Hands Off Tobacco! An Anti-Tobacco Program for Deaf Youth Cynthia B. Sternfeld, ED.S., LPC Susan M. Barnabei, B.S. Karan Kriger, B.S. Marie H. Katzenbach School for the Deaf
Debra S. Guthmann, ED.D. Frank Lester, M.S.W.
California School for the Deaf, Fremont
Barbara A. Berman, PH.D.
Division of Cancer Prevention and Control Research UCLA School of Public Health and Jonsson Comprehensive Cancer Center
Annette E. Maxwell, DR.P.H. Glenn C. Wong, M.P.H.
Recruitment, Retention and Communications Core UCLA Jonsson Comprehensive Cancer Center
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Hands Off Tobacco! An Anti-Tobacco Program for Deaf Youth This curriculum was developed through funding from TRDRP, the Tobacco Related Diseases Research Program, University of California (Grants # 10GT-3101, 12HT-3201, Barbara A. Berman, Ph.D., Principal Investigator, UCLA; Debra S. Guthmann, Ed.D., Principal Investigator, California School for the Deaf, Fremont). We wish to express our deep appreciation to the faculty, staff, students and their parents at the California School for the Deaf, Fremont (Fremont, California), the Marie H. Katzenbach School for the Deaf (Trenton, New Jersey), the California School for the Deaf, Riverside (Riverside, California), and the Minnesota State Academy for the Deaf (Faribault, Minnesota) for their participation in this study. We also thank Linda Oberg, M.S., M.A.; members of our Expert Curriculum Review Panel (Sook Hee Choi, M.A., Chriz DallyJohnson, M.A., Janet Dickinson, Ph.D., Thomas Holcomb, Ph.D., Nancy Moser, LCSW, Katherine A. Sandberg, B.S., CCDCR, and Mary Skyer) for their help in the formative stages of curriculum development; Mr. Jon Levy and the faculty, staff and students of the Orange County Department of Education Regional Deaf and Hard-of-Hearing Program, University High School, Irvine, California; and Heidi B. Kleiger, B.S., Lauren Maucere, B.S., and our colleagues at the Greater Los Angeles Agency on Deafness (GLAD), Los Angeles, California, for their help and support in this program of research. Images used for analysis, critique and description throughout this curriculum were obtained primarily from the website www. trinketsandtrash.org. Additional sources of materials include the American Lung Association and the website www.WhyQuit.com.
Š2004, 2007 University of California, Los Angeles
Introduction for Teachers
Hands Off Tobacco! An Anti-Tobacco Program for Deaf Youth
C
IGARETTE SMOKING is the single most preventable cause of death and disease in our society. It is responsible for approximately one in five deaths—over 440,000 deaths each year— in the United States. This is more than the number of people killed by AIDS, alcohol, motor vehicle accidents, homicide, illegal drugs and suicide, combined. Nearly half of all Americans who continue to smoke will die from a smoking-related disease. Across the globe, smoking accounts for approximately 4.2 million deaths annually, and this number is growing. By 2025 it is estimated that seven million people throughout the world will die from tobacco use each year.*
Is tobacco use a problem for young people? Yes, absolutely. More than 90% of all adult smokers begin to smoke while they are children or teenagers. In the United States alone, more than 4,000 young people under the age of 18 smoke their first cigarette each day, and 2,000 others go on to become regular, daily, smokers. That's more than 730,000 new underage daily smokers each year. More than a third of all youngsters who ever try smoking a cigarette become regular, daily smokers by the time they leave high school. About 4.5 million youth under the age of 18 are current smokers. Monitoring the Future, an annual series of nationwide surveys conducted by the University of Michigan Institute for Social Research among 8th, 10th and 12th grade students, reports that cigarette use has been falling among American adolescents since the mid-1990s. But the rate of decline is slowing, and there is growing concern that these gains may be near an end. And even with these gains, which simply offset the dramatic * Trends and patterns change very quickly. We therefore
choose to provide only limited data in presenting this curriculum. The Campaign for Tobacco-Free Kids Web site (www.tobaccofreekids.org), the annual Monitoring the Future report (www.monitoringthefuture.org or http://drugabuse.gov), and the Youth Tobacco Survey are only a few of the many places on-line where there is easy access to current information regarding changing patterns of tobacco use among children and teenagers.
