Tools You Can Use
AAFP Ask and Act Tobacco Cessation Program
The American Academy of Family Physicians' Ask and Act Tobacco Cessation Program has resources for physicians and patients in the Ask and Act practice toolkit at www.askandact.org.
for the Prevention and Treatment of Nicotine Addiction
A toolkit for use when educating healthcare providers on implementating the Public Health Service Clinical Practice Guidelines.
Use Documentation Forms
These forms were used by The National Partnership for Smoke-Free Families research project grantees to obtain standardized measures of smoking status and other information on study subjects. The series includes a core baseline assessment form, a core screening form, an end-of-pregnancy assessment form, and a core postpartum assessment form.
Clinician's Packet: A How To Guide for Implementing the Public HealthService Clinical Practice Guidelines
A how-to guide for implementing the Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence. It contains information about developing a system, advising patients, special populations, and reimbursement; and products for clinicians and consumers.
Five A's Intervention Record Documentation Form
These patient chart forms are used by state demonstration projects to collect information on provider delivery of the 5 A's. There are provider-administered and patient-administered versions, both including prenatal and postnatal versions.
Health Care Professionals Can Help Pregnant Smokers Quit
This one-page handout developed by The National Partnership for Smoke-Free Families describes the 5 A's intervention for pregnant women.
Key Points to Help Dispel the Myths about Nicotine and NRT
Developed to ensure that cessation information and communications contain accurate information on nicotine and its role in quitting smoking.
Leading the Way: Helping Our Patients Be Tobacco Free
A carefully researched and developed comprehensive tobacco control curriculum available to dental hygiene faculty at no charge. Includes a faculty guide, six training modules, and a useful toolbox.
Maine Prenatal Collaborative Tobacco Treatment Database
This sample MicroSoft Access® database from the Maine Prenatal Collaborative contains screens for documenting delivery of the 5 A's and additional patient / provider information.
Need Help Putting Out That Cigarette? Booklet
This 15-page self-help booklet from the American College of Obstetricians and Gynecologists and the National Partnership for Smoke-Free Families is designed especially for pregnant women to guide them in their cessation efforts. A Spanish version is also available.
Capacity for Prenatal Tobacco Treatment Survey Instrument
This 28-item questionnaire is based on the Assessment of Chronic Illness Care tool for measuring the level of organizational support for prenatal tobacco treatment.
Post-Partum Relapse Prevention Telephone Protocol
This tool provides a detailed counseling protocol designed for quit coaches and other providers who want to address post-partum relapse. Consists of scripts and a worksheet on basic counseling principles.
Pregnancy and Post-Partum Quitline Toolkit
This toolkit provides information specific to quitting during pregnancy that can be integrated into already existing quitline services.
Pregnant and Smoking? Office Poster
This poster is designed to encourage women to ask their provider for assistance in quitting smoking.
Pregnant and Smoking? Office Poster (Native American version)
This poster is designed to encourage women to ask their provider for assistance in quitting smoking. This version features a Native American family.
Provider Knowledge, Attitudes, and Behaviors Survey Instrument
This survey instrument provides an assessment of provider knowledge, attitudes and behaviors regarding the 5 A's. It can be used before and after quality improvement activities to promote the best practice intervention.
Reimbursement for Smoking Cessation Therapy: A Healthcare Practitioner’s Guide Download PDF
Developed to provide information to healthcare providers and their administrative staffs on how to obtain reimbursement for smoking cessation counseling. This guide contains advice for providers who wish to maximize benefits for smoking cessation, navigate around coverage deficiencies, and advocate effectively for adequate coverage.
Smoking Cessation During Pregnancy: A Clinician's Guide to Helping Pregnant Women Quit Smoking Order Form
American College of Obstetricians and Gynecologists (ACOG) has produced a training manual called "Smoking Cessation During Pregnancy: A Clinician's Guide to Helping Pregnant Women Quit Smoking." This educational program provides the background and tools necessary for clinicians to implement evidence-based interventions in the office setting.
Smoking History Survey for Pregnant Women Documentation Form
This standardized form contains a short, three section survey on a pregnant woman's smoking status, history of tobacco use, and second-hand smoke exposure.
Treating Tobacco Use and Dependence: A Clinical Practice Guideline (USPHS, 2008) Download PDF
This guideline, an updated version of the 2000 Smoking Cessation Clinical Practice Guideline, presents recommendations for treatment of tobacco use based upon a systematic literature review and analysis, peer-review process and expert panel opinion.
You Can Quit Smoking! Bookmark
This bookmark for the pregnant mother-to-be provides information on why she should quit smoking and how to keep on track with a quit plan.
Youth Quitline Ads
Series 1 | Series 2 | Series 3
The following print ads are targeted to youth and provide examples of ways to promote quitline services to youth. Examples from various state materials were used to develop the Ads. These are templates that can be used by any state to promote their state quitline.
With Help From Your Doctor Office Poster
This poster was created for provider offices with the tagline "With help from your doctor, you could quit smoking by your next visit".
Helping a Pregnant Woman Quit Smoking: Community and Worksite Toolkit
A toolkit for employers which contains materials that can help pregnant women quit smoking and explains the importance of support from the work place, community, friends, and family.
Employers’ Smoking Cessation Guide: Practical Approaches to a Costly Workplace Problem Download PDF
Developed as a tool to help employers – large and small – enact affordable, effective smoking cessation programs in their companies. This guide makes the “business case” for employer involvement in smoking cessation, highlighting the enormous direct and indirect costs—both in health care and lost productivity—of smoking.
Health Insurance Benefits
At-a-glance summary from the "Build a Financial Infrastructure." This summary is intended to help guide discussions among employers and purchasers and can be tailored to each state.
Workforce 2010: An Essential Health Promotion Sourcebook for Employers,
Large and Small
This Partnership for Prevention publication designed for employers presents a set of national health objectives, with 10-year targets. The goal is to help explain objectives to employers so they can work on helping the nation achieve these targets.
Make it Your Business: Insure a tobacco-free workforce Employer’s Toolkit Download PDF
Developed by the Tobacco-free Coalition of Oregon, this employer’s toolkit makes the case for providing cessation benefits or services to Oregon employees and provides tools to help promote them.
Preventive Services: Helping Employers Expand Coverage Download PDF
Developed by the Partnership for Prevention, this guide provides employers with information on return-on-investment data, health research and various health plans. The goal is to give employers the information they need to provide quality health coverage at a reasonable cost.
Addressing Tobacco in Managed Care: A Resource Guide to Health Plans Download PDF
This guide provides information, examples and other resources for health plans interested in developing, implementing and evaluating effective interventions aimed at reducing tobacco use.
A Toolkit: Invest In A Healthy State : Covering Tobacco Cessation Services Under Medicaid Download PDF
The Center for Tobacco Cessation, in partnership with the National Partnership to Help Pregnant Smokers Quit, has developed a Medicaid and smoking cessation information packet. The materials included address issues of critical importance to Medicaid programs, including the health and economic costs and benefits of coverage, snapshots of current state activities, and how states can improve their cessation benefits and coverage. You may download the full packet or the individual factsheets listed below.