QUIT NOW

Quit NOW

NC HealthSmart School Worksite Wellness Toolkit Quit Now Workbook

NC HealthSmart School Worksite Wellness Toolkit Quit Now Workbook II

WHY QUIT NOW?

Tobacco causes more deaths than AIDS, alcohol abuse, automobile accidents, illegal drugs, fires, homicide and suicide combined.
ISSUE
Cigarette smoking is the number one preventable cause of death in the United States. It is responsible for one in every five American deaths. Tobacco use in any form is not only harmful for the person using the product but also for non-smokers and other people in the environment.

HEALTH CONSEQUENCES
Some of the proven health consequences of tobacco use include premature death, disability and disease including heart disease, stoke, several cancers (including cancer of the lung, larynx, pharynx, mouth, stomach, pancreas, bladder, cervix and esophagus), chronic bronchitis and emphysema. Tobacco use is also a cause of sudden infant death syndrome (SIDS) as well as intrauterine growth retardation leading to low birth weight babies and is a probable cause of unsuccessful pregnancies.

SECONDHAND SMOKE
Secondhand Smoke (SHS; also referred to as environmental tobacco smoke or passive smoke), which is a combination of smoke exhaled by the smoker and the smoke that comes from the burning end of a cigarette, cigar or pipe can also have adverse health consequences for non-smokers. Secondhand smoke is a cause of lung cancer and can cause heart attacks in non-smokers at risk for heart disease. It is also responsible for episodes of eye irritation among allergic persons. In children it is associated with an increased risk of SIDS, respiratory tract infections and asthma.

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RATIONALE
In view of the above mentioned health hazards it makes common sense to quit the use of tobacco. However, it is also true that once addicted to nicotine it is not easy to quit. Since employees spent a lot of time at their work, worksites can help interested staff members to quit tobacco by taking steps to make the worksite tobacco free. A tobacco free policy/environment at the worksite can be a huge incentive to help staff members quit. Your worksite wellness committee can take steps to protect all staff members from harmful effects of tobacco use and provide cessation support to smokers who want to quit. The following sections of this workbook provide suggestions and guidelines for implementing several such options.

Tobacco products: includes cigarettes, cigars, blunts, bidis, pipes, chewing tobacco, snuff and any other items containing or reasonably resembling tobacco or tobacco products. Tobacco use: includes smoking, chewing, dipping or any other use of tobacco products.

Adapted from Centers for Disease Control and Prevention: Office on Smoking and Health, U.S. Department of Health and Human Services, Wellness Councils of America, American Cancer Society. Making your Workplace Smoke Free: A Decision Makers Guide. 1996.

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TABLE OF CONTENTS
I. Quit Now HealthStart Activity .....1 II. Quit Now Individual & Group Resources .....5 Individual Resources 6 Group Support/Resources ..8 III. Quit Now Resources for Worksite Policies ...11 Quit Now Policies for Worksite .12 Sample Tobacco-Free Worksite Policies 14 IV. Quit Now Resources for Worksite Environments ...17 Literature Rack 18 Posters .19 V. Quit Now Additional Resources ...21 VI. Appendices ....27 Appendix A: I QUIT Challenge Announcement 28 Appendix B: I QUIT Challenge Sign Up Sheet .29 Appendix C: Motivational Posters ......30 Appendix D: Motivational Quotes33 Appendix E: I QUIT Challenge Pledge Card..35 Appendix F: QUIT NOW One Page Ideas..36 Appendix G: You Can Quit Pocket Card .51 Appendix H: I QUIT Challenge Certificate of Achievement 52 Appendix I: Free Resources for Individuals in NC Wanting to Quit the Use of Tobacco 53 Appendix J: Smokers Pledge .54

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TABLE OF CONTENTS, CONTINUED

Appendix K: Assessing a Group Cessation Program ..55 Appendix L: NC Tobacco-Free Schools Model Tobacco-Free School Policy .....56

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SECTION I
HealthStart Activity

Quit NOW

NC HealthSmart School Worksite Wellness Toolkit Quit Now Workbook

Quit Now HealthStart Activity

The HealthStart Quit Now Activity includes ready-to-use materials such as announcements, posters, and handouts that can be used by the worksite wellness committee to jumpstart wellness programs. Success with these activities will help to increase management support and staff interest in future, longterm programs. The follow outlines Activity the purpose, materials needed and action steps for completion. The Extra section of the activity identifies some things that are not required for the activity to be successful but will greatly assist in improving staff morale for participation in wellness activities. Even though this activity promotes participation of individual staff members, the committee should strive to accomplish changes in worksite policies and environments that support a healthy lifestyle. These changes will make it easier for staff to adopt healthy behaviors, make healthier lifestyle choices at work and reduce the risk for long-term chronic diseases.

The I QUIT Challenge Purpose

The I QUIT Challenge will encourage staff to make an effort to quit tobacco use and achieve better health. The ultimate aim of the activity is to help tobacco users quit completely. However, nicotine is very addictive and it may not be easy for tobacco users to quit for good. Therefore, this activity allows participants to choose their own time frame for quitting the use of tobacco. The challenge will provide participants with support materials and encouragement to stay quit.