increases in teen smoking in the first half of the 1990s, it is important to note that a quarter of young people —nearly one out of every four— are actively smoking by the time they leave high school. Furthermore, some young people who are not smoking in high school will begin after they graduate, and others who are not daily smokers in high school will become daily smokers after they leave school. Initiation and development of tobacco use among children and teenagers involves a process that starts with attitude formation about smoking, proceeds through trial and experimentation, and all too often ends in regular use. We also know that several factors place children and adolescents at risk for starting tobacco use and becoming an addicted smoker. These include: W Behavioral risk factors for tobacco use: Poor school performance, low aspirations for future success, school absences, and school dropout. Other behavioral factors include risk-taking and rebelliousness, coupled with a lack of skills to resist influences to use tobacco, alcohol or drugs. W Environmental factors: If family members or close friends smoke; and if tobacco products are readily accessible. Advertising and promotion are an important aspect of the environment, shaping young people's views of the utility of smoking and other tobacco use. So too are community-level factors such as the extent to which sales to minors are restricted, the cost of tobacco products, and restrictions on smoking in public places. These factors influence not only access to tobacco products, but also the perceived acceptability of tobacco use. W Personal risk factors: These include aspects of a young person's interaction with the social environment. Smoking is most likely among youngsters with low self esteem; who believe that tobacco use has a valuable social function; who Introduction 1
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believe that "everyone else smokes;" and who are susceptible to peer pressure to smoke. Personality factors such as depression, helplessness, aggression, pessimism, and limited ability to conceptualize the future have also been found to predict smoking among young people. Children from lower income families are also at greater risk for smoking than other young people. Although these characters increase the risk of tobacco use, the fact is that smoking initiation occurs among young people across all behavioral, environmental and personality characteristics. To understand why young people continue to smoke once they have started, we need to take into account the very real danger of addiction.
results in relapse when a quit attempt is made. Once they begin, many smokers—young and old—find themselves caught up in a cycle of addiction that makes quitting very difficult. How does the Addiction Cycle work? While much has still to be learned about the process of nicotine addiction, including the role of genetics in this process, much has already been learned (See Figure 1).
Is tobacco use addicting for children and teenagers?
W Nicotine is one of more than 4,000 chemicals found in the smoke from tobacco products such as cigarettes, cigars and pipes, and in smokeless tobacco products such as snuff and chewing tobacco. Nicotine is absorbed through the skin and mucosal lining of the mouth and nose or by inhalation in the lungs. It enters the blood stream and travels throughout the body.
Certainly. In fact, not only do most adult smokers report that they started smoking as children or teens-most also report that they were addicted by the time they left high school. This is why reaching out to young people now about avoiding tobacco use is so critical. Tobacco use and addiction happen very quickly.
W Immediately after exposure to nicotine, there is a “kick” caused in part by the drug's stimulation of the adrenal gland which discharges epinephrine—adrenaline. The rush of adrenaline stimulates the body and causes a sudden release of glucose, an increasing blood pressure, respiration, and heart rate.
What do we mean by “addiction?” Addiction is characterized by compulsive drug-seeking and use, even when the user knows the dangers involved. Tobacco certainly fits this description. Most smokers identify tobacco as harmful and indicate that they would like to quit. Nearly 35 million smokers make a serious attempt to stop smoking every year. But less than 7% of those who try to quit on their own stay off cigarettes for more than a year. Most relapse-that is, they go back to smoking in a few days after trying to quit.
W Depending on how it is taken, nicotine can reach peak levels in the bloodstream and brain very quickly. A cigarette, for example, is a highly engineered, efficient drug-delivery system. The inhaled smoke from a cigarette carries nicotine deep into the lungs where it is quickly absorbed into the blood and carried to the heart and the brain. It reaches the brain within about ten seconds of inhaling.
