of the American Lung Association of the District of Columbia DISTRICT OR with and funded by the
A projectA PROJECT OF THE AMERICAN LUNG ASSOCIATION OF THE in partnership COLUMBIA,
D.C. Department of Health
IN PARTNERSHIP WITH AND FUNDED BY THE D.C. HEALTH DEPARTMENT
TOBACCO CESSATION SPECIALIST TRAINING
Sponsored by the American Lung Association of D.C.
WHERE: American Lung Association of D.C.
1725 K Street, NW, Suite 1209
Washington, D.C. 20006
Near Farragut North and Farragut West Metros
DATE: October 17 and 18, 9 a.m. to 4:30 p.m.
This training prepares cessation specialists to facilitate the community-based Freedom
From Smoking program. In order to participate in the training, you must be a nonsmoker
or an ex-smoker for at least one year. Continental breakfast and lunch provided both days.
You must agree to conduct community-based support group cessation programs or
intend to provide individual smoking cessation counseling to participate in this
training.
Intensive two-day training includes:
Stages of Change and Motivational Interviewing: Using motivational
interviewing techniques, you will learn how to help smokers change their readiness to quit
from pre-contemplative to contemplative to action and stay quit for good.
Latest Nicotine Withdrawal Treatments: You will be guided through the vast array
of FDA-approved pharmacotherapy treatments now available to help smokers quit.
Creative Epidemiology: Learn strategies on how to make health statistics meaningful
to your patients and clients through exercises designed to create and emphasize relevancy.
Special Issues in Cessation: Instruction includes an emphasis on how to deal with
weight and stress management, two key reasons why people relapse, and overview of
other special issues such as co-dependency and mental illness.
Freedom From Smoking: You will learn to conduct the American Lung
Association’s gold standard Freedom From Smoking® program. This is an 8-session group,
7-week support program to help people who are ready to quit smoking. It has been
developed and tested by the American Lung Association and will be available for free to
D.C. residents during the Tobacco Free Families Campaign.
Materials: You will receive the Freedom From Smoking® Facilitator Manual, as well as a
cessation resource manual of research and information to help smokers quit.
YOU ARE ENCOURAGED TO SIGN UP AS SOON AS POSSIBLE AS SPACE IS
LIMITED TO 15 PARTICPANTS
Participant Registration Form
(Please print or type)
Name: ________________________________________Date: ___________________________
Occupation: ____________________________________________________________________
Organization Name: ______________________________________________________________
Organization Address: ____________________________________________________________
City/State/Zip: __________________________________________________________________
Business Phone: _________________________________________________________________
Business Fax: _________________E-mail Address: _____________________________________
Special diet needs: Vegetarian ___ Other ______________________________________
Are you an ex-smoker? YES ___ NO ___ If yes, quit date and year:___________
You must be a nonsmoker or an ex-smoker for at least one year
Have you conducted group support programs? YES___ NO____
If yes, what type of program? _________________________________________________
Do you have experience in public speaking? If yes, please explain ____________________
_________________________________________________________________________
Will you be conducting a group program as part of the Tobacco Free Families Campaign,
sponsored by your organization? YES____ NO____
If yes, date and location of program:
Date:____________________________ Location:___________________________________
I agree to conduct at least one Freedom From Smoking program or individual
outreach initiative to help smokers quit smoking during the period of October 18,
2006 to September 30, 2007.
Signed: _______________________________________ Date: __________________________
Please fill out this participant form and return by October 6, 2006
via fax to 202-682-5874 or email to tkoker@aladc.org
For more information call Tiange Koker at 202-466-5864 x223
I m p r o v i n g L i f e, O n e B r e a t h a t a T i m e