IDENTIFYING THE PERSON READY TO QUIT

You encountered a tobacco user and you asked the question, “Are you ready to set a quit date in the next
30 days?”
The patient says, “Yes”.
You respond, “I am very happy to hear that you have made a decision to quit.”

Having persons deciding to quit is the goal of many health workers and counselors. It also motivates
health professionals and BTI counsellors to guide somebody to quit successfully.

The Readiness to Change Model reminds us that not all tobacco users will be ready immediately. But it is
important for us to have proper skills and knowledge so that when they are ready, we can provide
immediate guidance and support.

Figure 4.1. Readiness to Change Model

BTI: Module 4. Ready to Quit 1

CONTINUE TO USE THE FIVE A’s:
Ask, Advice, Assess, Assist and Arrange

As in other patient cases, we always get more information about the patient. You have probably collected
this information in previous consultations. It is best to review them. If you have not collected this infor-
mation, it would be best to collect them.

Ask about tobacco use. Check out when the user started to use tobacco. Also ask about frequency and
the extent of use. The person’s health history (e.g. hypertension, asthma, COPD, diabetes mellitus, tuber-
culosis, etc.) and family history (e.g. history of stroke, heart attack, diabetes, etc.) may help emphasize
the need to quit smoking. Record these observations on the patient’s history chart.

Advise the tobacco users to quit. Review the benefits of quitting and discuss the harmful effects of to-
bacco use if not yet done.

Assess any willingness to make a quit attempt within the next 30 days. Some tobacco users are prepa-
ring to make a quit attempt and are willing, when asked, to set a Quit Date within the next month. Other
tobacco users may already be attempting to quit. You will learn to support these individuals by assisting
them in developing a Quit Plan.

Assist the tobacco users in setting a Quit Date within the next 30 days and help initiate a Quit Plan.
Some people may not wish to take the time to develop a Quit Plan. You can educate them, however, by
pointing out that quitting is often very difficult, and spending a few minutes to plan at the beginning can
be very important in helping them reach their goal. Remember people have the right to refuse help. You
are offering information and support only.

Arrange for follow-up whenever possible. Let the tobacco users know that you are available especially
during the first two weeks of quitting. Inform them that you will continue to ask about their tobacco use
(Fiore et al., 1996).

DEVELOPING THE QUIT PLAN

The Quit Plan can be used to quickly assist the tobacco users. The Quit Plan includes spaces to fill in
their Quit Date and a support person or group, information on problem solving, medications for tobacco
cessation, and referrals to other medical services. It should take no more than 10 minutes to assist them
in getting started in a Quit Plan.

BTI: Module 4. Ready to Quit 2

The parts of a Quit Plan are:
1. Quit Date within 30 days
2. Name of Individuals for Social Support
3. Problem Solving Skills
4. Self-help Materials
5. Referral to Other Programs or Services

While starting the Quit Plan, it is advisable to discuss names of individuals or groups that can provide
social support. These may include family members, close friends, health professionals, councilors or a
religious person (e.g. a pastor or religious worker) that the client can easily confide to and trust.

Quit Date

Remember that in setting a quit date, assist them not to pick tomorrow their quit date or either set too far
off in the future (more than 30 days). They should not set a date during night outs. Pick a date that does
not have built-in problems. Tell them to inform their friends about their quit date.

Here are some advice in setting the quit date:

 “It is best not to pick tomorrow as your quit date.”
 “It is best not to set your date too far off in the future.”
 “It is best to pick a day that doesn’t have built-in problems.”
 “It is best not to set your quit date during gimmick nights/ night outs.”
 “Tell your friends about your quit date.”

Problem Solving Sheet

The Problem Solving Sheet provides specific advice, tips and reminders for a tobacco user in the process
of quitting. It aims to provide strategies and create a supportive environment for a person ready to quit.
Refer to the Annex of Tools for the Problem Solving Sheet. A copy of this sheet may be provided to the
patient.

Best advice you can give to clients before quitting:

1. Set a Quit Date. It is helpful to choose a date that has a positive meaning or impact to you such as
a birthday or anniversary.
2. Tell friends and family about your Quit Day.

BTI: Module 4. Ready to Quit 3

 3. Get rid of all the cigarettes and ashtrays in your home, car, and at work.
4. Stock up on oral substitutes –sugarless gum, carrot sticks, hard candy, cinnamon sticks, coffee
stirrers, straws, and/or toothpicks
5. Practice saying, “No, thank you, I don’t smoke,” or “I don’t use tobacco.”

Important advice during/ after quitting:

1. Set up a support system. Inform your family and friends that you are quitting. You might have other
friends who have successfully quit or do not use tobacco at all. This might be the best time to hang
out with them more, and join them in new activities.
2. Think about your past attempts to quit. Try to figure out what worked and what didn’t.
3. Sometimes, people find themselves in a new situation that allows them to successfully quit. These
may include transferring to a new location, getting a new job or joining new organizations such as
a church group or getting a new relationship. These situations may be provide healthy environment
in the quit process.

