tobacco

Personalized Reasons for Quitting Tobacco Use

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Personalized Reasons for Quitting Tobacco Use

Personalized Reasons for Quitting Tobacco Use

(Stated in positive terms)

For Any User

• Save money. Money not spent on tobacco products, insurance costs, and health services will be available for personal benefit

• Feel better

• Improve ability to exercise, perform better in sports

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An example of a stop-smoking agreement form

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An example a stop-smoking agreement form.

QUIT FOR GOOD RX
I agree to stop smoking on:
Date: _____/_____/______.
I understand that stopping smoking is the single best thing I can do for my health, and my
health professional has strongly encouraged me to quit.
Patient's Signature:________________________________
Health Professional's Signature:_____________________________
Today's Date:_____/______/_____

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Description: 
Results of a study done to examine the efficacy of a motivational interviewing intervention for adolescent smokers (From their Website).
Source: 
Robert Wood Johnson Foundation (RWJF)
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The Legacy for Health website includes information about smoking cessation.
Source: 
Legacy for Health
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Patient Example: Jennifer's Youth Tobacco Assessment Form

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This is an example of a patient's responses to the Tobacco Use Assessment Form for Children or Teens.

Name: Jennifer Simpson

Date: 6/ 1 /2005

Have you ever smoked cigarettes or used any other tobacco product?
 
X   No
___ Yes, but just a little experimentation, for example, a few puffs of a cigarette
___ Yes, more than just experimenting. If Yes, please answer the following questions (A-C):

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Description: 
A chart detailing precautions and dosing of several nicotine replacement therapy formulations, including gum, lozenge, transdermal patch, nasal spray, and oral inhaler.
Source: 
American Academy of Family Physicians
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Description: 
Contains information on different forms of nicotine replacement therapy, such as the nicotine patch, gum, lozenge, inhalers, and nasal sprays
Source: 
Quitnet.com
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A chart giving information on different products for tobacco dependence including the nicotine patch, gum, lozenge, nazal spray, bupropion, and varenicline.
Source: 
In.gove
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Adolescent Screen for Tobacco Dependence: The Hooked on Nicotine Checklist

Description: 
This checklist was first described in the Development and Assessment of Nicotine Dependence in Youth study, and was designed to screen adolescents for symptoms of tobacco dependence (DiFranza et al. 2002a). An adolescent answering yes to any of these questions is said to have some dependence on tobacco.

Name: _______________________ Date: _____________________

1. Have you ever tried to quit but couldn’t?   YES   NO

2. Do you smoke now because it’s really hard to quit?   YES   NO

3. Have you ever felt like you were addicted to tobacco?   YES   NO

4. Do you ever have strong cravings to smoke?   YES   NO

5. Have you ever felt like you really needed a cigarette?   YES   NO

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Responding to Marketing Questions

Description: 
Marketing questions deciphered.

Marketing statements by tobacco companies are explained by the image they convey and their actual countermessage.

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