The desire to quit is not just expressed by adults. Once children and teenagers begin to smoke, they commonly believe that they can quit whenever they choose. The truth is that quitting, even for a young person, is difficult to do. While some young smokers are able to quit before leaving high school, nearly three out of every four regular smokers in high school have already tried to quit but failed. The most important reason for this is that tobacco products contain nicotine, a chemical as highly addictive as cocaine and heroin. And addiction to tobacco products can occur very quickly. Children and teenagers who try to quit find that they experience the withdrawal symptoms that adults experience, and this frequently
W Once in the brain, nicotine stimulates the release of the neurotransmitter dopamine. Dopamine is involved in regulating feelings of pleasure, and creates a “reward pathway” that encourages continued nicotine intake by the tobacco user. Nicotine also has an impact on other brain chemicals that affect mood and performance, including acetylcholine (arousal, cognitive enhancement), norepinephrine (arousal, appetite suppression), vasopressin (memory improvement), serotonin (mood modulation, appetite suppression) and beta-endorphins (reduction of anxiety and tension). W Research indicates that other chemicals in tobacco may also play a role in the addiction
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Introduction for Teachers Figure 1: The Addiction Cycle
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So the person smokes another cigarette. And the cycle starts over again.
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Within seconds of inhaling, nicotine speeds its way to the smoker’s brain.
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Over time, the brain becomes accustomed to nicotine stimulation. Once this happens, the smoker experiences unpleasant withdrawal symptoms if the nicotine craving is not satisfied.
4 The smoker’s brain starts to crave another “hit” of nicotine—which prompts the person to smoke another cigarette.
process by decreasing levels of an enzyme that break down dopamine, thereby inhibiting the body's ability to block the increase of dopamine. W After the initial “hit” of nicotine in the brain, its concentration in the blood begins to fall rapidly. Nicotine is eliminated from the body primarily by the liver. In about 30 minutes the body has cleaned out much of the nicotine. Without nicotine to provide the pleasure stimulus in the brain, a smoker then begins to feel tired, jittery and depressed. These feelings are symptoms of withdrawal, and trigger a craving for another dose of nicotine by smoking another cigarette, or chewing on another plug of smokeless tobacco. Tobacco users continue to smoke or chew throughout the day to maintain the drug's pleasurable effects and prevent unpleasant withdrawal symptoms. W With repeated smoking during the day, nicotine levels accumulate, plateau through the day, and then gradually fall overnight. Many smokers describe the first cigarette of the day as the most pleasurable because of the relief it gives to withdrawal symptoms they experience upon waking in the morning.
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In the brain, nicotine causes the release of a chemical called dopamine which stimulates feelings of pleasure and relaxes you.
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But as soon as the person stops smoking, this stimulation wears off as the nicotine level in the body falls.
A typical smoker takes about 10 puffs on a cigarette during the five minutes that a cigarette is lit. A smoker that smokes a pack of cigarettes a day—20 cigarettes—gets 200 “hits” of nicotine to the brain each day. W As the nervous system adapts to nicotine, smokers tend to develop a tolerance to the chemical. This causes tobacco users to smoke or chew more over time to achieve the same nicotine “hit.” W When people try to quit they frequently experience withdrawal: irritability, difficulty in concentrating, sleep disturbance, increased appetite, depression, and fatigue. These feelings usually last for a few days or weeks. But they can last longer. They can be mild or severe. They frequently result in relapse to tobacco use. W Behavioral and psychological aspects of addiction are also very important and can contribute to the craving for a cigarette. For some smokers, the feel, smell and sight of a cigarette, and the behaviors associated with obtaining, handling, lighting and smoking cigarettes are associated with the Introduction
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pleasurable effects of smoking. Smokers come to associate these behaviors with a reduction in stress. Given the difficulties in stopping smoking once someone is addicted, it becomes clear why prevention—finding ways to encourage people to never start smoking in the first place—is so important. And because most smoking begins in childhood and adolescence, the importance of prevention among young people is clear. But prevention is difficult to achieve. What makes tobacco use prevention such a difficult task? Prevention is difficult because the act of tobacco use—smoking cigarettes, cigars, and other tobacco products, or chewing smokeless tobacco—has been linked to social meanings and utilities, apart from its physiological effects, that make tobacco use attractive. The act of smoking or chewing tobacco is associated with independence, toughness, rebellion, camaraderie, sophistication, relaxation and fun. Tobacco use is perceived as being “cool.” How did tobacco use come to have these social meanings? Most of this is the result of the tremendous marketing effort put forth by the sellers of tobacco products. First, they developed innovative strategies for marketing tobacco, pioneering the use of brand names and packaging to segment markets (cigarettes for men versus those for women; for tough men versus the sophisticated individual; and those for the young). Perhaps more important, they promoted tobacco use as not only normal and acceptable, but as a desirable practice as well.
