1. Introduction Session 1 Remember to have with you: Participant Manuals
Tobacco Tracker Sheets
QuitCore intake forms
If you plan to offer an optional support person session take invitation letters for participants to take home
Flip Chart
PowerPoint projector
Suggest bringing AlbertaQuits brochure and/or Helpline Fax Referral – let participants know they can access concurrent support through Helpline and/or through the AlbertaQuits website and community forum. Another option is the encouragement text messages or e-tips when they have selected a change/quit date. Note text message encouragement still uses the language of quit date.
If you have a carbon monoxide analyzer provide participants the option of checking baseline at end of session – and again after making a significant change (reduction or stop smoking)

2. Welcome to QuitCore Session One
Introduction
Name, what are you looking for in attending?
Creating Safe and Secure Guidelines
Identify that as a group program we want to provide a safe and secure place for people to be able to learn from each other, share experiences, problem-solve, and encourage each other. Have a flip chart ready and indicate you would like group participants to identify what group guidelines would make them feel comfortable participating in the group. If no one starts provides a suggestion i.e. conversations in the group will be kept confidential
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3. What we will talk about in this session…
Basic structure & content of the course
Individual Goals
Quitting Support Techniques
Stages of change model (Where am I)
Nicotine Addiction
Self-Monitoring
Lets talk about the program…
Program schedule – six 90 minute sessions
Content of the program: Provide each person with a participant manual and ask them to write their name on it. This manual is yours as a “how to quide” and a journal to record your experiences and planning as you progress through the sessions.
Why is it designed this way? Group support format: Page 22 of Facilitator Manual
Designed to help each participant to explore their own tobacco use, your reasons for change, and assist with creating plans to change your tobacco use and meet your goals whether you are ready to stop smoking, wish to do a reduce to quit, or reduce your tobacco use towards a future quit. The structure of the sessions is designed to provide information, and strategies, you can chose from while you also learn from each other. We will support you in problem-solving, learning skills, and making behavior changes to meet your goals.
QuitCore BlueCross Info card

4. Where are you at? Importance Confidence Readiness ________________
Ideas – print a Ready, Willing, and Able tool from the downloadable tobacco cessation toolkit on AlbertaQuits. Provide this to each individual to look at as you ask people how important is it for you to change, how confident are you in your ability, and how ready to you feel. Based on responses you could explore what people need to increase confidence and tie this to what will be covered over the six sessions of the group.
Second idea – laminate numbers and put them up on the walls of your room. Have participants walk to the number which identifies them when you ask about importance, confidence, and readiness
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5. Why did you choose to
make a change
in your tobacco use now?

6. What are your benefits of becoming tobacco free?
We often focus on the negative impacts of smoking and what will be avoided when people stop smoking. It is important to look forward to what you believe will be better after you stop smoking or using other forms of tobacco. What are you most looking forward to happening? What will be better in your life?

7. Stages of Change Model 11 Pg 11
Reviewing Stages of Change is an opportunity to identify where people see themselves? Are they attending to prepare to Quit or Reduce? Are they ready to take Action? Did they Stop using tobacco before joining QuitCore and are looking to maintain the change?
Make sure to talk about Quitting or Stopping Smoking as a process not an event. It takes practice to change behavior – especially if something has been an automatic part of your life for many years. Talk about each prior attempt as an opportunity to learn instead of a failure. Get people to talk about what skills they have learned with previous attempts, what worked for them, what were the reasons they started smoking again and identify the group will support them in developing new approaches to support their success and/or remove barriers.
For the following – chose wording which you feel comfortable with and at the understanding of participants.
You can share we consider tobacco dependence to be a chronic relapsing condition involving addiction to nicotine. Like any chronic condition people have cycles of relapse and remission. 11

