Smoking
Put Prevention Into Practice
Name:______________________________________________________
RX for Prevention: ___________________________________________
____________________________________________________________
____________________________________________________________
Follow-up:___________________________________________________
____________________________________________________________
____________________________________________________________
Clinician's Signature: _________________________________________
Date:_______________________________________________________
- Cigarettes and other tobacco products hurt your lungs and your heart and also cause
cancer.
- Cigarettes and other tobacco products stain your teeth, cause wrinkles, and make
your breath and hair stink!
- Children who live with smokers have more ear infections, asthma, and pneumonia.
- If you smoke, ask yourself when you would like to quit. When you are ready, do the
following:
- Make a plan and set a date to quit. Ask your doctor/clinical setting for help.
- Tell your friends and family that you are going to quit. Get rid of your
cigarettes and ashtrays.
- Ask your doctor about new medicines that can make it easier to quit
smoking.
- If you fail the first time, don't give up. Try again!
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