Stop smoking (behavioral change) programs provide practical and personalized guidance and support to help tobacco addicts quit. A quit date is chosen (usually in two weeks) and a personalized quit plan is constructed to prepare the person for a successful quit attempt. The quit plan includes identifying personal trigger factors for tobacco use, identifying reasons for previous relapses and planning in advance (i.e., prior to the quit date) behavioral coping techniques and strategies that the patient will use to counter the identified trigger factors and reasons for previous relapse. It also includes education about the nicotine withdrawal symptoms and cravings which are anticipated to occur after the quit date and a specific plan on how to counter these (e.g., pharmacotherapy, relaxa-tion techniques, exercise, etc.). It also includes constant encouragement and support by the program facilitator and co-patients before and after the quit date. Successful tobacco quitters often achieve their success only after 2-5 tries. Therefore, if a quit attempt fails, the best advice is to keep trying and consider the failed attempt practice for a new suc-cessful attempt.

Physician Counseling: The agency for Health Care Policy and Research has established guidelines for physicians on how to counsel their patients on smoking cessation. These are summarized by five A's:

Ask: ask every patient if they use tobacco at every visit. (The following additional ques-tions will usually elicit a relevant and useful tobacco use history: 1) how long have you smoked and how many packs per day? 2) why do you smoke and what are your trigger factors? 3) have you ever tried to quit, and why or why not? 3) if you did try to quit what hardships did you encounter? 5) are you willing to quit within the next month?)

Advise: strongly advise every identified tobacco user to quit at every visit. Address their personal health risks of using tobacco and the health benefits of quitting which would be particularly relevant to them (see pgs 19, 32-33, 56).

Assess: assess every tobacco user's willingness to make an attempt to quit at every visit. (e.g., willing to make a quit attempt within the next thirty days). For those not willing to quit at that time or are not sure (pre-contemplation or contemplation stages), provide a motivational intervention by advancing personally relevant reasons why they should at-tempt to quit. Remember the 5 R's of a motivational intervention in your counseling: Relevance (e.g., relevant to a patients disease status, family or social situation, see pgs 19 and 56); Risks (e.g., acute and long term health risks and environmental risks to oth-ers; see pgs 28-29 and table on pg 56); Rewards (e.g., save money, less environmental risk to others, set a better example for children, improved health and hygiene, etc; see