Which action is the first step of the 5 A's?

• A. Ask
• B. Advise
• C. Assess
• D. Arrange

Answer: (A)

In this approach to brief tobacco-cessation counseling, the first action is to Ask about tobacco use. This step is essential because you can’t effectively Advise, Assess readiness, Assist with quitting, or Arrange follow-up unless you first know whether the patient uses tobacco. Asking should be quick, universal, and nonjudgmental, such as simply inquiring, “Do you currently use any tobacco products?” By identifying tobacco use up front, you open the conversation, establish relevance for the rest of the steps, and set the stage for personalized support. After this, the next steps follow logically: Advise to quit, Assess willingness to quit, Assist in quitting, and Arrange follow-up. Without that initial identification, the subsequent actions can’t be properly applied.