Quit4Life - You're Only 4 Steps Away From Quitting Smoking

2005
ISBN: 0-662-38858-5
Cat. No.: H46-2/04-381E

Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section.

Table of Contents:

• How to Use Quit4Life
  • The Quit4Life program has 4 steps
  • There's Never Been a Better Time to Quit4Life
  • Did you know? Most Canadian youth DON'T smoke
  • Why do think smoking is becoming less popular
  • Did you know that when there are tax increases on cigarettes, it helps smokers to quit
  • Did you know that no-smoking policies in public places
  • All kinds of people, of all ages, have quit smoking
  • This program, Quit4Life, is designed to help you
• Step 1: Get Psyched
  • Experts agree: if you want to quit smoking, you have to be psyched to quit
  • Gross. Take 1. Do you know why cigarettes cause mouth diseases
  • Gross. Take 2. Do you know why smoking causes lung cancer
  • Gross. Take 3. What does blood have to do with smoking
  • Gross. Take 4. Why do cigarettes cause impotence
  • Gross. Take 5. Why is the TAR in cigarettes harmful
  • Benefits of quitting
  • Psyched yet? Here's one more thing to think about
• Step2: Get Smart
  • The 2nd step to quitting is to find out as much as you can
  • Why Do You Smoke
  • How do you find your triggers
  • What are Your Roadblocks to Quitting
  • Mental Roadblocks
  • Belief that smoking doesn't hurt anyone under 30
  • What It Means To Be Addicted
  • What's the difference between addiction and habit
  • Here's how it works
  • So you can see why "I won't get addicted" is a myth
  • How soon after waking up do you smoke your 1st cigarette
  • Habit
  • Practice Quitting
  • Quit Calendar
  • Want some ideas
  • What Can You Expect When You Quit
  • How Can You Cope? Withdrawal
  • Common symptoms are
  • What's Your Plan for Withdrawal
  • Cravings
  • Breaking the Habit
  • Temptations
  • How to Break the Boredom Cycle
  • How Can You Deal With Stress
  • If you feel stressed, try some of the things on this list instead of smoking
  • What's sex got to do with smoking
  • Why did lung cancer increase so much
  • What Does Sex Have to Do With It
• Step 3: Get Support
  • Who Will Support You
  • How Can You Deal With Non-Supporters?
• Step 4: Get On With it
  • How to Prepare for Your Quit Date
  • What about Cold Turkey
  • Think about it
  • Make a Plan and Set Your Quit Date
  • Take action - Helpful Hint
  • The Top 5 Things You Should Include In Your Quit Plan
  • What have others put into their Survival Kits
  • Give Yourself a Pep Talk
  • What To Do If You Slip: Don't Panic
  • A slip is not a failure
  • Socializing Without Smoking
  • What if you find your motivation to quit is slipping
  • What Does Sex Have to Do With It
  • Special information for occasional smokers
  • Medications to Help You Quit Smoking
  • Here's the scoop on medications
  • Go on-line for more
• Additional Resources For Youth
• General Information

How to Use Quit4Life

The Quit4Life program has 4 steps.

• Step 1. Get Psyched
• Step 2. Get Smart
• Step 3. Get Support
• Step 4. Get On With It

Your chance of success is greater if you do all 4 steps.

To order copies of this handbook, or to use the self-help program, check out the  Quit4Life website.

There's Never Been a Better Time to Quit4Life.

How to use Quit4Life

Quit4Life (or Q4L for short) has four parts because people who successfully quit smoking usually complete 4 steps.

To improve your chances of success, complete all 4 steps.

• The fewer steps a person takes, the less likely they will quit smoking.
• If you haven't seriously tried to quit before or you haven't used other quit smoking programs, it is best to take your time and go through each step in order.
• This handbook may also be used as part of a 10 session group program.
• Ideally, you should start this program at least 2 -6 weeks before your quit date.
• Don't rush through all the steps in a single day.

Did you know? Most Canadian youth DON'T smoke.

Smoking is becoming less popular among youth in Canada. The graph compares the percentages from 2002 to the percentages in 1994. The majority of youth (78%) have never tried smoking. Overall, there are now more ex-smokers than current smokers in Canada.

Why do think smoking is becoming less popular?

Maybe because youth today have more information than before.

• 96% of youth believe tobacco is addictive.
• 95% of youth believe smoke can harm non-smokers' health.
• 79% of youth believe it's nicer to date non-smokers (91% of non-smokers believe it's nicer to date non-smokers).
• 69% of youth believe occasional smoking harms health.

Says Who?

Youth Smoking Survey, 2002

Did you know that when there are tax increases on cigarettes, it helps smokers to quit?

• Higher prices affect young smokers the most.
• Every time the price goes up from a tax increase, more youth smokers decide to quit.
• Knowing how much you save from not smoking helps keep you smoke-free. Let's say you start smoking at age 15 and smoke an average of a pack of cigarettes every day. By the time you turn 30, you will have spent about $56,809 on cigarettes (at the average current price of $9 a pack). Just think about what you could have done with that money. Buy a car. Spend a year in Europe. Pay for university. Puts it in perspective, doesn't it?

Did you know that no-smoking policies in public places:

1. Help protect people from second-hand smoke?
2. Help current smokers to quit smoking?

• Smokers who live in homes where smoking isn't permitted are almost twice as likely to quit smoking as a smoker who lives in a home where smoking is permitted.
• Smoke-free workplaces, schools, restaurants, arenas, stores, bus stations, government offices, and other public places all help motivate smokers to quit smoking and stay smoke-free.

All kinds of people, of all ages, have quit smoking.

• The sooner you quit smoking, the less damage you will do to your body, and the sooner your body starts to heal.
• It's easier to quit with some help and support.

This program, Quit4Life, is designed to help you.

• It's based on science and psychology.
• It's based on input and feedback from youth.
• It has already been tested with hundreds of youth across Canada who used it to quit or cut down on their smoking.

Step 1: Get Psyched

Experts agree: if you want to quit smoking, you have to be psyched to quit.

You can psych yourself to quit by:

• Focusing on what smoking does to your health. Today -- not just years in the future.
• Learning about why you smoke and how to quit.
• Focu$ing on what it really cost$ to $moke.

When Q4L was tested with youth across Canada, they asked for gross pictures to help psych them up about the negative health effects of smoking so that they would be more motivated to quit.

It can be really scary when you figure out why smoking harms your health.

