adolescents

Patient Example: Matthew's Tobacco Use Assessment Form

Description: 
This is an example of a patient's responses to the Tobacco Use Assessment Form.

Tobacco Use Assessment for Matthew McGregor

1. Have you ever smoked cigarettes or used any other tobacco product?
  __X__ Yes
 

_____ No

 

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Patient Example: Jason's Tobacco Use Assessment Form

Description: 
This is an example of a patient's responses to the Tobacco Use Assessment Form.

Tobacco Use Assessment for Jason

1. Have you ever smoked cigarettes or used any other tobacco product?
  __X__ Yes
 

_____ No

 

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Description: 
Highlights from the 2004 Surgeon General's Report on the impact of smoking on unborn babies, infants, children, and adolescents.
Source: 
CDC
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Description: 
Youth tobacco prevention information from the CDC. Educational resources include: fact sheets on tobacco use, Surgeon General's Report Materials, DVDs and videos, posters, guides, and surveys. There is also information on celebrities against smoking, and the tobacco-free sports initiative.
Source: 
CDC
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Part of a health education website for teens, this section offers tobacco cessation advice aimed at teens. Produced by the Nemours Foundation, an organization dedicated to improving the health and spirit of children.
Source: 
Nemours Foundation
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Description: 
Information on tobacco addiction from NIDA for Teens website
Source: 
National Institute on Drug Abuse (NIDA)
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Information on smoking prevalence in women, special health risks for women, and smoking cessation. Most teens are aware that people who have smoked for awhile can get lung cancer and emphysema and eventually die, but many don't know about all of the bad things that smoking can to them right now. If you smoke, you owe it to yourself to find out about the effects of smoking on your life now. This guide provides some information about what smoking is doing to your body and some of the common reasons why people keep smoking even though they know it's bad for them. These are important things to think about to help you decide if you should continue smoking. (From their website)
Source: 
Center for Young Women's Health, Children's Hospital, Boston
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Complete report by the CDC on preventing tobacco use among young people.
Source: 
Centers for Disease Control and Prevention (CDC)
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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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Patient Example: Jennifer's Youth Tobacco Assessment Form

Description: 
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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