had already linked the rise in tobacco use with an equally dramatic increase in lung cancer and other diseases. Spurred on by these research findings, the government, voluntary agencies and others began to disseminate information about the health effects of tobacco use. The government also began to make efforts to control the marketing and sale of tobacco products. These efforts led to a greater awareness of the health risks of smoking and to declines in smoking rates since the peak years in the 1960s. This took place first for men, and then later—and more gradually—for women. Still, the significant fact is that nearly a quarter of the adult American population, or about one in four adults in the United States, smokes cigarettes. And despite what is known and continues to be discovered about the health consequences of tobacco use, the tobacco industry remains a powerful economic and political force, both in the United States and around the world. Over one billion men and 250 million women in the world are daily smokers-consuming 15 billion cigarettes every day-and the ranks are growing every day. Today the tobacco industry spends upward of $11.5 billion dollars annually on marketing in the U.S.-about $31 million dollars each day. Some of the most familiar images in marketing—the Marlboro Man, Joe Camel, and beautiful Virginia Slims models to name a few— are linked to tobacco products. And marketing is only one of the many ways in which the tobacco industry has sought to gain and retain acceptance for its products and for this industry in the United States and elsewhere.
In the early decades of the 20th century, tobacco use was linked to manliness, success, athleticism and more through carefully crafted marketing strategies. As a result, before World War I, tobacco use was primarily a male behavior. Recognizing that few women smoked, tobacco companies in the 1920s and 1930s began to market tobacco products to women by linking smoking to thinness, emancipation, independence, youth, fun and beauty.
When it comes to young people, the tobacco industry has always denied that it markets its product to children and teenagers. But the industry's own internal documents reveal that young people have long been viewed as an important segment of the tobacco market. Children and teenagers are susceptible to tobacco messages and images, teenagers are more likely than adults to recall tobacco advertising, and a far greater proportion of young smokers buy the top three brands of cigarettes—those most heavily advertised—than do adults.
