Pamela Spencer is a 39-year-old female who has been married to the man she calls her best friend for 19 years. She and Sam have two daughters who are 17 and 14. Pam works full-time at a department store and spends the equivalent of another full time job-40 plus hours per week-making her house a home. In her spare time, she loves to garden. Her beautiful yard is full of flowers, bushes and trees. She is often tired, but knows it is because of her busy schedule and responsibilities as a wife, mother and employee–and she will be turning forty soon.


Pam tries to stay healthy by gardening, taking nightly walks and watching her diet closely – even though she loves French Fries and sweets – she tries to make smart choices by choosing a salad or fruit. Below you will find a one day snapshot of her food choices.


Even though Pam enjoys gardening and nightly walks with Sam, both activities have become too challenging because she tires quickly and is frequently out of breath. She chalks this up to what seems like is a never-ending cold.


Pam started smoking in high school because back then it was the cool thing to do. She knows smoking is harmful to her health, but when she has tried to quit, she gained weight. She assumes being overweight is worse for her than smoking. Pam is trying to cut back from smoking a pack and a half a day (30 cigarettes). But Sam smokes and they both light up during and after dinner and sometimes while watching TV. They know it’s a bad habit, but they both enjoy it. Pam has read the warning labels on the packages, but, other than sometimes being short of breath, she’s healthy. Smoking gives her time to think and serves as an outlet for tension. She’ll cut back or quit when her life slows down.


Pam is feeling stressed out lately and her phlegmy cough isn’t helping. The coughing keeps her up at night, allowing her mind to be consumed with worry. She worries that her position at the store will be cut. She worries about her mother, who was just released from the hospital, after being admitted with chest pain that ended up being a symptom of her emphysema and not a heart attack. She worries about Callie, her youngest daughter, who seems a little insecure and has a couple of friends Pam believes are already smoking–at 14! Most of all, she worries that her “Do as I say, not as I do” speech is not effective on her two girls (especially Callie) and that they will begin to smoke-something she does not want for her daughters.


  1. Internet Research: What diseases are associated with smoking or chewing tobacco?


  2. Internet Research: How many toxic substances and chemicals are found in cigarettes?

    Internet Research: What are the most hazardous substances in cigarettes?

    Internet Research: Why are they dangerous to your health?


  3. View the Video: List three (3) facts regarding the effects of smoking on the lungs.


  4. Review Pam’s Personal Health Record: In which areas is she considered to be “At Risk”?


View Pam’s Personal Health Record