8. Fagerström tolerance questionnaire
This scale is used to measure level of dependence or addiction to the nicotine in cigarettes or other forms of tobacco. Pg 12
Ask each person to go to page 12 of their participant manual and answer the questions for their own knowledge/self assessment.
You can ask if anyone would like to volunteer their results? Was anyone surprised by their score?
This is a good place to talk about the QuitCore BlueCross card. One of the key things for people to realize is that medication to minimize or prevent withdrawal is intended to help with the physical addiction to nicotine which is only one part of each persons tobacco dependence. It is equally important to identify the roles tobacco/smoking has in your life, all the ways using it has become woven into your life in ways that are unconscious, and finding ways to change these patterns is equally important to improve your chances to successfully stop smoking.
• By taking part in QuitCore, participants who commit to attend the full program can also access financial supports for nicotine replacement therapy (NRT) or prescription cessation medication such as Champix (varenicline) or Zyban (bupropion SR). This is a specific enhancement to the QuitCore program and is not available separately from the program.
• Nicotine Replacement Therapy (NRT) provides the body with low doses of nicotine without the other harmful parts of tobacco. Products like nicotine gum, inhalers, lozenges or patches can aid a person in quitting.
• Combining counselling such as that offered through AlbertaQuits with the use of NRTs, Champix, or Zyban increases an individual’s chances of quitting successfully when compared to using one quit method alone.
• The enhanced cessation medication support is provided in a partnership between AHS and Alberta BlueCross.
We will have anyone interested in receiving this support indicate on our QuitCore intake form your interest in enrolling for this support. Please check yes and fill in your personal health care number.
You will usually receive your QuitCore BlueCross card from your group facilitator during Session Four or Five.
When you receive your card you will also receive a letter identifying that each of the five types of NRT, and all brand names, are covered through this program. You will not be required to have a prescription for the NRT (which is different from most benefit programs) but you will need a prescription if you and your prescriber chose to use Champix (varenicline) or Zyban (bupropion SR). It is recommended you take your letter with your card when you go to your pharmacy.
Your card will cover a maximum of $500 dollars of NRT, Champix or Zyban and the card expires seven months after it has been generated. You are only eligible for one QuitCore BlueCross card in a twelve month period. If you come back to attend QuitCore twelve months, or more, after your first card is generated you will be eligible to get another card.
You can take your QuitCore card to a community pharmacy/pharmacist of your choice and work with the pharmacist to get the right products to help you minimize withdrawal as you make the behavior pattern changes needed to reduce and stop smoking.
Note if you are taking any prescription, or over the counter medications, it is important for your pharmacist and physician to know that you are reducing and stopping smoking. Some medications are processed differently when a person smokes - and when they quit - so it is important that these medications are monitored and changed by a prescribing health care provider familiar with your care.
When a pharmacy bills a benefit program for medication they are eligible to bill a dispensing fee for each medication which includes nicotine replacement therapy. This dispensing fee will be billed against your $500 dollar maximum and will not be charged to you directly.
 The Alberta pharmacy association, Alberta Health, and BlueCross have an agreement establishing the price range which can be charged for each medication covered under BlueCross medication programs. Your pharmacist will use this range when billing your QuitCore BlueCross card for your NRT or prescription medication. For this reason there is no purpose in comparing promotional prices at different stores as they do not apply when billing medication to a coverage program. 12

9. Quitting Support Technique #1 Self-monitoring: When, where & why I use tobacco
GOALS
To become aware of triggers and cues
To stop and think before using tobacco
To cut out “automatic” tobacco use
To monitor progress:
use tracker sheet
Talk about each person’s tobacco dependence is based on both their individual level of nicotine addiction and all the ways that tobacco has become woven into their life
In an unconscious or automatic way. We provide nicotine replacement therapy, or prescription medication, to reduce discomfort from withdrawal while people make the behavioral changes to replace tobacco’s role, break associations, and make not using tobacco their new normal. 13

10. Quitting Support Technique #1 Self-monitoring: When, where & why I use tobacco
Date/Time
Craving 1 - 5
Situation
Mood
Ask who likes to record, diary, and/or journal – and who doesn’t.
Emphasize the importance of this homework between session one and session two so people can learn more about their own tobacco use and become consciously aware of all of their triggers. This will allow them to develop coping strategies and chose behavior change options which will support their goals for change.
Provide each participant cut out copies of the tobacco tracker sheet (print from downloadable tobacco cessation toolkit or QuitCore facilitator online files) and review how to complete the chart. Provide people with the option of recording each day between session one and two – or to consider at least recording one week day and one weekend day (if they work weekdays). Let them know if they miss recording a cigarette/tobacco use on their recording day not to worry about it. This is for their learning they are not handing it in to you.
Suggest using the optional handout – the Pain Paradox to explain the value of doing your homework to increase chances of success 13

11. Quitting Support Technique #2 The butt jar
GOAL
To give me a powerful negative experience of cigarettes and
smoking
Keep the jar away from children and pets
Provide as an optional activity participants may try. Works best to have a sample jar if you are able to access the materials. Some people will find the butt jar unpleasant or disgusting – someone with a high level of nicotine addiction may find it a trigger. 14

12. Quitting Support Technique #3 The money jar
GOAL To give a visual cue of how much my tobacco use hurts me financially and to provide for future external rewards when I quit or reduce my use
Participants may prefer to use the financial calculator on AlbertaQuits
Or apps which do this tracking – two tobacco cessation apps in Canada which have been validated are Crush the Crave and Break it Off.
One other alternative is to use the tobacco wheel from the tobacco quit kits 15

13. Self Evaluation - Homework
Monitor tobacco use – tracker sheet
Change brands of tobacco.
Buy only one package at a time
Start a butt jar - Start a money jar (optional)
5. My Quit Plan – list reasons to quit using tobacco.
Read the “Participant’s Manual
Suggest to people that they read the info at the end of section one in their participant manual on nicotine addiction/withdrawal, NRT, medications and caffeine pages 16 through 30.
Suggest they look at the “Chart my decision to change tobacco use” on page 37 before next session.