The aggressive promotion of tobacco use—especially cigarette smoking—as a socially acceptable and desirable behavior resulted in a dramatic increase in tobacco use in the 20th century, to where more than half of all adult men and a third of adult women in the U.S. were smokers by the 1960s. By this time, however, scientific research
While Camel cigarettes no longer uses Joe Camel in its advertising, we can learn a great deal from this highly successful campaign. While this campaign was taking place, a study of product logo recognition of three-to-six-year-olds revealed that over 90% of the six-year-olds correctly matched the cartoon Camel with cigarettes. Between 1989
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and 1993 the amount spent on Joe Camel went from $27 million to $43 million. This led to a 50% increase in Camel's share of the youth market. It had no impact at all on the company's adult market share. We often think of peer influences and adult role models as key to understanding tobacco use. And without doubt, these are critical factors we need to take into account. But the social and cultural environment also has a direct impact on the behavior of young people, and plays an important role in shaping the behavior of peers and adults. Cigarettes and other tobacco products have come to have an important place not only in adult culture, but in youth culture, as well. What are the health and other consequences of smoking? Condemnation of tobacco dates back for centuries. Prior to the 20th century opposition to tobacco use was often on moral and religious grounds. Health concerns were voiced. But they did not emerge as the most significant argument until the 20th century, when physicians and researchers began to report the health consequences of this behavior. In 1964, in response to growing calls for action, a landmark report was published, Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. This, the first Report of the Surgeon General regarding tobacco, documented what was then medically known: smoking was a cause of cancers of the lung and larynx (voice box) in men and chronic bronchitis in both men and women. Extensive research into the health effects of smoking continued, from that time until the present, and the understanding of tobacco's role in disease and death has grown. The Surgeon General’s Report and others have carefully documented many of these issues—the addictive nature of nicotine, the health consequences of secondhand smoke exposure, the implications of smokeless tobacco use—and more. In 2004, on the 40th anniversary of the first Surgeon General's Report, a new report, The Health Consequences of Smoking: A Report of the Surgeon General, was published. In that report the conclusion is drawn that smoking harms nearly every organ of the body, and that “smoking remains the leading cause of preventable death and has negative health impacts on people at all stages of life. It harms unborn babies, infants, children, adolescents, adults and seniors.”
W Smoking causes cancer and accounts for at least 30% of all cancer deaths. Tobacco smoke contains at least 60 cancer causing substances. Lung cancer is the leading cause of cancer death in men and women, and smoking causes about 90% of lung cancer deaths in men and almost 80% in women. Smoking is also a known cause of cancer of the oral cavity, larynx (voice box), pharynx, esophagus, bladder, pancreas, kidney, blood (leukemia) stomach, pancreas and cervix. W Smoking is a cause of coronary heart disease, the leading cause of death in the United States. A smoker is four times more likely to die from coronary heart disease than a nonsmoker; 21% of all coronary heart disease deaths in the U.S. each year are attributed to smoking. W Smoking causes respiratory diseases. It is a known to cause more than 90% of deaths from chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis; male and female smokers increase their risk of death from these diseases by nearly 10 times. Smoking causes chronic coughing and is linked to pneumonia. Smokers are more susceptible to influenza (the flu) and are more likely to experience severe symptoms when they get the flu. W Smoking causes strokes, the third leading cause of death in the United States, and circulatory deficiencies which can contribute to infection and tissue death, particularly for parts of the body like hands and feet that are distant from the heart. It is also known to contribute to aortic aneurysm, a dangerous weakening and ballooning of the major artery near the stomach. W Research has linked smoking to rheumatoid arthritis, hearing loss, vision problems (such as cataracts), facial wrinkling, gum disease (periodontitis), reduced bone density among postmenopausal women, hip fractures and osteoporosis, diabetes, and to making diabetes worse for those who have this disease. It can reduce the effectiveness of medicines used to treat, for example, diabetes, ulcers, sleeplessness and pain. Smokers who get immunizations such as flu vaccine and hepatitis B vaccine are not as well protected against the disease as are nonsmokers. Smokers have a lower survival rate after surgery compared to that for nonsmokers because of damage to Introduction 5
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the body's host defenses, delayed wound healing, and reduced immune response. Smokers tend to have more ulcers than non-smokers, and smoking keeps ulcers from healing. Smoking affects the sense of smell and smokers are more likely than non-smokers to snore. W Women who smoke and take birth control pills run an increased risk of stroke. Women who smoke are at increased risk for infertility. Smoking during pregnancy can cause health problems for both mothers and babies, such as pregnancy complications, premature birth, low birth weight infants, stillbirths, and Sudden Infant Death Syndrome (SIDS). Smoking by fathers prior to conception may have health consequences for their offsprings as well, even when the mother does not smoke. Children exposed to secondhand smoke after birth are at a greater risk of childhood wheezing, respiratory tract infections, of getting or worsening asthma, of chronic respiratory symptoms such as colds, coughs, sore throats, stuffy noses, and middle ear infections, of poorer lung function, increased heart rate, complications after surgery and higher blood levels of lead, a toxic metal. W Smoking has been linked to erectile dysfunction in men. W Adults exposed to secondhand smoke increase their risk of heart disease morbidity and mortality, lung cancer, eye and nasal irritation, pneumonia and other respiratory infections. W Socioeconomically, the costs of smoking are high. The financial costs of smoking-related diseases are borne by society in the form of higher health insurance costs and greater health care expenditures, especially in the public, taxpayer-financed health care system. The economic costs include lost productivity in the workplace due to smoking-related illness and premature death. These costs are staggering. It is estimated in the United States that smoking costs $75 billion in direct medical expenses and $82 billion in lost productivity every year. And there are the additional costs of dealing with the more than 140,000 smoking-related fires in the U.S. each year.