Materials Needed

I QUIT Challenge announcement (Appendix A) I QUIT sign up sheet (Appendix B) Motivational posters and quotes (Appendix C and D) I QUIT Challenge Pledge Card (Appendix E) Quit Now One Page Ideas (Appendix F) You Can Quit pocket card (Appendix G) Certificate of Achievement (Appendix H) Handout: Free Resources for Individuals in North Carolina Wanting to Quit the Use of Tobacco (Appendix I)

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Action Steps
1. Select the I QUIT Challenge Coordinator(s) Coordinator(s)____________________________________________________________ 2. Announce the I QUIT Challenge to staff by posting notices at several places in the worksite including staff notice board, restroom, break room, or other appropriate place. 3. The announcement should be made at least one to two weeks prior to the start date. This will give tobacco-users some time to assess their readiness to quit and make a decision to participate in the challenge. 4. Post a sign up sheet for staff to participate in the I QUIT Challenge. All staff members can participate whether current smokers/tobacco users, non-smokers or ex-smokers. The non-smokers and ex-smokers can serve to provide support and encouragement to their co-workers actively trying to quit. 5. Allow the participants to choose their own time frame during which they would make an effort to quit using tobacco in any form. This may be a week, two weeks, a month or more. Setting a quit date within a months time is recommended.

Support Materials for I QUIT Challenge Participants

On the start date of the I QUIT Challenge, the coordinator(s) should make the following support materials available for all participants who are trying to quit tobacco use.

Display motivational signs and posters at several prominent places in the worksite to encourage staff members to quit tobacco. (See Appendix C and D) Ask the participants to sign a personal pledge card (Appendix E). The pledge card should specify the quit duration, the motivating factor for quitting may be personal health reasons, health of their children or another reason) the personal goal some smokers may begin by decreasing the number of cigarettes smoked per day and others may wish to set a quit date in the near future and become tobacco free on that date Give the participants information on how to get support during their efforts to quit tobacco use. See Appendix I Free Resources for Individuals in North Carolina Wanting to Quit the Use of Tobacco. A personal You Can Quit pocket card may be beneficial for some staff members to encourage and remind them of their commitment to quit tobacco use. A sample pocket card is provided in Appendix G.
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Completing the I QUIT Challenge

On the day the I QUIT Challenge ends:

Present a Certificate of Achievement (Appendix H) to all participants. Request someone in administration, such as the superintendent, or school principal, to personally sign the certificates of achievement. Remind the staff that even though it is the end of the I QUIT Challenge it should not be the end of their efforts to achieve and maintain good health.

EXTRA:
Depending upon the level of support from your administration and the availability of resources for wellness activities at your worksite, the wellness committee may incorporate the following as an add-on to the challenge.

Management InputRequest someone in administration to personally sign on the certificate of achievements that are presented to staff members who participated in the challenge. IncentivesIf funding is available for incentives, it makes the most sense to use those dollars to provide nicotine replacement therapy (NRT) for those trying to quit. NRT can double quit rates. NRT should not be offered as an incentive but rather as a form of treatment, and should be offered to everyone except those who are pregnant, have had a heart attack within two weeks, have on-going arrhythmias or who have ongoing heart disease-related chest pain.

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SECTION II
Individual and Group Resources

Quit NOW

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Individual Resources
Your worksite may offer support to staff members who are interested in quitting the use of tobacco through self-help materials and/or group behavior modification programs. This is particularly true if your worksite has or is considering a tobacco-free policy. (See Section III Quit Now Policies for Worksites.) A tobacco free policy at your worksite may be a motivating factor for such staff members and encourage them to quit. If the worksite also offers support for staff members to quit the use of tobacco, it reassures them that the policies are meant to be anti-tobacco only and not anti-tobacco users. Many staff members at your worksite may prefer to use individual-based programs during their quitting efforts because these provide privacy and the flexibility to use at ones own convenience. Listed below are a few ways to share resources with staff members that are interested in quitting the use of tobacco.

Be sure that all staff members are aware of the toll-free quitline 1-800 QUIT NOW (1800- 784-8669) or TTY 877-777-6534. 1-800 QUIT NOW is a telephone use quitline where trained tobacco quit coaches provide comprehensive assistance to help the tobacco user quit. The tobacco user may call as often as he/she likes, and services are available in English, Spanish, and other languages. Share the guide Free Resources for North Carolinians Wanting to Quit the Use of Tobacco with all staff members. (Appendix I) For resources directly related to quitting the use of spit and/or chew tobacco, visit the following websites: Centers for Disease Control CDC TIPS: www.cdc.gov/tobacco/ American Dental Association: www.ada.org/public/topics/tobacco_faq.asp American Cancer Society: www.cancer.org Quit Now NC! : www.quitnownc.org Several hospitals and local health departments across North Carolina offer tobacco cessation programs. A complete listing of smoking cessation resources available in your local area may be accessed at www.ncgoodhealthdirectory.com Be sure to check with your health benefits representative to determine if there are on-site resources available to staff seeking a cessation program. Staff members should also be encouraged to meet with their healthcare providers for counseling and pharmaceutical advice.

