244SECT|ON‖· WHAT TO DO WITH THE INFORMATI○N and/or childcare, and discomfort with participating in a group discussion. Patients underrepresented in traditional cessation services, such as smokers of ethnic minority back grounds, actively seek help from quit lines(22) Every quit line serves thousands of tobacco users each year, a volume rarel achieved by other behavioral services, yet they currently reach only. 1-5%6 of the tobacco users in their states each year Practices can extend their capability of providing intensive counseling by encouraging patients to utilize a quit line. One way to do this after offering brief advice to quit is simply to provide the national toll-free number (1-800-QUIT-NOW) that automatically routes callers to their state's quit line and to recommend that patients call (reactive telephone counseling). This can be done in 30 seconds. When incorporating all the 5As into busy office visits shortcut and far better than not addressing tobacco use at al very reasonable is not feasible, this"Ask, Advise, and Refer"strategy(22)is a In some states clinicians can send referrals directly to the quit line, whose counselors will then contact the patient directly (proactive telephone counseling). Proactive counseling, which eliminates the need for the patient to place the call and has been proved to be more effective than reactive counseling(20), is usually arranged by completing a referral form(often signed by both patient and clinician), which is then faxed to the service. Most state quit lines offer proactive counseling only to smokers ready to make a quit attempt in the next 30 days (preparation stage of the transtheoretical model, see page 132 in Chapter 5), and practices may therefore need to screen potential quit line referrals to verify their stage of readiness to change. For smokers not yet ready to quit, providing the telephone number for them to call is more appropriate. In either case, clinicians should be prepared to respond to calls from patients who are referred to quit lines and want prescription-only cessation medication options that were not discussed and arranged before their referral COMMON PROBLEMS AND POSSIBLE SOLUTIONS Weight Gain The issue of potential weight gain is important for many patients who try to stop smoking. Some patients cite weight gain as the reason for relapse after previous attempts to stop The average amount of weight gained after cessation is approximately 5 lb. Some patients gain no weight after cessation, but a small proportion of people gain large amounts of weight There are several obvious recommendations that can be made to patients concerned about preventing weight gain. Attention to caloric intake can be as simple as monitoring portion size, making healthy food choices, and