A Personalized Quit Smoking Plan - U.s. Department Of Health And Human Services (Page 2 of 2) in pdf

A Personalized Quit Smoking Plan - U.s. Department Of Health And Human Services Page 2

You Can Quit Smoking

Five Keys for Quitting

Your Quit Plan

1. Get ready.

nday Monday Tuesd

1. Your Quit Date:

1 2

__________________________

! Set a quit date and stick to it – not even a single puff!

8 9 10

! Think about past quit attempts. What worked and

what did not?

2. Get support and encouragement.

2. Who can help you?

! Tell your family, friends, and coworkers you are quitting.

__________________________

! Talk to your doctor or other health care provider.

! Get group, individual, or telephone counseling.

3. Learn new skills and behaviors.

3. Skills and behaviors you can use:

__________________________

! When you first try to quit, change your routine.

__________________________

! Reduce stress.

! Distract yourself from urges to smoke.

! Plan something enjoyable to do every day.

! Drink a lot of water and other fluids.

4. Get medication and use it correctly.

4. Your medication plan:

Medication: _________________

! Talk with your health care provider about which

medication will work best for you.

Instructions: _________________

•

Bupropion SR – available by prescription.

__________________________

•

Nicotine gum – available over-the-counter.

__________________________

•

Nicotine inhaler – available by prescription.

•

Nicotine nasal spray – available by prescription.

•

Nicotine patch – available over-the-counter.

5. Be prepared for relapse or difficult situations.

5. How will you prepare?

__________________________

! Avoid alcohol.

! If you are around other smokers, try not to stay

__________________________

around them too long.

! If you are angry, upset, sad or frustrated, don’t smoke!

Try other things to feel better, like taking a walk.

! Eat a healthy diet and stay active.

Quitting smoking is hard. Be prepared for challenges, especially in the first few weeks.

Follow-up Plan:

_______________________________________________________

Other Information: _______________________________________________________

Referral:

_______________________________________________________

Clinician

Date

U.S. Department of Health and Human Services

Public Health Service

A Personalized Quit Smoking Plan - U.s. Department Of Health And Human Services Page 2

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