1. Freshstart Welcome to RAF Lakenheath Health & Wellness Center’s
Tobacco Cessation Program

2. Freshstart
Session One

3. Freshstart: Welcome! Congratulations! What is the Freshstart program?
Session One Objective
Nicotine Dependence and Addiction
Physiological Reasons for Smoking
Ambivalence About Stopping vs. Smoking
What do I want?
Quitting Reminders
Welcome participants to the Freshstart cessation program. Congratulate participants for taking a step toward a tobacco free lifestyle. Introduce yourself to the group of participants.
Introduce the Freshstart program: designed to help smokers quit by addressing behaviors, thoughts, and feelings of the smoker. Freshstart will use group interaction to encourage and support change. The program consists of four one hour sessions. Participants should attend all four sessions for two reasons:
There is a lot to be learned from the sessions, regardless of whether stopping smoking is easier or more difficult than the participant expected.
Presence is crucial for the participant and the others attending.
Distribute Freshstart Participant Guides
Explain the Objective of Session One: To understand how smoking affects me and those around me.
Review the objective of the Participant for session one: It is my goal to understand why I smoke and how smoking affects those around me.
Go over facts about the nature of being hooked on cigarettes. Review the content in the following sections:
Nicotine Dependence and Addiction
Psychological Reasons for Smoking. This section includes a participant activity defined on page 10 of the Facilitator’s manual. Participants can use page 3 of their Participant manual to write their answers.
Ambivalence About Stopping vs. Smoking. This section includes an activity (this activity is outlined only in the Participant’s manual). There are three parts to the activity:
1. On page 4 of the participant’s guide, Participants will write down the reasons they should stop smoking and the reason’s they should continue to smoke.
2. Participants will review each list and circle the most important items on each list.
3. Participants will place a star next to the most important reason on the entire list.
Encourage participants to ask themselves the question – what do I want the most? To quit or not to quit? If the most important answer is to quit smoking, then the time is right.
Quitting Reminders. Give each participant one 3 ½ x 5 index card. Instruct each participant to write down the reasons they have decided to quit. Participants should post this card in places where they are most likely to smoke. When a participant has an impulse to quit, this card should be used as a reminder.

4. Freshstart: Introductions!
Three Key Questions
What benefits do you hope to achieve from quitting?
What triggers your desire to smoke?
What motivated you to come today?
On average, how many cigarettes have you smoked up to this session?
Ask participants to take turns introducing themselves. As part of the introduction phase, ask each participant to answer the three key questions on this slide. (Write questions on a flip chart or chalkboard for participants to make reference to.)
As a facilitator – you might find it helpful to take notes during this session for purpose of planning the next session. Remembering answers from participants will help you make the Freshstart program a more personal experience for each participant.
Record participant’s progress on page 34 of the Facilitator’s Guide (re: On average, how many cigarettes have you smoked up to this session?)

5. Freshstart: Understanding Why You Smoke
Confidence to Quit
Fears of Quitting Tobacco
Approaches to Quitting
Cold Turkey
Gradual (tapering vs. postponing)
The Quitline
Nicotine Replacement Therapy (NRT)
Physiological Effects of Smoking
Discuss that it takes confidence to quit smoking (Participant’s Guide page 5). Instruct participants to complete the activity Fears of Quitting Smoking (Participant’s guide page 5). Encourage participants to discuss their fears with the group – this will help participants see that they are not alone.
Allow group members to discuss methods of cessation they have heard about or have tried in the past. Describe the cessation methods supported by the Freshstart program:
Cold Turkey
Gradual Approach (tapering vs. postponing) Postponing is not outlined in the participant’s guide.
The Quitline
Nicotine Replacement Therapy (NRT) - discuss using NRT with your doctor
Discuss the Physiological Effects of Smoking. Use the “Effects of Smoking on You and Those Around You” on page 6 of the Participant’s Guide as a guide for discussion – it was designed to have more detailed information. You may want to ask one or more of the group participants to read the information on page 6 to the group.
Review the Physical Benefits of Quitting Smoking –Facilitator’s Guide page 35/ Participant’s Guide page 28.

