SMOKING ASSESSMENT Lifescripts: Advice for Healthy Living INFORMATION FOR PATIENTS
Your doctor would like to record your smoking history and assess your current cigarette use. The aim is to determine what type of quit program or treatment will work best for you, to help you achieve a smoke-free lifestyle.
If YES, how many cigarettes do you smoke a day?
If NO, if you used to smoke, when did you quit? (please be as accurate as
If NO, please indicate patient's smoking history
3. If you decided to stop smoking right now, how confident of success would you
Select a number that best matches your current attitude, from 0 (not at all confident) to 7 (very confident)
4. When you wake up each day, how soon do you smoke your first cigarette?
5. How many cigarettes do you smoke on a typical day?
V e r s i o n 1 . 0 J u n e 2 0 1 0 P a g e 1 o f 3 INTERPRETING THE QUESTIONNAIRE Question 2: Interest in quitting
Ask: What would need to happen to make you keener to quit – say, to make you give an answer of 6 or 7 instead of 3?
Help patient explore costs and benefits of smoking, offer help if wants to quit in future,
re-check interest in quitting at next appointment. Give Quit book.
Ask: Why do you want to quit? Why did you choose 6 or 7 and not 2 or 3?
Confirm patient’s interest in quitting, find out when plans to quit, set quit date. Offer prescription for smoking cessation. Give Quit book.
Question 3 Confidence in quitting
Ask: What would be the hardest thing about quitting? What made it difficult to quit last time you tried? What would need to happen to increase your confidence to 6 or 7?
Explore and tackle barriers (e.g. withdrawal, stress reduction, weight control). May need more intensive help and encouragement. Identify support e.g. partner. Refer to Quitline
Encourage and warn about setbacks and how to cope with them. Advise about programs and services that help others quit. Refer to Quitline.
Questions 4–5 (combined score). Probability of nicotine addiction or dependence
Very low or low – advise good chance of success if attempt to quit. Assess psychological dependence.
Moderate to very high – recommend nicotine replacement therapy or prescribe bupropion.
Encourage all to tackle addiction, habit and psychological aspects of smoking
Assess mental health and medication. Monitor as required
Ex-smokers
Affirm the person's decision and achievement
Mark record to follow up: 12 months after quitting there is still a 20 - 30% chance of relapse
Current smokers
Explore motivation to quit, barriers and confidence to quit, individual's strategies for coping and
Provide clear non-judgmental advice to quit: set a quit date (if ready), offer Quit book, refer to
Advise overcome habit by delaying cigarette or substituting with another action (drink water,
Recommend nicotine replacement therapy or prescribe bupropion if dependent
V e r s i o n 1 . 0 J u n e 2 0 1 0 P a g e 2 o f 3
Make a follow-up appointment See Smoking Cessation Guidelines for Australian General Practice(www.quitnow.info.au) V e r s i o n 1 . 0 J u n e 2 0 1 0 P a g e 3 o f 3
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SMOKING ASSESSMENT 
INTERPRETING THE QUESTIONNAIRE 
Make a follow-up appointment