Effectiveness of the 5A’s Approach Combined with CO Analysis in Tobacco Cessation: A Study of 500 Patients at A Dental College-Based Tobacco Cessation Centre

@article{1722898,
      author = {Dr. Syeda Arshiya Ara, Dr. Syeda Taheera Fathima},
      title = {Effectiveness of the 5A’s Approach Combined with CO Analysis in Tobacco Cessation: A Study of 500 Patients at A Dental College-Based Tobacco Cessation Centre},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {10},
      number = {3},
      pages = {841-855},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1722898.pdf},
      abstract = {BACKGROUND

Tobacco use continues to pose a significant public health challenge in India, contributing substantially to preventable illness and premature death. Nicotine dependence is a chronic, relapsing condition that often benefits from structured, supportive interventions. The dental outpatient setting offers a valuable and timely opportunity to identify tobacco users and initiate early cessation support. Integrating compassionate behavioral counseling with objective feedback tools, such as carbon monoxide monitoring, may gently enhance patient awareness, strengthen motivation, and support sustained quit attempts. This approach holds promise for improving cessation outcomes while fostering a patient-centered culture of care.

AIM: 
To evaluate the effectiveness of the 5A's approach combined with carbon monoxide analysis in tobacco cessation among patients attending a dental college-based tobacco cessation centre.
OBJECTIVE:
1.To assess the nicotine dependence level in tobacco users (smoked and smokeless form). 
2. To assess the prevalence of oral diseases due to tobacco use and its stage.
3. To use the newly made chart of 5A’s and assess the usefulness of the chart in tobacco cessation counseling.
4. To assess CO using a Smokerlyzer hand-held machine and correlate it with the smoking status.

MATERIALS AND METHODOLOGY:
A two-year institutional study was conducted among 500 patients attending the Department of Oral Medicine and Radiology. Individuals identified as tobacco users were enrolled and received structured cessation support based on the 5A’s approach (Ask, Advise, Assess, Assist, Arrange). Nicotine dependence was evaluated using the Fagerström Test for Nicotine Dependence, and baseline exhaled carbon monoxide (CO) levels were measured with a Smokerlyzer device to provide objective feedback. Each participant underwent individualized behavioral counseling, received educational materials on the health effects of tobacco use, and was guided in developing a structured quit plan tailored to readiness and dependence level. Follow-up assessments were conducted to monitor progress, reinforce motivation, and evaluate changes in tobacco use behavior and CO levels over time.

RESULTS:
The study population was predominantly middle-aged, with the highest proportion of participants in the 30–40 year age group (31.9%), followed by 40–50 years (25.3%) and 20–30 years (24.1%), while smaller proportions were observed in the 50–60 years (10%), 0–20 years (4.2%), and 60–70 years (3.2%) age groups, and very few participants belonged to the 70–80 year age group. Assessment of nicotine dependence using the Fagerström Test indicated that the majority of participants had minimal dependence (456; 91.2%), followed by moderate dependence (42; 8.4%), with only 2 participants (0.4%) showing high dependence. Among minimally dependent individuals, smoking was the most common form of tobacco use (298), followed by smokeless tobacco (186), while very few used both forms (2); among moderately dependent individuals, 8 were smokers and 5 used smokeless tobacco, and one highly dependent participant was a smoker. With regard to tobacco-related oral morbidities, Oral Submucous Fibrosis (OSMF) was the most frequently observed condition (211 cases), followed by leukoplakia (91) and periodontitis (62), while other conditions included smoker’s palate (8), candidiasis (6), tobacco pouch keratosis (3), gingivitis (2), and other tobacco-associated lesions (117). In proportional distribution, OSMF accounted for 42.2% of cases, followed by leukoplakia (18.2%) and periodontitis (12.4%). Comparison of exhaled carbon monoxide (CO) levels before and after counselling showed a reduction in CO exposure, with the number of individuals with 0 ppm increasing from 120 before counselling to 213 after counselling, while higher CO levels decreased considerably. Similarly, comparison of nicotine dependence levels before and after counselling demonstrated improvement, as 121 participants became tobacco-free following counselling, minimal dependence decreased from 456 to 358, moderate dependence reduced from 42 to 21, and no participants remained in the highly dependent category, indicating the effectiveness of tobacco cessation counselling in reducing nicotine dependence and tobacco exposure.

CONCLUSION:
The present study demonstrates that the 5A’s counseling approach combined with carbon monoxide (CO) monitoring as an effective strategy for promoting tobacco cessation in a dental outpatient setting. The integration of structured behavioral counseling with objective feedback from CO analysis helped increase patient awareness, motivation, and engagement in quitting tobacco. A notable reduction in nicotine dependence levels and CO exposure, along with the increase in tobacco-free individuals after counseling, highlights the positive impact of this intervention. Therefore, incorporating the 5A’s model with CO monitoring in dental clinics can serve as a practical and valuable approach for early intervention and effective tobacco cessation support.},
      month = {September},
  }