6. Freshstart: Understanding Why You Smoke
Making This Attempt Your Last
Set a Quit Date!
Review Session One
Review material discussed in the Strategies and Information section. Ask participants if they have any questions on the material presented.
Ask participants if this is their first attempt at quitting smoking. If it is not, encourage participants to make this attempt their last. Point out that many former smokers made several efforts to become nonsmokers before they were successful. Let participants know that this is not meant to discourage them but to show them that they are not alone.
If there are individuals in the group that have attempted to quit before, instruct them to complete the activity on page 12 of the participant’s guide. The smokers who are making this their first attempt to quit will benefit from how other group members answer the questions. Promote a group discussion of the answers.
Ask participants to decide on a quit date. Instruct them to tell as many people as possible – this will help build a support system. Instruct participants that their quit date should be any day from the present up to the day before the third session. Instruct them to take a careful look at a calendar – avoid planning a quit date on a stressful day (e.g. start of a new job, day child leaves for college).
All participants must come to session two with a quit date.
Instruct participants to review the content in Session One in the Participant’s Guidebook.
Questions?

7. Freshstart
Session Two

8. Freshstart: Mastering the First Few Days
Questions from Session One
Share personal experiences
Session Two Objective
Begin this session by asking participant’s if they have any questions from session one or if they would like to share any personal experiences encountered in the time between session one and two. If participants are quiet, prompt discussion with one or two questions, be sure to capture the average number of cigarettes they have smoked up to this point.
Ask participants to announce their quit date and method of quitting to the group.
Ask participant’s if anyone called the Quitline for additional support.
Ask participant’s if anyone has quit smoking? If yes, congratulate them on their quit and ask them if they have any questions about their experiences since stopping.
Ask participants who have not quit if they encountered any situations discussed in Session One that they were able to overcome. If yes, congratulate them.
IN ADDITION, ASK PARTICIPANTS THE FOLLOWING:
How do you feel today compared to how you felt last week?
Are you finding it easier than you expected?
How is this time different from your previous attempts at stopping?
What is the average number of cigarettes they have smoked up to this point? (Record participant’s progress on page 34 of the Facilitator’s Guide.)
Review the Objective of Session Two: To master the first few days off cigarettes.
Review the objective of the Participant for session two: It is your goal to understand how you can successfully cope with withdrawal symptoms and stress when you quit.

9. Freshstart: Mastering the First Few Days
Withdrawal Symptoms
Fighting Withdrawal Symptoms
Being Assertive
Thinking Positively
Making This Time Unique
Explain the two important points associated with withdrawal symptoms.
Review common withdrawal symptoms.
Review the content included under “Fight Withdrawal symptoms with Four Practical Behaviors.” Lead participant’s through the three relaxation exercises.
Discuss with participant’s the importance of being assertive. Lead participants through the Assertive Activity outlined in the Facilitator’s Guidebook on page 21. This activity should be done as a group - participants can write their responses on pages 16 and 17 of the participant guidebooks. The repeat box on page 17 of the Participant’s Guidebook is for completing the exercise at home with situations that are applicable to each participant’s personal situations.
Discuss with participant’s the importance of thinking positively. Work with participant’s to complete the constructive thinking activity on page 22 of the Facilitator’s Guide/page 18 of the Participant’s guide.
Discuss with participant’s how they are going to make this attempt to stop smoking unique.

10. Freshstart
Session Three

11. Keep Individual Quit Date
Freshstart: Mastering the First Few Days
Keep Individual Quit Date
Review Session Two – start using relaxation exercises
Four Practical Tips
Complete Assertiveness Chart at home
Encourage participants to keep their individual quit date.
Instruct participants to review session two and to start using the relaxation exercises.
Remind participant’s to use the four practical tips:
Water
Stick of cinnamon
Physical activity or gum
Deep breathing
Encourage participant’s to complete the assertiveness training chart at home.
Questions?

12. Freshstart: Mastering Obstacles
Questions from Session Two
Share personal experiences
Session Three Objective
Begin this session by asking participant’s if they have any questions from session two or if they would like to share any personal experiences encountered in the time between session two and three. If participants are quiet, prompt discussion with one or two questions, be sure to capture the average number of cigarettes they have smoked up to this point.
How do you feel today compared to how you felt last week?
Are you finding it easier than you expected?
How is this time different from your previous attempts at stopping?
What is the average number of cigarettes they have smoked up to this point? (Record participant’s progress on page 34 of the Facilitator’s Guide.)
By session three, every participant should have reached their quit date. If they have not, remind them that it is a critical component of the program.
Congratulate those that have quit smoking. Ask others to offer suggestions to those who have not yet quit, or to those who have quit but are still struggling. Ask participants if the assertive tips in their participant's guide have been helpful.
Review the objective of Session Three: To master the skill of staying off cigarettes. Review the objective of the participant: To master the obstacles I will face as I move into the direction of a smoke-free lifestyle.