• Not simply that you can end up with cancer, heart disease, smoker's face, tooth loss, emphysema or limb amputations, but why smoking leads to these things.

"The biggest issue to quit is the cost. I've got bills that I have to pay. I have to save up for my University. I can't afford to smoke". Q4L Participant

Gross. Take 1. Do you know why cigarettes cause mouth diseases?

This is one of the least favourite pictures on cigarette packs because it's one of the grossest. Here's the story.

• Smoking can cause trench mouth, an infection of the gums due to too much bacteria in the mouth (see the puffy red). It can develop into mouth sores and painful ulcers.
• Cause plaque build up (see the yellow stuff).
• Stain your teeth and gums (see the black stuff).
• Cause mouth cancer.
• Smoking can cause periodontitis -- an infection and swelling in your gums that smells really bad.
• The infection rots the tissue and bone that hold your teeth in (see the gum rot?).
• If there's nothing to hold your teeth in -- they fall out.
• Or, you may have to get your teeth pulled to prevent the infecton from spreading through your body.

Gross. Take 2. Do you know why smoking causes lung cancer?

Some people think the harmful effects of smoking involve only breathing in the smoke and using their lungs as filters. They think that the smoke, tar, nicotine, and other chemicals from cigarettes stay in their lungs, it doesn't belong there, and that's why smoking can lead to lung cancer over time.

• That's part of the story.
• There's a BIGGER picture.
• And it's really gross.

Images courtesy of the Australian National Tobacco Campaign

Smoke going through an airway in a lung. All the thousands of chemicals in the smoke do damage as they travel. One of the worst things they do is change the DNA -- the "P53 gene" in your lung cells. Changes to the "P53 gene" causes cancer.

This is a cancer tumour growing in a lung. Over 50 different chemicals in cigarettes cause cancer tumours like this to grow. It only takes one damaged cell to start a cancer tumour growing. Just one cell.

Benefits of quitting: You protect your DNA and save your cells from changing (and growing a tumour).

Gross. Take 3. What does blood have to do with smoking?

Not only do the tar, nicotine, and thousands of chemicals in cigarettes damage your lungs, they also get into your blood stream and travel through your body, they go wherever your blood goes...

• through every tiny delicate blood vessel
• to every organ (heart, kidneys, liver, skin...)
• to every limb (right down to your fingers & toes)
• to your eyes, gums, mouth, & brain... do their special brand of damage everywhere they go.

The nicotine in every cigarette can, all by itself,

• Tear the linings of your blood vessels.
• Cause your blood vessels to go into spasms preventing blood from getting to your heart and other organs.
• Prevent oxygen from getting to where it needs to go.
• Like your lungs, which is why you get out of breath faster than nonsmokers (even in your youth).
• Like your lower legs and feet, which causes them to "die" and they have to be cut off (amputated).
• Or like the skin on your face, which causes wrinkles.

"Smoker's Face" is a good example. Cigarette smoking:

• Damages the small blood vessels in the skin.
• Damages the blood supply to the skin.
• Damages the tissue under the skin.
• Damages the 'elastic' tissue of the skin.

Smoker's face is an actual medical term. It is described as wrinkled with 'crows feet', older than a person's actual age, and a yellow-gray leathery complexion. Smokers don't look healthy.

Benefits of quitting: You protect your blood and your good looks.

Gross. Take 4. Why do cigarettes cause impotence?

• Smoking causes build up of sticky 'plaque' in your blood vessels.
• The build-up makes it hard for blood to get through your vessels and go where it needs to go to fuel your cells.
• The build-up starts with your 1st cigarette.
• If you smoke, you already have some of this in your blood vessels.

• Sticky build-up being squeezed out of an artery of a 32-yr old smoker.
• The more you smoke and the more years you smoke the more sticky build-up you'll have.
• This sticky stuff builds up in all the blood vessels, including the arteries that supply blood to the penis.
• The blood vessels in the penis are small. They get clogged up with the sticky plaque before bigger ones like the ones that go to the heart.
• The blood vessel in the picture of the sticky build-up is the aorta, the main artery (blood vessel) from the heart. If this large artery has this much sticky build-up at age 32, imagine how plugged up the small arteries in the penis must be.

Images courtesy of the Australian National Tobacco Campaign

What's sex got to do with it?

Now you know why smoking leads to impotence in guys starting in their 20's...

Smoking causes:

• the sticky stuff to build up in blood vessels
• blood can't get through
• no blood
• no erection.

Benefits of quitting: Prevent sticky build up in your blood vessels.

Gross. Take 5. Why is the TAR in cigarettes harmful?

Images courtesy of the Australian National Tobacco Campaign

1 year's worth of tar in the lungs

Here's the amount of tar a pack-a-day smoker consumes every year. Some tar gets exhaled (one reason for bad breath).Some gets coughed up (gross). The rest stays in your lungs (oh-oh).

If this is how much a pack-a-day smoker takes in each year, imagine how much tar you would take into your body if you smoked until you were 30 years old...multiple what you see in the picture by say, 15, for 15 years. That means 15 beakers full of tar!

Tar can:
Rot your lungs.
Kill your cells.
Cause cancerous tumours.

Imagine pouring hot tar used to repair roads on your hand and leaving it there. What do you think would happen to your skin?

Why wouldn't that be happening to your lungs with the tar from cigarettes? Think about it.

Benefits of quitting: Keep the tar out of your lungs.

The tar, nicotine, and chemicals in cigarettes don't know how old you are -- they don't wait till you're 30 years old to do what they do.

• They do damage as they go.
• Every cigarette causes damage.
• The damage builds up over time like a junk pile until you hit the mystery tipping point where daily damage hits a critical point -- the cancer growing in your mouth or lungs becomes big enough to detect or the sticky stuff builds up so much it blocks blood from getting to your heart and you have a heart attack or the infection in your mouth makes your teeth fall out (you get the picture).

A lot of tipping points happen after you are 30 years old -- but not all. People in their 20's and 30's can and do get hit with so-called adult diseases like -- lung cancer. Lung cancer under 40 years of age is rare, but it can happen.

Every cigarette does damage to your body.

• The damage builds up over time.
• The sooner you quit the less damage you do.
• The good news is there are definite POSITIVE changes to your body when you quit.

