feel you will need to have in place in order to deal with cravings, triggers and temptations? (eg NRT, medication, etc.)
  What do you see as your biggest barrier? How do you plan to get around it?

• Assist the client to include a family member or peer for support.
  Do you have a support person that can assist/encourage you to stick with remaining smoke-free?

ARRANGE:

• Arrange for follow-up with client.
  Would you like me to refer you to the Smokers’ Helpline?
  Let me know how you are doing with this.

Resource options (Click to order):

• One Step At A Time Program Booklet - For Smokers Who Want to Quit
  A booklet to help a person who smokes and wants to quit, examine their smoking habit, their ideas and attitudes about quitting. Walks them through making a plan. Useful for people in the Contemplation, Preparation, Action or Maintenance (including slips and relapses) stages.
  
• Nutrition Tips for Quitting Smoking fact sheet
  Tips to help ex-smokers deal with cravings. For people in the preparation, action and maintenance stages of quitting smoking.
  
• Thinking about Quitting
  Smokers' Helpline pamphlet provides info about how to obtain one-to-one confidential counselling, support and advice by providing phone number and hours of Smoker’s Helpline. For people in the contemplation through maintenance stages of quitting smoking.
  
• Eating Well with Canada’s Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  
• Canada’s Physical Activity Guide to Healthy Active Living
  Includes benefits of regular physical activity, explains how much and the kind of activity you need to stay healthy and provides tips for getting started. Encouraging activity a home, at school, at work, at play and on the way! Useful for people in the precontemplation through maintenance stages of quitting smoking.
• Smoke-free Homes pamphlet
  Provides info about poisonous chemicals found in second-hand smoke; offers 2 decals (welcome to our smoke-free home & car); health effects of second-hand smoke; tips to make your home smoke-free. Useful for people in the precontemplation through maintenance stages of quitting smoking.

Future Intervention: At next interaction with client, ask again.

ASK:

The last time we spoke, you were making plans to quit smoking. Have you quit?

NO		Still PREPARATION
YES		ACTION

Click on Action (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Goal for Client Intervention:

• Help client not to use tobacco and to use slips and relapses as a learning opportunity.

Intervention Options:

ASK:

• Ask client about relapse prevention plan, triggers, successes, NRT and/or medication use.
  What strategies are you using to cope with urges to smoke?
  What kinds of situations are tempting for you?

ADVISE:

• Advise client to reward self.
  What have you done to reward yourself?  

• Advise client to identify what is working and what barriers exist.
  What parts of your plan are working well? What is still a barrier?
  How could you plan to get around it?  

• Advise client to be confident in ability to succeed.
  You are making good progress. You should be proud.  

• Advise client to develop/establish social support network.
  Who will you ask for support and what will you ask them for? What do people do that is not helpful? How can you ask them to stop?

ASSIST:

• Assist client to put slips and relapses into perspective.
  Don’t be discouraged if you slip. Most people experience that. Slips and relapses are learning opportunities, and you can transfer that learning to countinued success or future quit attempts.

ARRANGE:

• Arrange for referrals and resources (NRT, medication, community resources, referral to Smokers’ Helpline, etc.)

Resource options (Click to order):

• One Step At A Time Program Booklet - For Smokers Who Want to Quit
  A booklet to help a person who smokes and wants to quit, examine their smoking habit, their ideas and attitudes about quitting. Walks them through making a plan. Useful for people in the Contemplation, Preparation, Action or Maintenance (including slips and relapses) stages.
  
• Nutrition Tips for Quitting Smoking fact sheet
  Tips to help ex-smokers deal with cravings. For people in the preparation, action and maintenance stages of quitting smoking.
  
• Thinking about Quitting
  Smokers' Helpline pamphlet provides info about how to obtain one-to-one confidential counselling, support and advice by providing phone number and hours of Smoker’s Helpline. For people in the contemplation through maintenance stages of quitting smoking.
  
• Eating Well with Canada’s Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  
• Canada’s Physical Activity Guide to Healthy Active Living
  Includes benefits of regular physical activity, explains how much and the kind of activity you need to stay healthy and provides tips for getting started. Encouraging activity a home, at school, at work, at play and on the way! Useful for people in the precontemplation through maintenance stages of quitting smoking.
• Smoke-free Homes pamphlet
  Provides info about poisonous chemicals found in second-hand smoke; offers 2 decals (welcome to our smoke-free home & car); health effects of second-hand smoke; tips to make your home smoke-free. Useful for people in the precontemplation through maintenance stages of quitting smoking.