Here are some tips to stay smoke-free:

1. Do not smoke. This means not at all—not even one puff!
2. Keep active—try walking, short bursts of exercise, or other activities and hobbies.
3. Drink lots of water and healthy juices.
4. Attend a stop-smoking class or follow your self-help plan.

Other tips to avoid relapse:

1. Avoid situations where the urge to smoke is strong.
2. Avoid people who are smoking.
3. Avoid drinking alcohol.
4. Think about how you can change your routine.
5. Use a different route to go to work to break the routine.
6. Drink tea instead of coffee.
7. Eat breakfast in a different place or eat different foods.
8. Come up with new activities perhaps a new hobby or learn a new skill.

Self-help Materials

The following materials are included in the Tools Annex (B-E, I, J, K) in this short course. These can be
used for individuals who are ready to quit.

BTI: Module 4. Ready to Quit 4

 Tools Description
My Quit Plan This is a card the summarizes the patient’s name, smoking history,
plan for quitting and the tobacco quit counsellor. This is like the pa-
tient’s record and may be included in other electronic medical rec-
ords.

Problem-Solving Sheet—Before These are specific tips the counsellor can discuss with the patient
Quitting (suggested tips) that summarizes tips before quitting.

Problem-Solving Sheet—After This list summarizes all advice we can provide to patients who have
Quitting (relapse prevention) started to quit.

Enhancing Motivation to Quit These are common roadblocks that keep people from quitting. It in-
Tobacco Use – Roadblocks cludes explanations and tips on how to counter these.

Health Benefits of Quitting To- Summary of all health benefits immediately after quitting, as well
bacco Use benefits gained 10 years after quitting.

Ill Effects of Tobacco Use Summary of ill effects of tobacco use including short-term, long-
term, environmental risks and other conditions.

The other Tools in the Annexes provide more information:

 Making the Decision to Quit Smoking
 Setting a Quit Date and Making a Plan
 Your Quit Date
 Staying Smoke-Free
 Withdrawal Symptoms
 Other Tobacco Cessation Services (e.g. Quitline, Local Support Group)

Take time to go through and study these tools. You will practice how to use them in the role play. More
importantly, you may use these tools in your role as BTI provider. Later, you may have these tools printed
for your patients.

Pharmacologic Treatment
Most clients can actually quit tobacco even without pharmacologic treatment. Hence, the importance of
guidance, strong support and a healthy environment.

Pharmacologic treatment may be recommended and regulated by trained doctors/ health personnel.
These include:
 Nicotine replacement - “methadone for the smoker” – gum, pastille, lozenges, patches, nasal spray,
inhaler
 Bupropion
 Varenicline

BTI: Module 4. Ready to Quit 5

Pharmacologic treatments are designed to decrease cravings as well as withdrawal symptoms. They
were found to contribute up to 30% quit rate at 1 year. On the other hand, pharmacologic treatment
should always be used in conjunction with behavior modification and with supervision of a trained pro-
fessional who knows the contraindications and common adverse effects of medications. Keep in mind
that there is no “best” medication to help you quit, everyone is different.

Referral to Other Programs or Services

Other programs and services have been developed to guide clients in quitting tobacco use:
1. Local Tobacco Cessation Services such as in the health center or hospital
2. Quitline
3. Local Support Groups are a good opportunity for clients to meet new friends who have successfully
quit tobacco use. They may have organized joint activities to enhance support.

BRIEF INTERVENTION WITH A TOBACCO USER WHO IS

READY TO QUIT

Watch the video role-play of a brief intervention with a tobacco user who is ready to quit.

KEY POINTS TO REMEMBER

 When the answer is "YES", assist the individual to develop a Quit Plan by determining a Quit date.
 People have the right to refuse help, developing a quit plan in particular, but you may point out that
quitting is often very difficult, and spending a few minutes to plan at the beginning can be very im-
portant in helping them reach their goal.
 The parts of the simple Quit Plan are:
a. The Quit Date
b. Names of individuals for social support
c. Problem-solving skills
d. Self-help materials
e. Referrals to other programs or service

BTI: Module 4. Ready to Quit 6

 This e-book and related documents are intended for use
by a broad range of healthcare and non-healthcare
professionals (private or government). It is based on the
Brief Tobacco Intervention training curriculum developed by
Health Partners Limited Liability Corporation in Guam, USA,
and is customized based on the Philippine context.

All rights reserved.

The mention (if any) of specific companies or of certain

manufacturer’s product does not imply that they are endorsed or
recommended by the Department of Health (DOH) in reference over
others of a similar nature. Reproduction in full or in part of this e-
book for educational or other non-commercial purposes are
authorized without any prior written permission from the copyright
holder, provided the source is fully acknowledged as indicated
below. Reproduction for profit or for commercial purposes is
prohibited without written permission from the copyright holder.

Suggested citation: Department of Health (2019). Philippine Brief

Tobacco Intervention Course E-book. Manila, Philippines:
Department of Health.