The document provides information for people with disabilities on the importance of quitting smoking, as smoking can worsen health conditions and reduce life expectancy, and outlines strategies clinicians can use to help patients with disabilities quit tobacco using the 5 A's approach of asking about tobacco use, advising patients to quit, assessing willingness to quit, assisting with a plan and support, and arranging follow-up. The 5 A's approach emphasizes establishing a quit plan and date, discussing triggers and challenges, prescribing cessation medications if appropriate, and following up in the first week and month to address any issues that come up and reinforce commitment to abstaining from tobacco.

1. Everyone
has the rIght
For People with t o b e h e a lt h y
Disabilities:
Why is it important for me to quit for more information about people with
smoking? disabilities and quitting tobacco, please
• my heart and lungs will function better contact:
allowing me to move more easily
The Michigan Department
• the medicine I take will work more of Community Health
effectively and I might be able to reduce
some of the medications I am taking tobacco control program
• as a non-smoker, my life expectancy 517-335-8376
improves enabling me to enjoy my family www.michigan.gov/tobacco
and friends
• I will have more money health promotion
for people with disabilities
• my food will taste better and my sense of
smell will improve Candice Lee
517-335-3188
• the chance of heart attack drops within 24 www.michigan.gov/mdch/0,1607,7-
hours, and my risk for heart disease is cut 132-2940_2955_54051---,00.html
in half after one year of being smokefree
Your doctor can help you quit! Questions
to ask him/her:
• how will quitting make a difference in how
I feel? InformatIon for people wIth
• what is the first step I take to quit and will dIsabIlItIes and theIr caregIvers
you help me create a plan?
on how to quIt tobacco
• Is there medicine I can take to help me TOBACCO
quit? what are the side effects? REDUCTION
• what reactions can I expect if I cut back on AND
nicotine? PREVENTION
• how can I stay quit?

2. For Clinicians:
As a clinician, how do I identify a person How do I help people with disabilities quit tobacco?
with a disability?
utilize the evidence-based “5 As” strategy published in the “clinical practice guidelines for
a person with a disability has a long lasting treatment of tobacco use dependence.”
physical, intellectual (cognitive), mental, or
emotional condition ASK about tobacco use and document the ASSIST the person in the following ways:
status at every visit - Establish a quit plan including quit date
DID You KNoW? - “Mr. Smith, do you smoke or use spit - Fax refer to the MI Quitline
tobacco?” 1-800-QUIT NOW
• people with mental health disabilities
die an average of 25 years younger(1) - Designate a quit smoking buddy
ADVISE patient to quit
than the general population largely due
to conditions caused or worsened by - “Mr. Smith, do you know that smoking - Assign the person to a staff member in the
smoking makes your heart work harder? Quitting is office who will follow up during the quit
• smoking rates are disproportionately one of the best things you can do to keep process
higher (29.9% in persons with any your heart strong.” - Provide easy to read information on
disability vs. 19.8% in the general strategies for quitting
- “Mrs. Jones, I can see you are having
population) and they are more likely
to be heavy smokers (32.6 percent trouble breathing. By quitting, your asthma - Discuss triggers and challenges and how
smoke more than a pack/day)(2) may get better.” the patient will successfully overcome them
• people with mental illness spend - “Miss Smith, smoking is making your - Prescribe medication for tobacco
as much as 25% of their income on diabetes worse. I strongly urge you to think dependence if not contraindicated
tobacco and consume 44% of the about quitting.”
cigarettes sold in the u.s.(3)
tobacco use Is a chronIc condItIon
Don’t stoP hErE! smokers need theIr requIrIng ongoIng support.
care provIder’s full support to quIt most people make several quIt attempts
Why is it important to treat tobacco use in before they are successful.
persons with disabilities?
ASSESS if the person is willing to try a quit
• 70% wish to quit smoking, the same as ARRANGE for follow-up contact
attempt within 30 days
people without disabilities
- “Mr. Green, when is the last time you - During the first week following the quit date
• everyone deserves to be healthy and to and then again within the first month
thought about quitting? Would you
receive advice about maintaining good
be willing to try to quit within the next - Identify problems patients encounter and
health, including tobacco use assessment
month?” think about future challenges
and treatment. this is a social justice issue.
- “Mrs. Jones, tell me about a time when you - Assess medication use and problems.
• smoking adversely affects serious
quit smoking before. What helped you the Readjust psychotropic or other
secondary health conditions and may
adversely affect the clinical response to the most that time?” medications if needed
treatment of a wide variety of conditions PlEASE NOTE: It is well documented that many people - If tobacco use has occurred, review
‘self medicate’ with tobacco for its calming and anti-anxiety circumstances and elicit re-commitment to
1
california department of public health (cdph) office on disability and health (odh),
the california tobacco control program (ctcp) and the california effects. Anxiety disorders, from mild depression to PTSD total abstinence
2
preventing chronic disease - study, www.cdc.gov/pcd/issues/2007/oct/06_0179.htm. require diagnosis and adequate medical support while
3
usa today 5/3/2007 weaning the patient off tobacco products.