Thinking About Quitting

CLINICAL TOOLS (return to top)
The following are questionnaires and databases that can be incorporated into a patient's chart or used to monitor quality. For more information and additional tools regarding quality improvement, please click here. The questionnaires here are tailored to assessing the teenager’s willingness to work on a quit plan, and assessing their perceived benefits of quitting.

Tracking Form
Patient Tracking Form
This tracking form records the patient’s stage of change, actions taken by the provider, actions taken by the patient, and any provider comments concerning a tobacco use discussion during an appointment. It can be in a patient’s chart for future reference and to track movement along the stages of change.

Questionnaire
Tobacco History Questionnaire
This questionnaire is designed to assess the length of tobacco use, level of addiction, triggers, perceived benefits of tobacco use, number of previous quit attempts and quit methods, and personal challenges of quitting of a patient who reported tobacco use previously or through the Tobacco Use Questionnaire. It can be given directly to patents for completion or used by the provider as guidance for gathering information.

PATIENT HANDOUTS (return to top)
The following are informational forms that clinicians can hand to patients or parents. They can be edited or printed on your practice letterhead, although we cannot vouch for the accuracy of information once they are altered. These informational handouts were designed for the teenager who is thinking about quitting.wr

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List of Websites for Teens Who Are Thinking About Quitting
This document can be given to the patient by a provider who wishes to direct him or her to the websites and links listed in the following section, allowing the teen to explore and utilize these web resources on his or her own time or between visits. Description language has been changed for the target audience.


Referral and Follow Up Form
This document contains a list of possible referrals and follow-up tasks (worksheets and journals) for the teen to complete or pursue after a provider visit. The document already lists the information for the PA Quitline and the DeterminedToQuit website, but the provider can insert individual counseling and local resources in the spaces provided.


Why Should I Quit?
This worksheet is designed to help teens identify clear reasons why they think they need to continue using tobacco and why quitting may be better for them in the long run. It can be copied and used every one or two weeks to help teens see if their decisions about smoking have changed and if they want to talk someone about it.


Write Before You Light
This journal is designed to help the teen examine the relationship between his or her emotional health and tobacco use throughout the day. Teens can track projected smoking, actual smoking, associated mood, and possible environtal or social triggers that lead to craving tobacco. The journal can be easily duplicated and is accompanied by a brief set of instructions.

WEBSITES (return to top)
The following are direct links to tools and solutions from websites other than HelpTeensQuit. By clicking on the link, you will be taken directly to the clinical resource that may be helpful for a teen who is thinking about quitting. For a listing of homepage addresses for all of the websites referenced by HelpTeensQuit, please click here.

Patient Website
American Cancer Society: Smokeless Tobacco
This page provides information describing smokeless tobacco products, tobacco company marketing strategies for these products, and how smokeless tobacco compares to cigarette smoking. Smokeless tobacco-related cancers are also described, as well as issues related to and strategies for quitting. Website by the American Cancer Society.


Determined to Quit: Motivating to Quit
This “motivating to quit” page helps the teen recognize the benefits of quitting while providing specific questions that will help to identify personal motivations and difficult situations. The page also addresses common concerns about the side effects of quitting. Website by the Commonwealth of Pennsylvania.


Spit Tobacco: A Guide for Quitting
This website provides information about the dangers and addictive properties of chew, or spit tobacco, and helps to dispel some of the common myths associated with its use. In addition, the website helps the teen to identify some possible motivations to quit, and provides a quit guide that specifically addresses the first two weeks of quitting smokeless tobacco and preventing relapse. Website by the National Institute of Dental and Craniofacial Research.


TeenQuit: Frequently Asked Questions
This page lists common questions and concerns about quitting smoking and living a tobacco-free, providing information or solutions to help. Website corresponds to the ASCENT program.


TeenQuit: Gallery of Gore
This page contains pictures of diseased tongues, lungs, gums, lips, teeth, and feet caused by tobacco use. The teen can print out these pictures in cigarette-pack sized images to place on the outside of his or her pack in order to encourage tobacco use awareness and motivate to quit. Website corresponds to the ASCENT program.


TeenQuit: Know Your Stats
This page allows the teen to enter his or her average cigarettes per day and hypothetical quit date and the website will calculate the number of future cigarettes smoked, amount of minutes lost from life from smoking future cigarettes, average amount of money spent on future cigarettes, and offer financially-equivalent alternative activities. Website corresponds to the ASCENT program.


TeenQuit: Piggy Bank Cost Calculator
This page contains a cigarette cost calculator that allows the teen to enter the number of cigarettes smoked per day, how many years the teen plans to smoke (or has smoked already), and the cost of a pack of cigarettes. TeenQuit then calculates the amount of money the teen would save (or has spent) in order to motivate the teen to quit. Website corresponds to the ASCENT program.


TeenQuit: Real Stories
This series of pages allows the teen to read several quit stories and think about the authors’ motivations to quit and quit methods. Website corresponds to the ASCENT program.

	REFERRAL (return to top) Many tobacco cessation programs will work with teens who are thinking about quitting, but some may insist that the teen be willing to work on a quit plan immediately. In general this is an ideal time to make this referral. We encourage you to contact your local programs to find out whether they are accepting referrals and if their program is right for your patient. For a listing of local tobacco cessation programs click here.

	Thinking About Quitting
	Contemplation is a time when the teen is considering tobacco cessation, but is not actively planning to stop. Teens may be willing to talk about the pros and cons of tobacco use and to take advice on how to make a quit plan. The following documents and web links offer ideas and tools to support your intervention.
	What You Can Do: 1) Clinical Tools Track his or her progress using a tracking form and brief questionnaires. 2) Patient Handouts Provide an informational handout describing the risks of tobacco use and rewards of quitting. 3) Websites Web-based tools that will help him or her think about the risks of tobacco use and the rewards of quitting. 4) Referral Consider an appropriate community-based referral.