Benefits of quitting

• Within 8 hours carbon monoxide level drops in your body and the oxygen level in your blood increases to normal.
• Within 48 hours your sense of smell and taste improves and your chances of having a heart attack start to go down.
• Within 72 hours your lung capacity increases and bronchial tubes relax, making breathing easier.
• Within2 weeks, the nicotine is removed from your body.
• Within 3 months circulation improves and lung functioning increases up to 30%.
• Within 6 months coughing, sinus congestion, tiredness and shortness of breath improve.
• Within 1 year risk of smoking-related heart attack is cut in half, and your risk for cavities is lower.
• Within 10 years risk of dying from lung cancer is cut in half.
• Within 15 years risk of dying from a heart attack is equal to a person who never smoked!

What are the other benefits of quitting?

• No chance of accidentally burning a hole in your favourite clothes.
• Reduce your chances of developing heart disease.
• Reduce your chances of developing cancer.
• Reduce your chances of developing breathing problems like emphysema.
• Reduce your chances of developing infections and colds.
• Prevent early wrinkling because your face will get the oxygen and blood it needs.
• Increase your energy because more oxygen circulates through your body.
• Stop your teeth and fingers from turning yellow.
• Save a lot of money. A lot.
• Setting a great example for children (including your younger brothers and sisters) and other smokers.

Money: How Much is Smoking Costing You?

Let's say you are 15 years old right now. By the time you finish high school you could spend over $10,053 on smokes!

Think about it.

• You can buy a car for that kind of money, or pay 2 years tuition at most schools.
• And the money saved each year from not buying cigarettes will pay for the insurance, gas, maintenance, and fuzzy dice.

Cost Calculator: How much does it really cost to smoke?

* This will probably be a low estimate because it doesn't include how much the price of cigarettes goes up each year. But it gives you an idea.

From Now...	Events	Cost for 1 pack/day	What could you buy instead of cigarettes?
1 day	Tomorrow	$9
1 month		$270
1 year		$3,286
3 years	Finished high school	$10,053
10 years	You'll probably get married!	$35,970
15 years	You'll be 30!	$56,809
30 years	You'll be your parents age!	$133,266
50 years	You'll be... your Grandparents' age!	$277,843

* Assumes the price of cigarettes goes up 2% every year.

• Most youth say they don't plan to be smokers when they get older.
• Most believe they will quit before turning 30. Even if you did quit by age 30, you will end up spending about $56,809.00 on smokes.
• But statistics show that most youth don't quit before they turn 30 -- they continue to smoke until after they are 40 years old!
  Top of Page

Check out the graph.

• Notice that the percent of people who smoke increases up to about age 22.
• Notice that the percent of smokers doesn't decrease below the 15-17 year old smoking rate until after 54 years old.
• Since 90% of all smokers start smoking before they are 20, these numbers represent people who start smoking in their teenage years not new smokers who start after age 20.
• That means people who start smoking, are likely to keep on smoking until they are quite old.

That means if you are, say 15 years old right now, the statistical odds are you could smoke into your mid-50's, which means you will spend over $198,421 on cigarettes. That can pay for a house in most parts of Canada.

Psyched yet? Here's one more thing to think about:

What's Important to You?

One thing that keeps people from quitting smoking is a conflict between their long-term goals (what they want in life) and the short-term satisfaction of smoking.

• You may have a long-term goal of being healthy, but addiction or smoking pleasure in the short-terms pulls you in to smoke.
• The short-term is satisfying and the delay in what might happen to your health in the long-term makes it hard to believe the bad things could happen. This makes it easier to smoke.
• You should expect this to happen.
• One technique to help get around this, is to tie your goal of quitting to your larger goals in life.
• You can either write out your goals or bring your future into the present with pictures.

Bring your future into the present with pictures. Here's what to do:

1. Cut out pictures and phrases from magazines, newspapers, or the web that describe what you want to have, do, and be like in your life.
2. Use these pictures to create a map of your inner hopes, beliefs, and desires -- pull the future into the present.
3. After you put your map (or list) together, ask yourself how quitting and smoking fits with your goals and values.
4. Use the Goals and Values worksheet to help you think it through.

Pro's and Con's

Another technique to help with the short-term and long-term conflict of smoking is to try to bring the negative effects of cigarettes into the present -- see how they will prevent you from getting what you really want in the future.

Try the pro's & con's worksheet

• The thing about cigarettes is that they seem to have advantages (pros) in the short-term and it's sometimes hard to see the disadvantages (cons).
• The other thing is that in the long-term smoking has only disadvantages, but the disadvantages in the future are hard to see in the present.
• You can bring the short-term and long-term pros and cons into focus by writing them down.

If you are still struggling with "should I quit or not" after you fill out the pros and con's, ask yourself"what will it be like in 5 years if I don't quit smoking?"

My values worksheet

Write down your values on this worksheet. Next, put a star* next to your top values, the ones that are most important to you. Then, write down how quitting smoking fits with things you value.

• These are the things I value:
• My most important values*
• How quitting smoking fits with my values

Write down your short term and long-term goals on this worksheet.
Then, write down how quitting smoking will help you achieve those goals.

	My goals	How quitting smoking will help me achieve these goals:
My goals for the short term
My goals for the medium term

Pro's and Con's of Quitting and Smoking

• Short-Term Advantages of Quitting
• Long-Term (more than 1 year) Advantages of Quitting
• Short-Term Disadvantages of Quitting
• Long-Term (more than 1 year) Disadvantages of Quitting
• Short-Term Advantages of Smoking
• Long-Term (more than 1 year) Advantages of Smoking
• Short-Term Disadvantages of Smoking
• Long-Term (more than 1 year) Disadvantages of Smoking
  

Step 2: Get Smart

The 2nd step to quitting is to find out as much as you can.

• Why Do You Smoke?
• What are your Roadblocks to Quitting?
• Addiction vs. Habit
• What Can You Expect When You Quit?
• What's Sex Got To Do With It?

Why Do You Smoke?

There are general reasons you smoke -- stress, troubles, breakingup with a boyfriend, fitting in, having fun.

But more important are the specific reasons you smoke.

• What triggers you to smoke? The people you are with, the situations you are in, the emotions you are feeling, or the thoughts you are having?
• Once you figure out what triggers you to smoke, you can figure out what you can do instead of smoking when those triggers come up.

How do you find your triggers?

• Follow your tracks like a detective.

Punch out the Smoke Detector Tracking Form in the middle of this book. Put it in or on your cigarette pack. Try and track your smoking for one whole pack.

