With smokers unwilling to quit, have a brief discussion following the 5 Rs: relevance, risks, rewards, roadblocks, and repeat as necessary at future clinic visits.
1. Relevance. Have patient indicate their own personal reasons for quitting smoking, being as concrete and specific as possible.
2. Risks. Ask the patient to identify potential negative health consequences of tobacco use. Discuss acute, long-term, and environmental risks.
b. Long-term risks: myocardial infarction (MI) and stroke, peripheral vascular disease, lung and other cancers, etc.
c. Environmental risks: increased risk of heart disease and lung cancer in spouses; higher rates of smoking in children of smokers; sudden infant death syndrome, asthma, middle ear disease, respiratory infections in children of smokers.
3. Rewards. Ask the patient to identify the specific benefits that may come from quitting smoking, such as improved taste and smell, better-smelling car and clothing, feeling better physically, etc.
4. Roadblocks. Ask the patient to identify barriers to quitting (such as fear of withdrawal symptoms, weight gain, depression, enjoyment of tobacco, etc.), and use problem solving to try to address issues.
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