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Many voluntary, local and national organizations and health departments have also developed self-help guides for individuals to use in their efforts to quit tobacco. Most of these self-help materials are available as an online Of current smokers, an estimated 32 million tool or in the form of booklets, audio, or smokers (about 70% of all smokers) report videotapes. Most of that they want to quit smoking completely. these materials are also free or available - Centers for Disease Control and Prevention. at a nominal charge. Cigarette smoking among adults-United States.1994 Mortality and Morbidity Weekly Report 1996. Appendix I provides a list of free resources available to individuals for obtaining support for tobacco cessation. Incentives for staff members who have made successful quit attempts can be a big motivating factor for these individuals to stay quit and also serve as encouragement for others to quit. Depending upon the resources and budgetary constraints of your worksite, incentives can range from cash bonuses to free give aways or even a simple recognition on the bulletin board, in the newsletter or as a paycheck insert. Individual staff members can be motivated to quit for their own health, as well as for the health of their children, grandchildren, or other family members. See Appendix J for a Pledge Card that can be distributed among staff members who want to quit because of family reasons. Also included in Appendix G is a Pocket Card that can be printed and distributed to motivate staff members to keep up in their efforts to quit. Simple, easy-to-read smoking cessation materials in English and Spanish, for individual use can be downloaded and printed from the US Department of Health and Human Services website. These materials can also be ordered through the order form available at the website below. One hundred copies of most materials are free of cost to order: www.ahrq.gov/consumer/tobacco

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Group Support/ Resources

Structured group programs provide the guidance and support needed by many individuals to succeed in their efforts to quit tobacco. Members of a group often provide support and counsel one another. This service can either be contracted to outside providers or the staff members can be given a listing of available programs in the community. Staff members who are trying to quit tobacco use may also form peer groups among themselves and provide encouragement to each other, especially when cravings and other withdrawal symptoms occur.

If your worksite decides to contract with an outside provider for offering tobacco cessation support to staff, it might be useful to screen such providers for their services. Refer to Appendix K for a checklist that can be used in assessing a group cessation program. An online North Carolina county specific directory of tobacco cessation programs and resources is available at www.ncgoodhealthdirectory.com

The worksite wellness committee may offer scheduled educational classes for staff to support and encourage them in their decisions to quit tobacco. The educational sessions may be presented in a series of Lunch & Learn, staff development, or staff meeting presentations. Select materials that are suited for adults and fits the time period available. Videotapes related to several smoking cessation topics are available at no cost from Tobacco Information and Prevention Source, Centers for Disease Control and Prevention: www.cdc.gov/tobacco/pubs1.htm#Videotapes American Legacy Foundation along with supporting partners offers a free online group support program called Circle of Friends Uniting to be Smoke Free. Individuals (smokers trying to quit and ex-smokers) can register for free. Members provide and seek support from other members through stories, message boards, e-cards, and instant messaging. Staff members at your worksite interested in this type of group support can join the Circle of Friends by calling 1-800-243-7000 or by visiting www.join-the-circle.org The U.S. Food and Drug Administration has approved seven first-line medications to help smokers quit. Five of these are nicotine replacement therapies and two are non-nicotine medications. All seven relieve withdrawal symptoms. Check with your companys health insurance plan to find out if it provides coverage for these pharmacological aids and if it does, inform the staff accordingly. Insurance coverage of tobacco-use cessation treatment increases both the use of effective treatment and the number of successful quit attempts. For more information on the

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why, what, and how of coverage for tobacco use cessation treatments, read the article available from the Centers for Disease Control and Prevention at: www.cdc.gov/tobacco/quit_smoking/cessation/coverage/index.htm

The worksite wellness committee may encourage a Buddy System amongst staff members who are interested in quitting. Two staff members can team up during their quitting effort. This can greatly increase their motivation, provide the required support during times of relapse, and help overcome cravings. The worksite wellness committee may try to identify ex-smokers at the worksite who can serve as role models and mentors for other staff members trying to quit. Staff members who want to quit can gain a lot of benefit and support from a co-worker who has been successful in his/her quit attempt.

Activity Idea:
The worksite wellness committee may also organize a challenge among staff members trying to quit. Refer to the HealthStart Activity, the I QUIT Challenge, located on page 2 of the Quit Now resource book.

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NC HealthSmart School Worksite Wellness Toolkit Quit Now Workbook 10

SECTION III
Resources for Worksite Polices

Quit NOW

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Quit Now Policies for Worksites

What is meant by a policy?
A policy can be a law or regulation. It can be a written rule, or a common practice. Policies can support healthy behaviors and encourage staff to quit tobacco. We can write policy at any level. The State Legislature, State Board of Education, school districts, or schools can create policy. Policies can produce change in our surroundings that help us quit tobacco. For example, NC legislation requires school districts to prohibit use of tobacco in school buildings, on school grounds, and at school sponsored events by August 1, 2008.

Why do we need tobacco-free policies in worksites?

