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Assessing
Your Readiness to Quit
Before Your Next Visit
IIn
the time between your visits with your INTERxVENT
MENTOR, you should read and
complete
your educational kits.
Use this sheet to record your work.
Think of this as “homework.”
Bring this sheet with you to your next
visit.
q
Review
your smoking history.
My
Smoking History
·
How
long have you been smoking?
years
·
How
many serious attempts to quit have you made?
_____ attempts
·
What
is the longest period of time since you first
started to smoke that you have been smoke-free?
______
·
What
helped you stay smoke-free?
____________________________________________
·
What
happened to cause you to start smoking again?
____________________________________________
q
Consider
your reasons for smoking.
List them here.
My
Reasons for Smoking
·
·
q
Complete
the Smoker’s Log for at least three days.
q
List
your advantages (“pros”) and disadvantages
(“cons”) for quitting smoking.
My
Advantages for Quitting (“pros”)
·
·
·
My
Disadvantages for Quitting (“cons”)
·
·
·
q
Compute
your cost of smoking for one year.
My
Annual Cost of Smoking is $__________
q
How
many “Yes” answers did you check related to
addiction to nicotine? ________
When you think you are ready to move forward, ask for
the next kit, “Preparing to Quit.”
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