Assessment Tools

The Brief Intervention

A few simple questions about tobacco use and quitting behavior can serve as an effective assessment to determine when to initiate a brief intervention.

Tools for brief interventions and assessment:

Brief Conversations: An effective assessment can be conducted using a few simple questions:

• Have you used tobacco in the past 6 months?
• Do you currently use tobacco?
• How often do you use tobacco?
• Have you ever tried to quit or thought about quitting?
• What strategies or medications did you use?

The Five A's: An effective five-minute assessment that includes asking, or identifying clients who smoke and would like to quit, agreeing to initiate action toward quitting, and referring them to assistance.

 

In-depth Counseling

For more in-depth or intensive counseling, a number of assessment tools have been developed which can be of great assistance in gathering important information.

       Fagerstrom Tolerance Questionnaire

• This brief questionnaire provides a means of quantifying the degree of dependence on tobacco which is being exhibited by the patient or client. A key question in this assessment is: "How soon after waking do you smoke your first cigarette?" Research has shown that this question is at least as important as asking an individual about how much they smoke. Dowload the Fagerstrom Tolerance Questionnaire.

• Hooked on Nicotine Checklist (HONC)
• The Hooked on Nicotine Checklist (HONC) is an alternative assessment tool that is often used for assessing teen tobacco use, though it can be used for adults as well. Endorsing even one symptom of loss of autonomy has been correlated with difficulty with quitting tobacco use. Given that teen patterns of tobacco use can differ greatly from that of adults, this is a more sensitive measure of the degree to which the individual has lost autonomous control over tobacco. Download The HONC.

• Assessment of Motivation: Readiness to Quit Ladder
• This tool was developed to help give a snapshot of the individual's current readiness to quit tobacco use. Generally, an individual who reports interest in quitting within 30 days is considered ready to begin treatment planning. An individual's readiness to quit can fluctuate greatly - an individual who reports no interest in quitting at the beginning of a session may be ready to quit by the end of the session.
• This is a tool, not a declaration of intent. If time is an issue, or this tool feels too cumbersome, some of the same information can be gathered with a scaling question: "On a scale of 1-10, how ready do you feel to quit the use of tobacco?" Download the Readiness to Quit Ladder.

• CAGE Assessment for Alcohol Abuse
• The CAGE is a very brief assessment of an individual's alcohol dependence. It is user-friendly and can be administered in a very conversational manner. It should not be considered as diagnostic, but is an indicator that further questions should be asked and that a referral may be necessary. Download the CAGE Assessment.
• The Brief MAST

• The brief version of the Minnesota Alcohol Screening Test (Brief MAST) is another tool for assessing alcohol dependence. It is possible to get false positives on this scale, but again it can be an indicator of the need to explore further. Download the Brief MAST.
• The Patient Health Questionnaire

• The Patient Health Questionnaire (PHQ-9) is a useful tool for assessing the presence of depression. Given the potential for individuals to become depressed when quitting tobacco use, it can be administered at various points over the course of treatment - at the time of intake, at the point of the quit attempt, and subsequent to quitting - to assess any change of status. This does not take the place of practitioner observation but is a good adjunct to assessing the presence of depression and the need to treat and refer. Download The Patient Health Questionnaire.

• Pack Tracks
• Smoking cigarettes often entails a great deal of unconscious smoking during which the individual smokes in an automatic fashion without being fully conscious of their behavior, thoughts and feelings. This version of Pack Tracks was developed by the American Lung Association and is a useful tool to help the individual better understand their smoking behavior. It is designed in such a manner that the person can slip the sheet of paper into the space between their pack of cigarettes and the cellophane wrapper, and are instructed to fill out the form each time they light a cigarette. Many smokers also underestimate the number of cigarettes smoked; this can be a means of bringing this to light as well. Pack Tracks could be assigned for a week or even just for one day. More on Pack Tracks.

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