For every cigarette you smoke:

• Mark down the time.
• Record where you are and whom you are with.
• Is your mood good (G), bad (B), or don't know (?).

Once you have completed the Smoke Detector Tracking Form, flip it over and answer the questions on the back to help you figure out more about why you smoke.

"I liked how the challenge was to answer: why do you smoke at all? This question became useful in helping me to question my cravings, rather than just try to fight them". Q4L Participant

What are Your Roadblocks to Quitting?

The way to figure out exactly what is holding you back from quitting is to check your tracks and figure out why you smoke (where you are, who you are with, how you are feeling, etc).

• Everything you do, all of human behaviour, has a "context", a background. We do what we do in specific situations, with specific people, feeling specific emotions.
• You probably smoke when you are with your friends but not at the dinner table with your family.
• If you keep a record of when and why you smoke, you can figure out what cigarettes are the tough ones to give up, what ones are the easiest to give, and what ones are in between
• The key to quitting is to figure out strategies to avoid having cigarettes in every single situation that triggers you to smoke.
• Another key to quitting is to deal with one cigarette at a time, which means dealing with one situation at a time.

Mental Roadblocks

Social pressure -- it feels too hard not to smoke when others are smoking.

• The key is to focus exactly on why you want to quit and practice saying "no thanks".

Fear of losing friends

• 96% of teens say they would support a friend who wanted to quit smoking.

Fear of weight gain.

• Many people don't gain weight after they quit smoking.
• Even people who do gain weight put on only 2 or 3 kg (4-6 pounds) on average.
• People who are physically active are less likely to gain weight -- so exercise!
• You can also reduce or eliminate weight gain after quitting by making sure you eat healthy food -- lots of fruits and vegetables.
• Also, most people put on weight as they get older -- whether or not they quit smoking -- so gaining weight isn't necessarily a fact of quitting.

Belief that smoking doesn't hurt anyone under 30.

• Did you read Step 1 about why smoking harms your health? (Cigarettes don't know how old you are).

What It Means To Be Addicted

Are you addicted?

• Yes
• No
• Don't know

How do you know?

What's the difference between addiction and habit?

Addiction

Physical addiction occurs when your body needs nicotine:

• to relax
• get a temporary boost of energy
• to prevent cravings
• to prevent withdrawal

Addiction isn't something you have control over.

The main thing about addiction is that you change the structure of your brain. (Yep, it's all in your head!)

Here's how it works:

Do you remember how it felt the very first time you took a drag off a cigarette or smoked your first cigarette?

• A little dizzy, maybe? A head-rush? Nauseous?

Everyone feels a bit dizzy. The reason?

• Your brain wasn't equipped to handle the amount of nicotine that hit it.
• Just like a hotel clerk working alone at the check-in desk and then all of a sudden, a whole busload of hockey players pulls up to the front door and everyone swarms into the lobby -- it's overwhelming.

That's how your brain felt the first time you swarmed it with nicotine.

If you don't feel as dizzy now when you smoke, it means your brain can handle the nicotine.

• The way it does that is to "grow" more nicotine "receptor" sites to "receive" and process the nicotine.
• Your brain physically changes.

The problem is that those new nicotine receptors start demanding nicotine.

• They will make their demands known to you. First they send you cravings.
• Then, if they don't get fed their fix of nicotine, you will start to feel jittery, irritable, stressed, sad, nervous, or get a headache.
• In other words, withdrawal.
• Sounds like a drug addict, doesn't it?

So you can see why "I won't get addicted" is a myth.

• Addiction isn't a matter of willpower or control.
• Addiction is a physical change in your brain in response to the drug -- nicotine.
• If you smoke, you change the physical structure of your brain. You have no say in the matter, you are not in control.

The more addicted you are, the more important it is for your brain to have a certain level of nicotine at all times.

• That's why heavily addicted people smoke within 30 minutes of waking up. Their brain demands that they bring the nicotine levels up to what the brain is used to having.
• If the nicotine level in the brain isn't brought up fast enough, the person will go into withdrawal and it becomes very unpleasant.

How soon after waking up do you smoke your 1st cigarette?

• within the first 30 minutes of waking up
• between 30 and 60 minutes after waking up
• within 2 hours of waking up
• after 2 hours of waking up

What are your signs of addiction?

Habit

You can also smoke out of habit. When you smoke, you learn to associate smoking with other things, like

• getting together with your friends
• having a good time
• being stressed
• eating
• drinking coffee.

That means, whenever you do the things you associate with cigarettes, you will be triggered to smoke, without even thinking about it or without even having a strong craving.

Practice Quitting

If you practice quitting before your quit date, you will have some experience with what it feels like not to smoke, and how you will begin to cope with withdrawal. Prepare to quit by practicing:

• Only smoke 1/2 of each cigarette.
• Try not smoking cigarettes you rate as "I could do without" on your Tracking Form (#1 and 2's).
• Try smoking 1/2 the number of cigarettes you usually do.

The more you practice, the more your confidence will grow.

Quit Calendar

Make your plan to practice quitting next week. Write it down on the Quit Calendar. Use the "Savings Calculator" to find out how much money you will save when you don't have those unnecessary cigarettes.

• Week
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday
  • $ Saved

Want some ideas ?

Check out another smoker's Quit Calendar.

Week	Monday	Tuesday	Wednesday	Thursday
1			Cut out 1s	The same
2	Tackle the 3s			Avoid triggers
3	Smoke only the three I really need	Smoke only the three I really need	Try to delay first smoke	Delay first smoke
4	Add up all the money I saved	Quit date	Try out some of the stress-buster activities in the program. Tell everybody to not offer me any more smokes!	Call Q4L aupport buddies and check how they are doing maybe go out to a non-smoking club

Week	Friday	Saturday	Sunday	$ Saved
1	Cut out 2s	Avoid triggers. Try different pool hall.	Keep 1s and 2s out	Insert savings for 10 cigarettes
2		Avoid triggers. Go dancing, not playing pool.		Insert savings for 20 cigarettes
3	The same	Avoid triggers. Don't drink, be the designated driver for after the party.	Smoke only the two I really need	Insert savings for 30 cigarettes
4	Find out when summer soccer tryouts are-get to gym?	Practice saying no to smokes with drinks. Look ar the scenarios in the program	Call Kim and get to the gym for sure	Insert savings for 40 cigarettes

What Can You Expect When You Quit?