13. Freshstart: Mastering Obstacles
Physical Improvements Following Cessation
Weight Gain
Alcohol and Cigarettes
Interpersonal Support
By session three, some participant’s will be experiencing withdrawal symptoms and others will be enjoying the benefits of stopping. Ask members of the group who are experiencing withdrawal symptoms. Ask those no longer experiencing withdrawal symptoms to share with the group how they dealt with the symptoms. Ensure those who are experiencing withdrawal symptoms that they will go away. You might want to review the Physical Improvements Following Cessation as outlined in the Facilitator’s Guide (page 35) and Participant’s Guide (page 28).
Discuss the challenge of overcoming the fear of weight gain; why people gain weight when they quit; watching portion sizes; having healthy foods on hand; increasing physical activity.
Discuss the bond between alcohol and cigarettes.
Discuss the need for interpersonal support from people who are going to be constructive, not people who are threatened by your quit. Encourage participants to reach out to friends or family members (Participant’s Guide page 20-21). Instruct participants to make a list of all the people they can depend on to help them stop smoking (Participant’s Guide page 21). On page 22 of the participant’s guide, instruct participants to write down how they would like the person(s) they have identified for support to respond to them when they are having a difficult time.

14. Review Session Three – continue using relaxation exercises
Freshstart: Mastering Obstacles
Review Session Three – continue using relaxation exercises
Four Practical Tips
Instruct participants to review session three and to continue using the relaxation exercises and incorporate physical activity in their day when they are most likely to smoke.
Remind participant’s to use the four practical tips:
Water
Stick of cinnamon, tic tac, or sugar-free chewing gum
Physical activity
Deep breathing

15. Freshstart
Session Four

16. Freshstart: Staying Quit and Enjoying It
Questions from Session Three
Share personal experiences
Session Four Objective
Begin this session by asking participant’s if they have any questions from session three or if they would like to share any personal experiences encountered in time between session three and four. If participants are quiet, prompt discussion with one or two questions, be sure to capture the average number of cigarettes they have smoked up to this point.
How do you feel today compared to how you felt last week?
Are you finding it easier than you expected?
How is this time different from your previous attempts at stopping?
What is the average number of cigarettes they have smoked up to this point? (ALL SHOULD BE ZERO) (Record participant’s progress on page 34 of the Facilitator’s Guide.)
Congratulate participant’s who have been successful. Be positive in encouraging any smoker who has not yet stopped. Determine what issues remain as the possible stumbling blocks. Encourage those that have stopped smoking to give feedback on their personal experiences and challenges.
Review the objective of Session Four: To enjoy staying off cigarettes forever. Review the objective of the participant: To remain smoke-free for life.

17. Freshstart: Staying Quit and Enjoying It
Ripple Benefits of Smoking
How to Avoid Returning to Smoking
Long-term Benefits
What If You Still Haven’t Quit or You Have a Relapse?
Discuss the ripple benefits of smoking with participants.
Discuss the reasons why many people return to smoking. Review Avoid Returning to Smoking in the Facilitator’s Guide page 30. In the Participant’s Guide, review Times of Crisis, Times of Happiness, Boredom and Loneliness, Alcohol, and Long-term Cravings on pages
Encourage participants to come up with a sentence that represents the number one reason why they will never smoke again. Instruct participants to write this sentence on the quitting reminders note card they created in session one.
Instruct participants to think about times of crisis or strain in life. Make a list of these situations in the Participant’s Guide on page 25. Once the list is made, instruct participants to write down how they will cope. Write these responses on the note card created in quitting reminders note card.
Review the long term benefits of quitting smoking.
Review “What If You Still Haven’t Quit or You Have a Relapse?” on page 25 of the Participant’s Guide.

18. Freshstart: Staying Quit and Enjoying It
Exchanging phone numbers
Review all sessions of the Freshstart program, including Additional Tips to Help You Remain Smoke- Free
Contact American Cancer Society ACS-2345
Ask participants if they are interested in exchanging phone numbers.
Encourage participants to review all sessions of the Freshstart program for reinforcement.
Encourage participants to contact the American Cancer Society should questions arise.
For participants who did not quit, remind them that many successful ex-smokers have a history of failed attempts before they finally succeeded.

19. Thank you!
Thank you for supporting the American Cancer Society Freshstart program.