Smoke-Free Home and Car Pledge

When you are near someone who is smoking, the smoke from burning tobacco can enter your lungs.  This is called 'secondhand smoke'.  Children and adults can get health problems from being around secondhand smoke.  Young children who are often around smoke are at risk for breathing problems and ear infections.  Even people who have never smoked can get lung cancer from other people's smoke.  To lower the risk of health problems, the Environmental Protection Agency (EPA) suggests making your home and car smoke-free.  If you need help to quit smoking, check out Quitline Iowa.

I pledge to protect my family from the health risks of secondhand smoke by making my home and car smoke-free.

Please fill out the form below to take the pledge:

Today's Date                     [None] Select a Date Delete the Date

First Name                         

Last Name                         

United States Resident  

Zip Code / Postal Code      

How Many Kids at Home (Age 6 or Younger) 

Before Pledge, Where Was Smoking Allowed?