• Some people feel nothing, no difference.
• Some people experience withdrawal, temptations, and/or cravings.

How Can You Cope? Withdrawal

The worst physical withdrawal happens in the first 2-3 days -- so plan for it. Create a mindset that prepares you to ride out the temporary discomfort. Think of it as a flu that has to run its course before you feel better.

• Withdrawal is the brain's experience of nicotine leaving and not being replaced.
• Withdrawal should pass completely within about 2 weeks. That doesn't mean you won't crave cigarettes anymore, only that the physical withdrawal from nicotine will be done.

Common symptoms are:

• hunger
• boredom
• tired
• grouchy
• irritable
• nervous
• depressed
• trouble sleeping
• cough more than usual
• frustrated
• heachache
• constipated.

What's Your Plan for Withdrawal?

• Drink lots of water and juice -- think of flushing your system.
• Take a hot bath or shower (or lots of them).
• Sleep. Lots.
• Do things to relax -- listen to music, try relaxation exercises, watch movies.
• Do something that distracts you -- sports, painting, go somewhere new, hang out with nonsmoking friends.
• Stay busy to avoid boredom.
• Move your body -- exercise, sports.
• Eat lots of fruits and vegetables (to overcome constipation).
• Try mild cough syrup or drops to soothe your throat if you cough a lot.
• Be patient. You trained your brain to need nicotine to make yourself feel normal.
• You will now need to train yourself to feel normal again without nicotine.

Cravings

• Cravings are your body's hunger for nicotine.
• Cravings may keep coming for a while, but will get fewer, be shorter, feel weaker, and come further apart as time goes by.
• One of the best ways to deal with cravings is to just sit and time them. They will probably last less than a minute and go away whether you light up or not.
• Cravings come like a wave so ride them like a wave -- sit through them and feel them rise up, wash over you, and then disappear until the next one.

Breaking the Habit

• If you smoke out of habit, it can be tricky to catch yourself before you light up.
• That's why the Tracking Form is a really good idea -- it makes you stop and think about each cigarette.
• Just that a one second pause before you light up can help bring an "unconscious" habit to your attention.
• Once it has your attention, you can make a conscious choice.
• The more times you make a conscious choice not to smoke, the easier it becomes to not smoke.
• It really is practice, practice, practice.

Temptations

What do you think will be your biggest temptations to smoke when you try to quit?

6 Ways to Deal with Temptation

1. Avoid tempting situations (especially for the first month or until you have made not smoking more tempting than smoking)
2. Ask your friends, family, and co-workers (if you have a job) not to tempt you. If they forget, remind them "Please don't do that. I really want to quit" or simply "no thanks".
3. Figure out what is so tempting and change it. Focus on negative thoughts of smoking -- think of the gross pictures. Or focus on positive thoughts about not smoking -- think of what you can buy with cigarette money or how much easier it is to breathe when you play soccer or skateboard.
4. Find the quickest way to distract yourself -- leave the room, go for a walk, have a shower, whatever works for you.
5. Remind yourself of your goal of not smoking. Make sure you have something to remind you why you want to quit -- a picture, a card from a friend, anything that makes you feel good about not smoking or bad about smoking.
6. Ask others to remind you of your goal to be a nonsmoker.

How to Break the Boredom Cycle

Many young people smoke because they feel that they have nothing else to do, or to kill time. These also are the 'automatic' cigarettes, the ones that you just light up without thinking about it. You've taught yourself to automatically pick up a cigarette at these times, without even asking yourself if you really need it. You know when you're bored... but do you know what's happening in your brain when you're bored?

Boredom is the reaction that your brain has when it needs to get some energy. Feeling bored stimulates the body to do something... anything... to bring up those oxygen levels and get some positive energy going.

Did you know that people who smoke a lot are less likely to be physically active, get less oxygen, and also have less energy, because they're smoking?

You will have to try more than once to break the boredom rut. Make it happen! And the next time you get bored, whatever you do, try to get your brain off automatic replay. That boredom cigarette? You really don't need it.

It becomes a vicious cycle: You don't have much energy to do anything, you get bored, you smoke, and you have even less energy. Ask yourself: Am I still bored after I light up a cigarette? Probably nine times out of ten you are... So... stop being bored and get your energy back!

How Can You Deal With Stress?

68% of teenagers who smoke say it helps them relax. Says Who: Youth Smoking Survey 2002.

Here's the problem with the logic that smoking helps with stress:

• Smoking actually increases your heart rate and makes you breathe faster (that's what happens when you are stressed... so smoking actually makes you stressed).
• The nicotine in cigarettes also makes you feel "high" (which is why nicotine is addictive) -- your body gets used to feeling a little high all the time so eventually it becomes difficult to relax.
• Some of the stress you feel may actually be the beginning of withdrawal. When you smoke, your brain gets used to a certain level of nicotine. When that level falls below normal, you start to feel jittery, nervous, anxious, and grouchy... in other words, you start to feel stress.
• So oddly, the best way to combat stress is to quit smoking.

If you feel stressed, try some of the things on this list instead of smoking:

• Have a long hot bath or shower (or lots of them). Listen to some soothing music that you enjoy (loud music can make you feel more stressed).
• Take a nap, call a friend, go for walk, read a magazine.
• Go for a run, bike, skateboard, snowboard, swim, skate...do something active to burn off the negative energy and to take your mind off the stress and regroup.
• Take some slow deep breaths -- count to 5 when you inhale, and then count to 5 when you exhale.
• Write down what's bothering you.
• If you are stressed because of another person, try to deal with that person directly instead of holding it all inside of you. It is amazing how good you feel after dealing with it directly. (Maybe start with "there's something I need to talk to you about....")
• Make a list of the things that are stressing you out. Then start taking care of everything on the list, one thing at a time. (You'll have to deal with things sooner or later...you might as well be in control).

What's sex got to do with smoking?

Lung cancer death is now the #1 cancer death among women (and men, by the way). More women die every year from lung cancer than breast cancer.

• Breast cancer deaths have stayed pretty steady over the last 30 years.
• Lung cancer deaths increased over 400% among women over a short 30 year period.
• The reason? Women started smoking in large numbers.
• Smoking is the number one cause of lung cancer -- 85% of lung cancer deaths are directly related to smoking.
• The line that goes across the top is the number of women who died from breast cancer every year from 1969 to 1996.
• The line going up to the right is the number of women who died from lung cancer.