Multiple scientific sources, including the U.S. Surgeon General, the National Cancer Institute, the Centers for Disease Control and Prevention and the Environmental Protection Agency have concluded that:

One motivating reason why people quit the use of tobacco is when their worksite goes tobacco-free. Secondhand smoke is a cause of disease, including lung cancer and heart disease in healthy non-smokers, resulting in the death of more than 65,000 non smoking Americans every year. The simple separation of smokers and non-smokers within the same air space does not eliminate the exposure of nonsmokers to second hand smoke.

Separate ventilation systems do not work. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), the international standard setting body for indoor quality, supports this 6th major conclusion by the Surgeon General, July 2006.

There is no known safe level of secondhand smoke exposure, and evidence suggests that even short-term exposure may increase the risk of experiencing a heart attack. Increased adoption, communication, and enforcement of tobacco-free policies by worksites can help to protect the health of staff and also provide a supportive environment for staff members who want to quit.

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Benefits of Becoming a Tobacco-Free School Worksite

The North Carolina statewide campaign for 100% Tobacco-free schools was launched to protect our children's health by encouraging all 115 school districts in North Carolina to adopt a model 100% tobacco-free policy. There are many benefits to the school district, staff members, students, and community members that accrue from having a tobaccofree workplace. Here are a just few:

Reduced medical costs

A smoker who quits could save his or her employer an estimated $1,429 in excess illness costs each year. Persons who quit smoking before age 65 are estimated to save from 45% to 67% of the lifetime excess medical costs of persons who continue to smoke.

Improved community image

Many organizations implement tobacco-free policies in part to influence the communitys opinions of the organization. With nonsmokers accounting for about 75% of adult consumers of goods and services, an organizations decision to go tobacco-free can influence their appeal to the community. Adopting a tobacco-free workplace policy can improve a worksites image in hiring as well. Organizations that demonstrate concern for the health and well being of their staff are more likely to be able to recruit and retain staff.

Public support for workplace policies

As the public has become more aware of the risks associated with exposure to secondhand smoke, support for smoke-free policies has steadily increased. According to Gallup polls, Americans not only know about the risks posed by secondhand smoke, but also favor efforts to reduce exposure to it. The percentage of Americans who favor some type of restriction on workplace smoking increased from 81% in 1983 to 94% in 1992.

Increased staff morale

Adopting a smoke-free policy sends a clear message to your staff and the community: We care about the health and safety of our employees. The employer's concern for the health of staff members is especially clear in the case of those who have conditions that make them vulnerable to secondhand smoke, such as staff members who are pregnant, have heart disease, or have breathing problems. Offering quitting support for staff members who want to quit sends a straightforward message that the company cares about all employees, including smokers.

Protecting students health

The standard of a safe school environment is not met when smoking is allowed indoors or outside near building entrances or fresh air intakes. Simple separation of ventilation systems is not effective. Further, passing through the smoking area may trigger an asthma attack or exacerbate respiratory problems in students. Additionally, over 80% of adult tobacco users started before age eighteen and approximately 3,000 young persons begin smoking daily. Influences come from parents, teachers, coaches and other adults, peers, mass media, and price/availability of tobacco products. Tobacco-free environments may prevent or postpone smoking onset in young persons.

Increased productivity
A tobacco-free workplace enhances productivity by reducing the health effects of secondhand smoke on nonsmokers, and by reducing smoking-related absenteeism among smokers who are motivated to quit as a result of the smoke-free policy.

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Sample Tobacco-free Worksite Policies

The following sample policies can be used to serve as a guide to draft a policy statement.

Sample Tobacco-Free Policies for Schools

NC legislation requires school districts to prohibit use of tobacco in school buildings, on school grounds, and at school sponsored events by August 1, 2008. The NC Tobacco-free Schools website provides an overview of a Model 100% Tobacco-Free School Policy and samples of several Tobacco-Free policies that have been adopted by NC school districts. Refer to Appendix L to view the Model Tobacco-free School Policy suggested by NC Tobacco-Free Schools. Quick website links for this Model Policy and sample policies from NC school districts can be found here:

www.nctobaccofreeschools.com/adopt/modelpolicyTPCB.shtm (Example Model Policy) www.nctobaccofreeschools.com/adopt/ncpolicies.shtm (Policy examples from districts across NC)

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Other Types of Tobacco-Free Policies for Worksites:

Sample Policy #1: 100% Tobacco Free Indoors

Effective (date), smoking and tobacco use is not allowed anywhere indoors at (worksite name). Tobacco use is strictly prohibited within the building(s), including offices, hallways, waiting rooms, restrooms, lunchrooms, elevators, meeting rooms, and community areas. Breaks will be granted to all employees in accordance with state personnel policies. Smoking must be confined to these breaks (including meal break) and to the outside, designated smoking area only. This policy applies to all employees, clients, contractors and visitors. All individuals share in the responsibility for adhering to and enforcing the policy. Any problems should be brought to the attention of the appropriate supervisor and handled through the normal chain of command.

