Table 1 An overview of a ‘quit plan’

My goals are:

 •………………………………………………………‥

 • ………………………………………………………‥

My most important reason(s) for preventing passive smoke exposure in my child is (are):

 1) ………………………………………………………

 2) ………………………………………………………

To accomplish my goal(s), I will take the following measures:

Specific action:

Date:

1) ……………………

……………………………………………………………

2) ……………………

……………………………………………………………

These are the following difficulties I may encounter and how I plan to solve them:

Difficulties:

Solution:

1) ……………………

……………………………………………………………

2) ……………………

……………………………………………………………

Other person(s) that could help me achieve my goals:

Person(s):

How?:

1) ……………………

1) …………………………………………………………

2) ……………………

2) …………………………………………………………

I will use the following results to ensure me that I am achieving my goals:

 • ………………………………………………………‥

 • ………………………………………………………‥