Age-Standardized Death Rates For Breast Cancer and Lung Cancer Among Canadian Women, 1975-2004

Says Who? Canadian Cancer Statistics 2004. Canadian Cancer Society, National Cancer Institute of Canada, Statistics Canada, Provincial/Territorial Cancer Registries, Health Canada

Why did lung cancer increase so much?

• Before 1965, lung cancer was almost unheard of among women... because not many women smoked (check the graph--no lung cancer).
• By 1965, 32% of women aged 15+ smoked -- 43% of women 20-24 years old smoked regularly, making this the largest group of female smokers in Canadian history.
• 30 years later, lung cancer also hit an all time high, surpassing breast cancer as the #1 cancer death (check the graph for the cross-over).

So why is lung cancer so high now if fewer women are smoking now then in 1965? It usually takes about 30 years for lung cancer to show up.

Age-Standardized Death Rates For Breast Cancer and Lung Cancer Among Canadians, 1975-2004

Says Who? Canadian Cancer Statistics 2004. Canadian Cancer Society, National Cancer Institute of Canada, Statistics Canada, Provincial/Territorial Cancer Registries, Health Canada

What Does Sex Have to Do With It?

Females

Tend to smoke for negative reasons -- to relieve stress, loneliness, and feelings of sadness (depression), and to control their weight.

May become addicted faster because they weight less so nicotine is more concentrated in their body.

May experience more intense withdrawal symptoms because they are more addicted.

Better chance of quitting if they don't start a quit attempt their during period.

Males

Tend to smoke for social reasons -- when they are out with their friends having a good time.

May smoke more because nicotine doesn't last as long in their bodies because they weight more.

Spend less time preparing for a quit attempt or learning how to cope with withdrawal, cravings, temptations.

Less likely to seek help to quit and most likely to overestimate chances of quitting.

Step 3: Get Support

Who Will Support You?

Quitting will be easier if you have support from your friends.

Studies show most teens would help a friend to quit smoking if they were asked. So ask.

Your friends and family won't know how to help you until you tell them how. So tell them.

Ask them for help and then tell them exactly how they can help you quit.

Ask for support with withdrawal symptoms. Explain you might be stressed for a few days. Ask for help:

"Can you please cut me some slack if I'm more stressed (...worried, depressed, angry, or tired) than usual." Or "Please make me laugh instead of getting mad at me."

If you do get grouchy with someone, have something prepared to say: "I'm sorry, I'm having a tough time with withdrawal. I'm almost through it, it will be over soon."

Ask for support for smoke-free spaces.

• Tell friends that they can help by going to smoke-free places -- houses, cars, restaurants, etc.
• Ask friends not to offer you cigarettes or smoke around you.

"One group of friends participated in the Q4L program together: 'The group support helped, because all my friends were in there, and that helped because they were not smoking either." Q4L Participant

Ask for help with temptation and social situations.

• Tell everyone close to you or who you would like to support you that you are trying to quit.
• Ask others to help you through difficult situations.
• Spend time with non-smokers, and people who have already quit smoking.

Ask for encouragement.

• Ask friends if they would like to quit with you.
• Ask others to encourage you especially if they see you are having a tough time.

Other Things You Can Ask For?

Build Your Support Network

Supporters

There's a punch-out support card in the middle of this booklet that you can give out to people you would like to support you. It has specific requests for help on the back.

How Does Second-Hand Smoke Effect Us?

Did you know that smoking can affect the health of everybody around you? Although it is any individual's choice to smoke, others are affected by these choices. Scientific research proves that people exposed to second-hand smoke are more likely to develop and die from heart problems, lung cancer, and breathing problems. Unfortunately, many of the harmful products in smoke are in the form of gas. Therefore, they cannot be filtered out through ventilation systems or special fans. If people smoke inside your home, you may find it harder to quit. Q4L program can help you find strategies to deal with this and ideas for how to get the support you need to help you quit.

When you quit, you will reduce the chance that other people, including your friends, will suffer health consequences from your second-hand smoke. Some of your friends may be former smokers, and will be able to give you a lot of support. You may want to try quitting together with some of your friends who still smoke. Remember that two out of three young people try to quit every year- some of your friends may have been trying too.

On the other hand, some of your friends who have never smoked may not know how to support your efforts to quit. And some of your friends who still smoke may not know how to help you make a change, while still doing things together. Quit4Life can help you develop a plan that involves your friends as much as you want to involve them, and helps you get the support that you need to quit.

How Can You Deal With Non-Supporters?

Possible Non-Supporters

1. --
2. --
3. --

Research shows that most people will support you if you try to quit. Just in case, can you think of anyone who might not support you? If you do come across the occasional person who gives you a hard time, here's what to do.

• Recognize that your decision to quit may make some people feel uneasy if they still smoke.
• Keep your focus on your goal of being a non-smoker and avoid criticizing others for their lack of support or caring.
• You may have to learn to speak up for yourself and ask others not to nag or tease you about quitting. Nagging and teasing may be their way of coping or supporting you -- they may not know how else to act.
• Practice. Think about some social situations in which others may not be supportive of you quitting -- make a plan ahead of time and practice what you can say and do if others make it difficult for you to remain smoke-free.

How can you tell whom to ask for help? Asking for help should feel good.

Step 4: Get On With it

So far, you've gone through Steps 1, 2, 3:

• Get psyched.
• Get smart.
• Get support.

How to Prepare for Your Quit Date

Just before you start, here's one more thing to think about that increases the chance of you being successful at quitting.

What about Cold Turkey?

Cold turkey means stopping all cigarettes all at once.

Although cutting back is a good way to practice and prepare for quitting, when you are ready to quit the best way to go is "cold turkey" -- no cigarettes at all.

Think about it.

If you only cut back and allow yourself to smoke some cigarettes, you won't lose the taste for them.

• You will still feel stressed when the nicotine levels get too low in your body.
• Your cravings won't go away, and neither will the temptations -- in fact, temptations may get stronger because you put yourself in a place of "deprivation" that doesn't go away.
• You will also feel a bit deprived because you are not having as many as you might like to... SO it is easy over time to slip from say 5 cigarettes a day to 10 a day to a pack.

