Statistics show that tobacco smoking is a critical cause of preventable deaths and diseases around the world. More than 1 billion people or 20% of the world’s population are smokers, with a majority of them being men. Smoking takes a toll on the smokers, exposing them to health problems, and devastating socio-economic effects of addiction. While most smokers are willing to stop, smoking is highly addictive and they find it hard to quit once they are hooked to nicotine. In recent times, various behavioural interventions have been proposed to encourage and support smoking cessation (World Health Organization. 2014). In this paper, I focus on the effectiveness of the 5As model as a behavioural modification technique for smoking cessation.

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The 5As model has been adopted in several countries across the world, including the United States, the United Kingdom, and Australia (Roberts, Kerr & Smith, 2013). The model is critical in enabling health professionals who may not be smoking cessation specialists to structure interventions to patients. The model consists of five main steps to enforcing a smoking cessation program: Ask, Advice, Assess, Assist, and Arrange. They are discussed below:

Step 1: Ask
At the onset, the health professionals identify if one is a smoker by asking the patient if they smoke or not. The health professional has to ask all the patients if they smoke or not, and do it in a friendly manner. The tobacco use status is then promptly recorded. If the response is No, the health specialist may ask for alternative information such as their exposure to second-hand smoke. The health specialist also reinforces the ‘No’ response with a relevant message (Roberts, Kerr & Smith, 2013).
In case the response is Yes, the process goes to the ‘Advice’ stage.

Step 2: Advice
After identifying an individual to be an active smoker, the health professional proceeds to advice the smoker on the need to quit smoking. The model recommends the use of a strong, clear and personalized message.
Strong- “as a health professional, I need you to understand that quitting smoking is the best decision you can take to protect your health. I am ready to help you do so.”
Clear- “it is important for you to quit smoking. I can help you. Light smoking is still dangerous to you.”
Personalized- to a young woman, for instance, the message could be: “tobacco smoking can affect your fertility and the health of the unborn child. It is important for you to stop.”

Step 3: Assess
The ‘Assess’ stage involves the health specialist asking the smoker if they are willing to make an attempt to quit from that moment. This stage determines the individual’s readiness to make the quit attempt. The physician asks the individual two main questions:
Would you like to live a life free of smoking?
Do you think you have any chance of quitting successfully?
If the patient is ready to proceed to make the quit attempt, the next steps begin.

Step 4: Assist
If the overall answer in the previous stage is Yes, the health professional helps the smoker to formulate a quit plan. The following steps can be used:
Set an agreeable ‘quit date.’ An appropriate time, preferably one that is less stressful should be selected.
Tell the family members and friends of the smoker to formulate a supportive environment. The physician helps communicate the information to the smoker’s family, first requesting for understanding owing to mood changes resulting from withdrawal. Any other smokers in the environment should be requested to desist from doing so in the vicinity. Secondly, support from family and friends is requested, asking them to create a supportive environment that will enable the smoker to attain the desired goal.
Anticipate and prepare for withdrawals and cravings during the period. The smoker has to prepare a plan for coping with the withdrawal symptoms, the cravings and triggers in the environment. One can, for instance, select healthy alternatives to smoking (Johnston, 2016).
Remove all the triggers that may prompt one to smoke. Triggers to smoke such as remaining cigars, tobacco products and ashtrays are removed from the environment such that the environment remains smoke-free. Spending time with non-smoking friends and family is another way to realize this objective. This helps to focus on the main goal of quitting to smoke.
Track the progress and have a follow-up strategy. The physician should help the patient to formulate a chart to mark their progress, the cravings and how they coped with them, and a review of areas where follow-up is needed.

In case the answer during the Assess stage was No, the assist stage comprises of motivations to quit. The 5Rs are applied:
Relevance of quitting smoking
Risks that smoking has on the individual
Rewards that quitting can have on the individual
Roadblocks that potentially inhibits the quitting desire.
Repeat these steps during the subsequent visits and appointments.

Step 5: Arrange
This stage entails the scheduling of follow-up and referral arrangements after the process has been completed. If quitting has been successful, the physician congratulates and reinforces the smoker. In case of relapse, follow up is scheduled and the steps above repeated.

Conclusion
The 5As model of smoking cessation consists of five steps, which take into consideration all the social needs, emotional challenges, and other issues that characterize smoking addiction. The approach takes a holistic approach to helping the smokers overcome the smoking challenge. Involving the family, workmates, and the community at large in creating a conducive and supportive environment makes the method a more appropriate approach as compared to others that do not involve the behavioural aspects (Johnston, 2016). From this method, behavioural modification techniques for smoking cessation are evidently effective in tacking the smoking problem that affects millions of people.