Future Intervention: At next interaction with client, ask again.

ASK:

The last time we spoke, you had quit smoking. How long have you been smoke-free? Has it been longer than 6 months?

NO		Still ACTION
YES		MAINTENANCE

Click on Maintenance (or whatever stage they are at) below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Goal for Client Intervention:

• Help client to maintain tobacco free living as part of their lifestyle.

Intervention Options:

ASK:

• Ask client about planning for the future.
  How are you managing? How confident are you that you will stay on track in challenging situations?

ADVISE:

• Advise on issues raised by patient, reinforcing health benefits.

ASSIST:

• Assist client to be aware of ongoing triggers and pitfalls.
  What do you need to keep avoiding for awhile to maintain your success?  

• Assist client to be aware of the need for ongoing support.
  What kind of support can others give you now?  

• Assist client to be aware of the importance of continuing to reward self.
  Make sure you remember to reward yourself for continuing. You deserve it!

Resource options (Click to order):

• One Step At A Time Program Booklet - For Smokers Who Want to Quit
  A booklet to help a person who smokes and wants to quit, examine their smoking habit, their ideas and attitudes about quitting. Walks them through making a plan. Useful for people in the Contemplation, Preparation, Action or Maintenance (including slips and relapses) stages.
  
• Nutrition Tips for Quitting Smoking fact sheet
  Tips to help ex-smokers deal with cravings. For people in the preparation, action and maintenance stages of quitting smoking.
  
• Thinking about Quitting
  Smokers' Helpline pamphlet provides info about how to obtain one-to-one confidential counselling, support and advice by providing phone number and hours of Smoker’s Helpline. For people in the contemplation through maintenance stages of quitting smoking.
  
• Eating Well with Canada’s Food Guide
  is for people 2 years and over.  Detailed recommendations for the number of servings from each of the four food groups are based on age and gender.
  
• Canada’s Physical Activity Guide to Healthy Active Living
  Includes benefits of regular physical activity, explains how much and the kind of activity you need to stay healthy and provides tips for getting started. Encouraging activity a home, at school, at work, at play and on the way! Useful for people in the precontemplation through maintenance stages of quitting smoking.
• Smoke-free Homes pamphlet
  Provides info about poisonous chemicals found in second-hand smoke; offers 2 decals (welcome to our smoke-free home & car); health effects of second-hand smoke; tips to make your home smoke-free. Useful for people in the precontemplation through maintenance stages of quitting smoking.

Future Intervention or Now: At next interaction with client, ask again.

ASK:

The last time we spoke, you had quit smoking. Are you still tobacco free?

YES		Still MAINTENANCE Is there another lifestyle topic you are concerned about, e.g. healthy eating, healthy weights, sun safety, etc.?
NO		RELAPSE

Precontemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Goal for Client Intervention:

• Help client to see relapse as a normal part of the process of change.

Intervention Options:

ASK:

• Ask client the reason(s) for resuming tobacco use.
  What happened to make you start using tobacco again?

ADVISE:

• Advise client that relapse is a normal part of the process of change.
  Almost everybody slips back sometime. It can take a smoker several quit attempts before they are successful. Most people find they gain knowledge about themselves that helps them succeed in their next attempt.

ASSIST:

• Assist client in recognizing the benefits that were gained.
  Your overall health was improved while you were tobacco free.
  Your risk for __________ reduced while you were tobacco free.

• Assist client in identifying and discussing reasons for relapse and identify strategies for dealing with these reasons for the next quit attempt.
  What did you like about being a non-smoker?
  Do you know what happened to make you return to smoking?
  What could you try next time to get around that?

ARRANGE:

• Arrange to re-stage client and reassess his/her current stage of change and intervene accordingly now or at the next contact.
  
  How ready are you to try quitting again?

Determine the client’s stage of change. Click on the appropriate stage below for examples of what the health professional might say to clients. These are suggestions to stimulate your thinking about what you want to say to that particular client.