"The thing that drew me into Q4L, I have been smoking since I was 11, and I felt like I was getting sick all the time with colds and stuff, and so, when they announced it over the PA, I figured, do you know what, at least I will have something to help me get through this". Q4L Participant

If you still smoke even 1 or 2 cigarettes, you won't notice the positive effects of not smoking either:

• You won't notice a difference in taste or smell.
• You won't notice that you have more energy and stamina.
• You won't stop coughing, or getting more than your share of colds.
• Your breath won't smell better and neither will your clothes.

Make a Plan and Set Your Quit Date

• Set a quit date within the next 2 weeks.
• Pick the top 3 reasons you want to quit smoking.
• Create strategies for not smoking in the situations that usually trigger you to smoke.
• Set up your supports.
• Prepare for your quit day.

Take action - Helpful Hint:

Regular physical activity is a good idea when you are trying to quit. It will make you feel better, keep you busy, reduce stress, and reduce the risk of weight gain.

Follow through on your plan.

The Top 5 Things You Should Include In Your Quit Plan

1. Set a quit date within the next 2 weeks.

• If you wait any longer, your motivation to quit might decrease and you'll have to psyche yourself up again.
• Pick a day that will be easy for you to quit. If you only smoke with friends at school, set your quit day for a Friday so you'll have a head start with the weekend.
• Make a contract with yourself and maybe a friend or two about when you are going to quit.

Quit Date:
Signature:

2. Pick the top 3 reasons you want to quit smoking.

• Write them down and put a picture with them if it helps.
• Carry your top 3 reasons to quit around with you.
• You will need these reasons to remind yourself why you want to quit when you are tempted to smoke.

Top 3 Reasons for Quitting:

1. -
2. -
3. -

3. Create strategies for not smoking in the situations that usually trigger you to smoke.

• From your Smoke Detector Tracking Form, rank the situations you smoke in from "easiest to not smoke" to "hardest to not smoke". Use the ladder below with the easiest on the bottom and hardest on the top.
• Rate your confidence from 0-100% to remain smoke-free in each situation.
• Create strategies to remain smoke-free in each situation for which you have less than 90% confidence.
• Strategies might include avoiding situations, chewing gum, telling yourself "not today", calling a friend, brushing your teeth, playing a video game, having a shower... whatever works "instead of" smoking.
• Write down your strategies -- if you don't write them down, it's easy to forget how you are going to get through them.

4. Set up your supports.

• Tell people you are going to quit and when.
• Tell them how they can help.
• Give them a pledge card.

Who l'll Tell I'm Quitting

The type of help l'll ask for

5. Prepare For Your Quit Day

Prepare to go "cold turkey".

• If you are going to use the nicotine patch or gum, make sure you have it ready to go on your quit day.
• Get rid of your cigarettes, ashtrays, lighters, and anything that reminds you of smoking. If you don't they will all act as temptations and make quitting harder.
• Don't hide any cigarettes "just in case" or for "just one". Remember how nicotine changes your brain. Having "just one" keeps your brain looking for nicotine, keeps you hooked.
• Practice quitting one cigarette at a time.
• Rehearse what you are going to say to people who offer you cigarettes
• Create a Survival Kit -- carry whatever you need to remain smokefree -- toothpicks, gum, computer game, low-calorie snacks...

What have others put into their Survival Kits?

• sugarless gum
• low calorie snacks (carrot sticks, celery, yogurt, sunflower seeds)
• lollipops, suckers
• toothpicks
• stress ball
• computer game
• doodle pad and pen
• comic
• hackey sack
• yoyo
• a deck of cards
• cell phone
• paper clips or anything else that will keep your hands busy
• lipstick
• nail file, nail polish
• card with all the reasons you want to quit smoking and then read it when you feel temptation coming on
• tracking form
• picture of someone who will be proud of you when you quit smoking
• pledge card
• your quit plan.

Give Yourself a Pep Talk

Much of our stress is due to the conversations which we have with ourselves, in our own minds. This is called 'self-talk'. Some self-talk is useful and constructive (e.g., planning your day, congratulating yourself on a job well done). However, some self-talk is negative and can contribute to your stress level ('I know I will fail again'; 'I'm not smart enough to do that'; 'Nobody will like me any more'). Negative self-talk can lead to stress and even make you behave in ways that are not in your best interest.

Being aware of negative thoughts is the first step in dealing with it. Once you recognize it as negative, ask yourself: 'Is this really true, or reasonable?'. You may want to visualize a stop sign, or some other sign, that tells you to STOP talking to yourself negatively

If you find yourself having a tough time and saying something negative like "I really want a cigarette" or "I can't do this"

• Immediately think or say "STOP".
• Then replace it with something positive

Positive like

• "I don't really want a cigarette, that's just my old thoughts kicking in"
• "I can deal with this"
• "If I hold out the craving will go away in a minute or so".

What To Do If You Slip: Don't Panic!

All of us mess up sometimes. If you give in to temptation and smoke a cigarette or two, don't panic. All your hard work isn't wasted.

The easiest way to get back on track is to put it out immediately.

• Don't finish it.
• Say something like "I really don't want this" as you put it out.
• Move to a different room.
• If you bought cigarettes, throw them away or give them away.
• Take some deep breaths. Breathe in to the count of 5, then breathe out to the count of 5. Do this a couple of times.
• Read your motivation cards with the reasons for quitting.
• Do something, anything to change what's happening -- brush your teeth, call a friend, walk...

A slip is not a failure.

The important thing is to get back on track as quickly as possible and to learn from the slip.

• Think about what led you to smoke.
• Figure out how you will handle the situation differently if it happens again.
• Be kind to yourself and think positively.

Remember that every time you make a serious quit attempt, you can use it to learn some important information that you can use the next time you try to quit.

Sometimes, it takes several tries to quit.

• Most people have to practice a few times, so if you didn't quite make it to be totally smoke-free yet, just keep on! You'll get there.

Says who? The Canadian Tobacco Use Monitoring Survey. It found that:

• Just under half of all youth quitters (49%) reported making more than one attempt before they successfully quit smoking.
• How many attempts? Almost 3 tries before finally succeeding.
• Young women aged 20-22 seemed to be able to quit most readily, averaging 1.9 attempts, whereas young men aged 23-24 had to make the most tries (4.2) before quitting successfully.