Sample Policy #2 100% Tobacco Free Indoors and Vehicles

Effective date), smoking and tobacco use is not allowed anywhere indoors at (worksite name) or in (worksite name) owned vehicles used by this work unit. Tobacco use is strictly prohibited within the building(s), including offices, hallways, waiting rooms, restrooms, lunchrooms, elevators, meeting rooms, community areas, and vehicles. Breaks will be granted to all employees in accordance with state personnel policies. Smoking must be confined to these breaks (including meal break) and to the outside, designated smoking area only. This policy applies to all employees, clients, contractors and visitors. All individuals share in the responsibility for adhering to and enforcing the policy. Any problems should be brought to the attention of the appropriate supervisor and handled through the normal chain of command.

Sample Policy #3 100% Tobacco Free Indoors and Buffer Zone

Effective (date), smoking and tobacco use is not allowed anywhere indoors or within 50 feet of the buildings at (worksite name). Tobacco use is strictly prohibited within or immediately outside of the building(s), including offices, hallways, waiting rooms, restrooms, lunchrooms, elevators, meeting rooms, community areas, and entrances and exits to buildings. Breaks will be granted to all employees in accordance with state personnel policies. Smoking must be confined to these breaks (including meal break) and to the outside, designated smoking area only. This policy applies to all employees, clients, contractors and visitors. All individuals share in the responsibility for adhering to and enforcing the policy. Any problems should be brought to the attention of the appropriate supervisor and handled through the normal chain of command.

Sample Policy #4 100% Tobacco Free Indoors and Protected Air Intake Sources
Effective (date), smoking and tobacco use is not allowed anywhere indoors at (worksite name). Tobacco use will be strictly prohibited within or immediately outside of companyowned or leased buildings, including offices, hallways, waiting rooms, restrooms, lunchrooms, elevators, meeting rooms, community areas, and entrances and exits to buildings. Smoking and tobacco use will only be allowed outside of the building (at least 50 away from the main entrance, handicapped entrance and any areas where smoke can leak into the building via intake vents, windows, and doors) or employees own cars. Breaks will be granted to all employees in accordance with state personnel policies. Smoking must be

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confined to these breaks (including meal break) and to the outside, designated smoking areas only. This policy applies to all employees, clients, contractors and visitors. All individuals share in the responsibility for adhering to and enforcing the policy. Any problems should be brought to the attention of the appropriate supervisor and handled through the normal chain of command.

Sample Policy #5 Value statement

Effective (date) it is the policy of (worksite name) to create a workplace environment which encourages employees to maintain a tobacco-free lifestyle and which values a smoke-free work environment as an essential part of both personal and corporate well-being.

Also, a complete listing of North Carolina smoke-free workplaces can be found at www.workingsmokefree.com. If your workplace adopts such a policy it can be easily added to this listing too by using the contact information at the website.

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SECTION IV
Resources for Worksite Environments

Quit NOW

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Literature Racks
Literature racks are a convenient means to keep the Quit Now message visible in the workplace and motive staff members to stop using tobacco. Commercial literature racks are available from office and library supply stores. Simple and inexpensive literature holders can be made from attractive plastic or ceramic flower pots, baskets and other office or household items. Use an attractive holder in a highly visible location to hold handouts, one-pagers, brochures, or pamphlets about the benefits of quitting tobacco in any form. Several ready-to-use handouts are included in Appendix F These handouts are also included as part of the toolkit CD-ROM for easy printing. Brochures, booklets and pamphlets on several other topics related to tobacco use and smoking can be downloaded for free or ordered for a charge from the list of related links given below.

Related Links

http://familydoctor.org/161.xml www.cdc.gov/tobacco/pubs.htm www.surgeongeneral.gov/tobacco www.smokefree.gov/info.html www.americanlegacy.org www.pacificnet.net/~safe/lit.html www.hopehealth.com www.personalbest.com www.krames.com www.parlay.com www.welcoa.org/store www.aicr.org/publications/brochures http://cissecure.nci.nih.gov/ncipubs www.ahrq.gov/consumer/index.html#smoking www.cancer.org/asp/freebrochures/fb_global.asp www.cancer.org/docroot/PED/content/PED_10_13X_Quitting_Smoking.asp www.nidcr.nih.gov/HealthInformation/OralHealthInformationIndex/SpitTobacco/ QuittingGuide

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Posters
Health messages displayed in high traffic areas can both inform staff of the facts and reinforce their healthy behaviors. The posters should be changed regularly depending upon the number of times staff pass by the message. Generally, after seeing the same message 10-20 times, people become desensitized to it and no longer see it. A good rule of thumb would be to change posters/messages once a month. Leaving the poster spot empty for a couple of weeks may also increase response to a new poster message. See Appendix C for some examples of motivational posters that can be printed from the CD-ROM provided with the toolkit. Appendix D contains samples of several motivating quotes related to smoking and tobacco use. These quotes are provided as a ready-to-print size in the CD-ROM. Post different quotes at different places at your worksite and switch them around every week or post the same quote at several places and change it after 1-2 weeks. Posters on smoking and tobacco use can also be downloaded or ordered for a charge from the following online sources:

Related Links

http://cissecure.nci.nih.gov/ncipubs www.epa.gov/iaq/ets/publications.html www.cdc.gov/tobacco/pubs.htm www.hopehealth.com www.parlay.com www.quitsmoking.com/signs

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SECTION V
Additional Resources

Quit NOW

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Additional Resources
The following is a listing of some organizations/programs that provide useful information on quitting smoking and other tobacco products. to tobacco and links to other resources. The ADA also provides resources for quitting the use of spit and/or chew tobacco at www.ada.org/public/topics/ smoking_tobacco Website: www.ada.org/prof/resources/ topics/tobacco

American Academy of Family Physicians

The Tobacco Prevention and Cessation section of the American Academy of Family Physicians provides links to several useful information sources including a free, online self-help guide that walks individuals through five key steps to kicking the nicotine habit. It also provides links to AAFP patient education materials on smoking, National Network of Tobacco Cessation Quitlines and the North American Quitline Map (list of state/local quitline phone numbers, web sites and other services) from the North American Quitline Consortium. Website: www.aafp.org/x27811.xml

American Legacy Foundation

American Legacy Foundation is a nonprofit organization that campaigns to reduce tobacco use in the United States. The organization is dedicated to building a world where young people reject tobacco and anyone can quit. The American Legacy Foundation also provides grants to support innovations in tobacco control. The website provides information on tobacco-use prevention, cessation, research findings, information on programs designed to reduce tobacco use among priority populations, and technical assistance and training. Website: www.americanlegacy.org

American Cancer Society

American Cancer Society provides detailed facts on tobacco use and smoking. It also provides resources and support for individuals interested in quitting, information on the Great American Smokeout event, guidelines for creating smoke free communities and a national overview of restrictions on tobacco use, sales, and advertising. Website: www.cancer.org

American Lung Association

The Quit Smoking section of the American Lung Association web site provides detailed information and links to smoking cessation support, tobacco control news and reports, and state legislated actions. It also offers a free, online 7-module smoking cessation program called Freedom From Smoking. The modules cover readiness to quit, stress management skills, substitute (for smoking) behaviors to avoid relapse, recovery symptoms, long term strategies and maintenance. Website: www.lungusa.org

American Dental Association

American Dental Association provides information on statewide coalitions that exist to reduce tobacco use, news and facts on tobacco, research articles related

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Americans For Nonsmokers Rights

Americans for Nonsmokers' Rights is the leading national lobbying organization dedicated to nonsmokers' rights. The organization challenges the tobacco industry at all levels of government to protect nonsmokers from secondhand smoke and youth from tobacco addiction. The website provides detailed information and resources on second-hand smoke, legal issues, becoming smoke free and several other topics. Website: www.no-smoke.org

exact triggers that one might face while breaking smoking habits. Website: http://committedquitters.quit.com

FamilyDoctor.org
This Web site is operated by the American Academy of Family Physicians (AAFP), a national medical organization. The web site provides relevant and up-todate health information related to smoking and quitting tobacco. Some of the materials are also available in Spanish. Website: http://familydoctor.org

Centers for Disease Control and Prevention

The Office on Smoking and Health (OSH) of the Centers for Disease Control and Prevention (CDC) is responsible for leading and coordinating strategic efforts aimed at preventing tobacco use among youth, promoting smoking cessation among youth and adults, protecting nonsmokers from environmental tobacco smoke and eliminating tobacco-related health disparities. The Tobacco Information and Prevention Source web page provides extensive information and links to how to quit, educational materials, reports, research data, tobacco control program guidelines, campaign and events etc. Several resources are available in Spanish language also. Website: www.cdc.gov/tobacco

Habitrol
It is a website sponsored by Novartis Consumer Health that provides support and guidance for smokers choosing to quit using a nicotine replacement therapy. The web site also provides a free, online Smoke Free Program that helps change the habits that lead to smoking and provides a support system with resources needed to beat tough cravings and avoid high-risk situations. Website: http://www.habitrol.com

National Cancer Institute

The tobacco section of the National Cancer Institutes website provides extensive information about cigarettes and other tobacco products, environmental tobacco smoke. This website also provides links to other tobacco related websites, cessation and prevention fact sheets and publications, information about clinical trials for tobacco-related cancers and tobacco use, tobacco related research, and state and national statistics. Website: http://cancer.gov/cancertopics/tobacco

Committed Quitters
This program is sponsored by GlaxoSmithKline (GSK) and is designed to help smokers who have purchased GSK nicotine replacement products to craft an individualized smoking cessation plan. The individualized plan provides each user with helpful hints to overcome individual barriers to quitting smoking, ongoing information to help stay committed and emails and newsletters to help manage the

National Womens Health Information Center

The National Womens Health Information Center is a project of the U.S. Department of Health and Human Services, Of-

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fice on Womens Health. The website provides extensive information on womens health related issues including smoking cessation, reasons to quit, and how to quit along with links to Surgeon Generals Reports and the latest tobacco related news on smoking. Most materials are available in Spanish. Website: www.4women.gov/quitsmoking

