Quit plan | |
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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: |  • ………………………………………………………‥ |
 |  • ………………………………………………………‥ |