But, if you are struggling remaining smoke-free (say, smoking more than 3 days in a row or one day every week for 3 weeks), try going back and reviewing all the steps in this program, beginning with Step One. The reason for reviewing the steps is that the top reasons people are successful at quitting are included in Steps 1-4. That is, people who are successful at quitting:

1. Work through the conflict of wanting to smoke and wanting to quit.
2. Get support.
3. Figure out their high-risk situations for having a cigarette.
4. Plan how to handle high-risk situations in advance.
5. Have a written plan for quitting that includes lots of techniques.
6. Don't give up on their plan too soon.

• How soon is too soon? Research suggests that people who are 100% confident they will quit are the most successful.
• Says Who? Dr. Patricia Smith and her colleagues at Stanford University. Smith, Kraemer, Houston Miller, DeBusk, & Taylor, 1999, JCCP, 67, 19-27.

Socializing Without Smoking.

Especially in the first month of quitting, try to avoid situations in which others are smoking. It can sometimes be too tempting.

• Go where smoking is not allowed, like the show, the mall, or concerts.
• Hang out with friends who don't smoke or who are trying to quit.

If you do find yourself in situations where others are smoking, it really helps to practice ahead of time what you will say and do.

• Practice ways of saying "no" when someone offers you a cigarette and then say it:
• "no thanks, I'm trying to quit"
• "go ahead without me, I'm just going to go to the washroom"
• Or you could ask a friend to take a walk with you so you won't smoke.
• Check Out "How to refuse"

What if you find your motivation to quit is slipping?

Two of the best ways to stay motivated to quit are:

1. Write your reasons for quitting down, carry them with you, and look at them often (pictures work just as well as words).
2. Create as many small successes as you can -- when one or more of your strategies to stay smoke-free works in difficult situations, you will feel more confident and more motivated to try again in more situations. It feels amazing.

What Does Sex Have to Do With It?

It's good to be optimistic in life. However, men are more likely to overestimate their chances of quitting smoking. Young men may spend less time preparing for their quit attempt or learning how to cope with withdrawal, cravings and temptations. This can reduce their chances of success.

Males who quit smoking are more likely to start smoking again when they are out with their friends and/or having a good time. Alcohol is a frequent trigger for smoking. Some people find they need to be more vigilant around alcohol at first, as a short-term survival strategy. This does not mean you won't ever be able to go into a bar or a party once you quit - with practice you can unlearn the association between drinking and smoking, and stay quit in all situations.

Special information for occasional smokers

Just because you don't smoke every day doesn't mean you shouldn't quit or follow all the steps in the Q4L program if you try to quit.

• Most young people start smoking on an occasional basis but end up smoking more over time.
• Even if you smoke only a few cigarettes a day or week, physical addiction and the habit of smoking will start to take hold. That's why many youth increase the amount they smoke over time.
• You may already associate smoking with certain people, places, or feelings.
• You may already experience cravings and temptations to smoke.
• Over time it will become harder to quit. So why not quit now?

Medications to Help You Quit Smoking

In Canada, there are three main medications that have helped some people to quit smoking -- nicotine patches, nicotine gum, and an anti-depressant prescription drug called Bupropion.

Here's the scoop on medications:

• The nicotine patch and gum are sold over the counter in pharmacies but talk to your doctor or the pharmacist before you try either one -- both have side effects.
• Do they work? There are not enough studies to show whether nicotine patches and gum work to help youth to quit.
• The anti-depressant drug, Bupropion, can only be purchased with a prescription from your doctor.
• Does it work? There is new research that shows Bupropion is not effective in helping teens to quit.
• Says Who? Dr. Joel Killen and colleagues at Stanford University of Medicine. Killen, Robinson, Ammerman, Hayward, Rogers, Stone, Samuels, Levin, Green, & Schatzberg, 2004, Journal of Consulting and Clinical Psychology (JCCP), 72, 729-735.

Go on-line for more!

Quit4Life is also available as a self-help on-line program. The new Q4L on-line program offers a personalized smoking profile and an interactive 4 week, 4 step program to help you quit smoking. The new program is available starting in March 2005 at www.quit4life.com

For more information on smoking and second-hand smoke, visit www.gosmokefree.ca.

Refusal skill	He or she says - or does	You say - or do...	What would you say or do ?
a) Reverse pressure	"Hey, lets go out for a smoke!"	"No, thanks, how about watching the basketball game in the gym. We need to support our team, and I'm sure they will win this time".
b) Cold shoulder	"Take a puff!"	Ignore person, and have a sip of water
c) Walk away	"Haven't seen you for a while here..."	"Got to go..."
d) Broken record	"Here, try one..." "Have a puff..." "Onewon't hurt..."	"...Forget it" "...Forget it" "...Forget it"
e) No thanks	"What's the matter, you look like you need a smoke..."	"Thanks for the offe, but no"
f) Give a reason or excuse	"Are you one of these health freaks now ? Here's a smoke, come and relax..."	"Not today, thanks, my taste buds have changes..." "I got to get to my job..."
g) Avoid the situation	Many of your friends are hanging out in the smoking area.	Stay away from the smoking areas
h) Strength in numbers	Observe where poeple hang out who do not smoke. They might need your support too.	Find some other quitters and hang around with them

Additional Resources For Youth

Cyberisle An interactive website designed by youth for youth.

Tobacco Facts. From BC, a site featuring facts and the poster child for smoking.

Tips 4 Youth from the U.S. Centers for Disease Control.

A Report for Kids About Smoking from the U.S. Centers for Disease Control.

A message from Christy Turlington and other Hollywood celebrities.

Charter School of San Diego website for youth.
This site includes "unfiltered TV" with video clips of youth attempting to quit

American Council on Science and Health, a website for youth that gives details of the effects of tobacco on every part of the body and every organ system.

Kids Help Phone
1-800-668-6868

Local youth centres (see your telephone book)
Campus health centres (in colleges and universities)

General Information

e-Quit. Health Canada's free, quit-smoking e-mails will support you through the process, one day at a time.

On the Road to Quitting. This proven program gets you off to a running start after you've spent a few minutes to complete a questionnaire and create your own personal profile.

Inventory of Tobacco Cessation Programs and Resources This inventory is a listing of various cessation programs and services that are currently available nation-wide or province-wide.

Canadian Lung Association
1-888-566-lung

Ontario Lung Association Has links to all kinds of great sites.

National Clearinghouse on Tobacco and Health
1-800-267-5234

Canadian Cancer Society
1-888-939-3333

Health Canada does not officially endorse any of the above sources of information and assumes no responsibility for their content or approach. These links are provided as a courtesy.