QuitNet
QuitNet is a large online community for people who are trying to quit smoking. Sponsored by the Boston University School of Public Health and the American Legacy Foundation, QuitNet offers many resources for people trying to quit in addition to resources such as online chat rooms and bulletin boards. Website: www.quitnet.com

NC Prevention Partners
NC Prevention Partners website provides an online smoking cessation referral directory with a county specific listing of available resources, a comprehensive listing of North Carolina organizations addressing tobacco use prevention, the North Carolinas prevention report card on tobacco and additional topics. Website: www.ncgoodhealthdirectory.com

Quit Now NC
Quit Now NC is a statewide tobacco cessation partnership that promotes awareness, develops resources and conducts trainings to help North Carolinians successfully quit tobacco. The website offers links to a variety of resources including a smoking cessation referral directory, national toll-free quit line phone numbers, information for health professionals and families. Website: www.quitnownc.org

NC Tobacco Free Schools

The purpose of this website is to provide information, resources and assistance to school districts that are 100% tobaccofree or are considering adopting the policy, as well as to people in communities across North Carolina who want to advocate for a 100% tobacco-free policy in their local school district. Here, you will find all the tools you need to create, adopt, implement, communicate and enforce a 100% tobacco-free policy. Website: www.nctobaccofreeschools.com

S.A.V.E.
S.A.V.E (Survivors and Victims of Tobacco Empowerment) is a project of NC GASP (North Carolina Group to Alleviate Smoking Pollution). This program encourages survivors of tobacco related illnesses and their families to come forward and tell their stories. Website: www.tobaccosurvivors.org

Smoke Free Families

Smoke-Free Families is a national program supported by The Robert Wood Johnson Foundation working to discover the best ways to help pregnant smokers quit, and spread the word about effective, evidence-based treatments. Website: www.smokefreefamilies.org

Quit.com
This website is sponsored by GlaxoSmithKline and is intended to give hints, suggestions and solutions to help smokers quit and maintain a smoke-free lifestyle. The program offers support for quitting smoking that combines solid solutions for dealing with the three-sided urges stemming from -mind, body and habit. The web site also incorporates information about nicotine replacement therapies. Website: www.quit.com

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SmokeFree.gov
This web site was created by the Tobacco Control Research Branch of the National Cancer Institute (NCI), with important contributions from other nationally recognized agencies and organizations such as the Centers for Disease Control and Prevention and the American Cancer Society. The website offers immediate assistance to someone wanting to quit by providing an online step-by-step cessation guide, publications, local and state telephone quitlines, NCIs national telephone quitline, and NCIs instant messaging service. Website: www.smokefree.gov

adversely affected by tobacco use and promote smoke-free environments. Website: www.communityhealth.dhhs.state.nc.us/ tobacco.htm

U.S. Environmental Protection Agency

The U.S. Environmental Protection Agency provides information on secondhand smoke as an environmental asthma trigger and links to other resources. Spanish language materials are also available. Website: www.epa.gov/iaq/asthma/shs.html and www.epa.gov/smokefree/pubs/humo.html

SmokeFreeNC.org
This is a website sponsored and maintained by the EnTER (Environmental Tobacco Smoke Training, Education and Research) Program of the University of North Carolina, Department of Family Medicine. The website provides information such as facts on tobacco use in North Carolina, an advocacy toolbox, guidelines for smoke free businesses, and links to several statewide and national advocacy sources and health and research agencies. Website: www.smokefreenc.org

WorkingSmokeFree.com
This website is offered by the Tobacco Prevention and Control Branch, NC Department of Health and Human Services. It is dedicated to helping North Carolina businesses achieve smoke-free workplaces. It provides information about making and implementing the decision to adopt a smoke-free workplace policy, the health and financial reasons to become a smoke-free workplace, resources to develop and implement a smoke-free policy and success stories from North Carolina businesses that have already made a successful switch to a smoke-free workplace. Website: www.workingsmokefree.com

Tobacco Prevention and Control Branch, North Carolina Department of Health and Human Services
The Tobacco Prevention and Control Branch works to improve the health of North Carolina residents by promoting smoke-free environments and tobaccofree lifestyles. Branch programs build capacity of diverse organizations and communities to carry out effective, culturally appropriate strategies to prevent youth tobacco use and access, promote and support quitting among tobacco users, reduce disparities by improving health related norms of special populations more

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APPENDICES

Quit NOW

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APPENDIX A: I QUIT Challenge Announcement

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APPENDIX B: I QUIT Sign Up Sheet

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APPENDIX C: Motivational Posters

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APPENDIX C: Motivational Posters

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APPENDIX C: Motivational Posters

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APPENDIX D: Motivational Quotes

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APPENDIX D: Motivational Quotes

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APPENDIX E: I QUIT Challenge Pledge Card

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX F: Quit Now One Page Ideas

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APPENDIX G: You Can Quit Pocket Card

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CERTIFICATE OF ACHIEVEMENT
APPENDIX H: I QUIT Challenge Certificate of Achievement

This Certificate is being presented to __________________________________ for the successful completion of the I QUIT Challenge for the period of _________________ to _________________.