But what do these health impacts mean to young people? Research has clearly shown that the earlier young people begin to smoke, the greater their risk of developing smoking-related diseases in adulthood. However, the primary difficulty in communicating these health effects to young people is that many of the most graphic consequences of tobacco use—lung cancer, heart disease, oral cancer, strokes and so forth—are far off in the future and beyond the horizon as far as an adolescent is concerned. In a youth-oriented anti-tobacco curriculum, it is important to emphasize both the immediate health and social consequences of tobacco use. What are the immediate health consequences of tobacco use for young people? W First, a young person's lung function is immediately impaired, and the effects are consistent with early signs of obstructive airway disease. What does this mean? Some lung tissue damage occurs, diminishing the ability of the lungs to take in oxygen. This damage gets progressively worse the more one smokes. Not surprisingly, young people who smoke are less physically active, perform more poorly at all levels of physical exertion, improve more slowly with training, and have poorer endurance overall than non-smokers. W Smoking slows the normal development and growth of a young person's lungs. This means that young people who take up smoking while their bodies are still growing may be permanently stunting their lung capacity. This has been shown to be especially the case for girls who take up smoking. W Smoking contributes to the onset of asthma, and can greatly aggravate an existing asthma condition. W High school seniors who smoke rate their overall health more poorly than do nonsmokers. They are more likely than non-smokers to report experiencing cough with blood or phlegm, shortness of breath when not exercising, and wheezing and gasping. Young smokers are more likely to suffer exercise-related injuries than their non-smoking peers, and heal more slowly from injuries. Over time, smoking causes premature wrinkling of skin.
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W There is evidence that smoking is sometimes a first step towards other substance use. Young people age 12-17 who smoke are more than 11 times as likely to use illicit drugs and 16 times as likely to drink heavily as young people who do not smoke. W But the damage is not confined to tobacco that is smoked. Smokeless (chewing) tobacco causes mouth sores and gum disease, even at a young age. Oral and nasopharyngeal cancers are less commonly seen, but can also occur at young ages. Both smoking and smokeless tobacco lead to bad breath, yellowed teeth, stained fingers, dulled taste buds, and a dulled sense of smell. W Of course, the most insidious impact of youth smoking is that those who start smoking at a younger age are more likely than later starters to develop a long-term addiction to tobacco. The younger a person starts, the greater the difficulty in quitting tobacco at a later age. Smoking also has social and economic consequences for young people. W Some of the effects on personal grooming— bad breath, yellowed teeth, and discolored fingers—have already been mentioned. Add to this list the smoky odor in hair and clothing, and burn holes in clothing. Smoking may change social relationships with others, including family, girlfriends or boyfriends, non-smoking friends, teachers, employers, athletic teams and other social groups. There are a host of social consequences related to the act of smoking itself, such as getting punished for breaking school rules, being asked to step outside of restaurants, or getting cited for smoking in a public place. Many of these social consequences may be more immediate, and therefore more important to young people, than the long-term health consequences of tobacco use. W Economically, smoking is an expensive activity. As a daily habit, smoking or chewing tobacco represents a high opportunity cost for young people. At anywhere between $3 and $5 per pack of cigarettes, smoking represents a great deal of foregone savings or purchases of other goods, entertainment or services.
