Secondhand Smoke (SHS) Deserves More Than Secondhand Attention: Modifying the 5As Model to Include Counseling to Eliminate Exposure

Most Americans smoke or are exposed to secondhand smoke (SHS) on a daily basis. Current tobacco treatment guidelines recommend the use of the 5As model to screen and treat primary tobacco users. Evidence supports that SHS is harmful, that the diseases caused by SHS are preventable, and that public health policies and individual counseling are effective in reducing exposure. Further, smoke-free environments are associated with increased cessation in primary smokers. When patients screen positive for SHS, they should be counseled to avoid it by negotiating smoke-free homes and cars, particularly if they have cardiovascular disease or if they have children. Thus, all patients should be screened for primary tobacco use and for exposure to SHS via a suggested modification of the 5As.