__________________________________ Presented by

__________________________________ Worksite

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APPENDIX I: Free Resources for Individuals in NC Wanting to Quit the Use of Tobacco

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APPENDIX J: Smokers Pledge

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APPENDIX K: Assessing a Group Cessation Program

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APPENDIX L: NC Tobacco-Free Schools Model Tobacco-Free School Policy (Name of School District) Tobacco Products Policy Code:

A Model 100% Tobacco-Free School Policy For North Carolina School Districts The (name of school district) Board of Education recognizes that the use of tobacco products is a health, safety, and environmental hazard for students, employees, visitors, and school facilities. The board believes that the use of tobacco products on school grounds, in school buildings and facilities, on school property or at school-related or school-sponsored events is detrimental to the health and safety of students, staff and visitors. The Board acknowledges that adult employees and visitors serve as role models for students. The Board recognizes that it has an obligation to promote positive role models in schools and promote a healthy learning and working environment, free from unwanted smoke and tobacco use for the students, employees, and visitors on the school campus. Finally, the board recognizes that it has a legal authority and obligation pursuant to G.S. 115C-407 Policy prohibiting Tobacco Use in School Buildings as well as the federal Pro-Children's Act, Title X of Public Law 103-227 and the No Child Left Behind Act. Tobacco Use Prohibited No student, staff member or school visitor is permitted to use any tobacco product at any time, including non-school hours: in any building, facility, or vehicle owned, leased, rented or chartered by the (Name of School District) Schools; on any school grounds and property including athletic fields and parking lots owned leased, rented or chartered by (Name of Board of Education); or at any school-sponsored or school-related event on-campus or off-campus. In addition, school district employees, school volunteers, contractors or other persons performing services on behalf of the school district also are prohibited from using tobacco products at any time while on duty and in the presence of students, either on or off school grounds. Further, no student is permitted to possess a tobacco product while in any school building, while on school grounds or property or at any school-sponsored or school related event or at any other time that students are under the authority of school personnel. Tobacco products may be included in instructional or research activities in public school buildings if the activity is conducted or supervised by the faculty member overseeing the instruction or research and the activity does not include smoking, chewing, or otherwise ingesting the tobacco product. Definition of Tobacco Products and Tobacco Use For the purposes of this policy, tobacco product is defined to include cigarettes, cigars, blunts, bidis, pipes, chewing tobacco, snuff, and any other items containing or reasonably resembling tobacco or tobacco products. Tobacco use includes smoking, chewing, dipping, or any other use of tobacco products. Legal Reference: Adopted on: (Date) Revised on: Page 1 of 2

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APPENDIX L: NC Tobacco-Free Schools Model Tobacco-Free School Policy (Name of School District) Tobacco Products Policy Code:

Signage Signs will be posted in a manner and location that adequately notify students, staff and visitors of about the 100 percent tobacco-free schools policy. Enforcement for Students Consequences for students engaging in the prohibited behavior will be provided in accordance with the schools student behavior management plan. Students who violate the school districts tobacco use policy will be referred to the guidance counselor, a school nurse, or other health or counseling services for all offenses for health information, counseling and referral. The administration will consult with appropriate health organizations in order to provide student violators with access to an Alternative to Suspension (ATS) program. The ATS program will provide up-to-date information on the many consequences of tobacco use, offer techniques that students can use to stop tobacco use at school, and provide referrals to local youth tobacco cessation programs. Parents/guardians will be notified of all violations and actions taken by the school. Schools may also use community service as part of the consequences. Suspension will only be used after a student has three or more prior violations or refused to participate in other outlined measures. Enforcement for Staff and Visitors Consequences for employees who violate the tobacco use policy will be in accordance with personnel policies and may include verbal warning, written reprimand, or termination. Visitors using tobacco products will be asked to refrain while on school property or leave the premises. Law enforcement officers may be contacted to escort the person off the premises or cite the person for trespassing if the person refuses to leave the school property. Opportunities for Cessation The administration will consult with the county health department and other appropriate health organizations to provide students and employees with information and access to support systems, programs and services to encourage them to abstain from the use of tobacco products. Prevention Education The administration will consult with appropriate health organizations to identify and provide programs or opportunities for students to gain a greater understanding of the health hazards of tobacco use and the impact of tobacco use as it relates to providing a safe, orderly, clean and inviting school environment. The administration will insure, per G.S. 115C-81.a3.11, that the North Carolina Healthful Living Education Standard Course of Study for grades K-9 be taught using sequential, age appropriate, current, accurate, evidenced based curricula and a skills based approach (involving students in active "hands on" learning experiences). Procedures for Implementation The administration will develop a plan for communicating the policy that may include information in student and employee handbooks, announcements at school-sponsored or school-related events, and appropriate signage in buildings and around campus. An enforcement protocol, which identifies consequences for students, staff and visitors who violate the policy, will be created and communicated to all students, staff and parents. Page 2 of 2 Legal Reference: Adopted on: (Date) Revised on:

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