What efforts have been made to change the acceptance of tobacco in our culture? What can we do in the future? The rising prominence of tobacco use in this and other countries has been accompanied by movements that seek to control or restrict this behavior. Some of these earliest movements were based on “moral” or “hygienic” concerns. By the mid 20th century, the anti-tobacco effort began to crystallize around the increasing scientific awareness of the health consequences of smoking. This growing awareness provided the impetus for new antitobacco efforts by government, as well as voluntary agencies such as the American Lung Association, the American Cancer Society and the American Heart Association. Today, these groups, together with a host of academic, educational, professional, legal, private and grassroots organizations play a significant role in the struggles to prevent tobacco use; educate the public; regulate tobacco distribution, sales and marketing; demand moral and financial accountability from tobacco companies for the costs of smoking; fight for non-smokers rights to smoke-free air; craft ordinances to limit smoking in public places; examine the marketing practices of tobacco companies worldwide; shed light on the political strategies of this industry; and conduct all of the other activities that have become hallmarks of the international anti-tobacco movement. The anti-tobacco movement has become a significant force for change. Its efforts have contributed to a reduction in tobacco use in our country and other industrialized nations, and steps are being taken to ensure international cooperation in tobacco control efforts. The World Health Organization's (WHO) Framework Convention for Tobacco Control, is a pioneering example of such cooperation. It provides a framework for nations to work, and work together, to contain the rapidly spreading tobacco epidemic. What has been learned to date suggests that no single approach can, alone, solve the tobacco control problem. Diverse approaches are needed, and comprehensive programs that include multiple strategies seem to have the greatest impact. Economic approaches, such as increasing the cost of cigarettes, are seen as key to tobacco control. Research indicates that for every increase of 10%
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1964 Surgeon General’s Report Broadcast advertising ban
U.S. entry into WWII
Number of cigarettes
U.S. entry into WWI
1998 Master Settlement Agreement Fairness Doctrine requires free time for antitobacco ads
First modern reports link smoking and cancer Great Depression
Federal cigarette tax doubles
Non-Smokers’ Rights Movement begins
Year Figure 2. Adult per capita cigarette consumption and major smoking and health events, United States, 1900-1999
in the cost of cigarettes there is a decline of about 4% in tobacco use, and that this impact is greatest among young people. Increasing the tax on tobacco products is one way to increase their cost. However, the average price of cigarettes and the average cigarette excise tax in this country are well below those in most other industrialized countries. The taxes on smokeless tobacco products are well below those on cigarettes. Other economic approaches relate to efforts to reduce the supply of cigarettes, such as by removing price supports, ensuring that our trade policies discourage—not encourage—the exporting of tobacco products to other countries, and by establishing and enforcing laws that prevent the smuggling of cigarettes. Efforts to limit tobacco industry advertising and promotion have been attempted since the 1960s. In 1965, general health warnings were placed on cigarette packages. While seen at the time as an important step forward, placement of these weak messages in fact prevented any further federal, state or local requirements for health messages. The enactment of the Comprehensive Smoking Education Act of 1984 (Public Law 98-474) required four rotating warnings on cigarette packages, but failed to adopt other Federal Trade Communication (FTC) recommendations for stronger messages on packages. Far stronger messages, including visual images, have been enacted in other nations, such as Canada and Brazil.
In another attempt to control advertising, successful court action in 1969 invoked the Fairness Doctrine to require broadcast media to air antitobacco advertising (at no charge) to counter the paid tobacco advertising on television and radio. Evidence suggests that the anti-tobacco advertisements had considerable impact on the public's view of cigarettes that alarmed the industry. In 1971, the tobacco industry agreed to a ban on the advertising of tobacco products on broadcast media, in part because the legislation also eliminated the Fairness Doctrine requirement that led to the airing of anti-tobacco messages. Although this agreement was hailed as an important step forward for tobacco control, evidence suggests that it did little to reduce the advertising and marketing efforts of tobacco companies. Tobacco companies dramatically increased their print and “point of purchase” advertising; placement of tobacco products in movies; the use of promotional logo and brand name items; sponsorship of cultural, sports, and other events; as well as political contributions to seek less restrictive legislation on tobacco production, sales and marketing activities. The growing body of evidence about the health effects of environmental tobacco smoke exposure for children and adults has led to widespread clean indoor air regulation since the 1970s. Grassroots action by non-smokers has played a vital role in the passage of laws, policies and rules that,
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today, limit—and in many instances entirely eliminate—smoking and exposure to ambient smoke in many settings. These include government offices, public places, eating (and drinking) establishments, work sites, military establishments, and domestic and many international airline flights. Anti-tobacco activists continue work towards increasing this regulation in indoor and outdoor settings, and in encouraging smokers to make their homes and cars “smoke free.” Restricting the access of minors to tobacco products has widespread approval. All states prohibit sales or distribution of tobacco to minors, and recent advances have limited where vending machines selling cigarettes can be placed, to reduce the likelihood that they will be used by children or teenagers. However, it is not clear that young people have difficulty in obtaining tobacco products, and efforts continue to be made to ensure that local ordinances are in place and vigorously enforced. Significant steps have been taken to help people manage their nicotine addiction. These have included developing and disseminating self-help materials, and strategies that can be used by physicians, nurses, dentists, and other health care providers to assist their patients in quitting. Strides have been made in developing effective pharmacologic interventions, such as, for example, nicotine replacement products. Past and current efforts have also focused on developing products that result in “harm reduction” for tobacco users who do not quit. Encouraging cessation is an important element of prevention. As smokers and other tobacco users quit, the health and other consequences of tobacco use decline. As more and more people enter the ranks of those who don't smoke or use smokeless tobacco, acceptance of tobacco use in the community begins to decline, as well. Norms begin to change. Since the 1950s, people have been suing the tobacco companies, using several different private litigation strategies. In 1998 a Master Settlement Agreement was negotiated by the tobacco industry with 46 states and the District of Columbia, five commonwealths and territories. (The four remaining states had already successfully sued the industry.) In exchange for relief from some types of litigation, the tobacco companies paid a large sum of money, and agreed to change aspects of its past practices, such as placement of tobacco products in movies and advertising targeting young people. The tobacco companies were also
required to fund the American Legacy Foundation which has pursued tobacco prevention via its Truth campaign, support of research, and other activities. The hope that states would use funds they received in the Settlement to further support anti-tobacco programming has not, for the most part, been realized. It is not clear how dramatically tobacco industry activities have changed. Litigation continues to the present. Finally, the anti-tobacco movement has sought to “get the word out”—to educate the public not only about the health and other consequences of tobacco use, but also about the activities of the tobacco industry. Learning about the industry from its own internal documents, made available from industry “insiders” and through litigation, has been an important part of this process. Mass media campaigns have played an important role, as well. The goal of changing adult culture, norms and behavior has been central to these and other tobacco control efforts. So too has working with children to prevent the uptake of tobacco use in the first place. And, as is so often the case when it comes to children, this has brought anti-tobacco activists and researchers to the school-house door. What efforts have been made to bring tobacco prevention to schools? School-based efforts to encourage young people not to smoke began in the 1960s. The earliest programs were based on an Information-Deficit Model. These programs assumed that young people did not know or fully understand the dangers of smoking, and if they did, they would choose not to smoke. Unfortunately, these programs, which were geared to providing information about the health consequences of tobacco use, did not work. They failed to consider the complex link between knowledge and behavior, that young people would not consider health consequences that might occur sometime in the future as relevant to their lives, the role of environmental and individual forces and factors in tobacco use, and the role of addiction. To address the limitations of this approach, during the 1970s researchers shifted their focus to developing and testing programs based on an Affective Education Model. These programs reflected the observation that the use of cigarettes was associated with negative or antisocial patterns of adolescent behavior. Educators concluded that these patterns—and in turn behaviors such as smoking—
Introduction 9
Introduction for Teachers reflected reduced levels of perceived self-worth and poor attitudes toward family, school and community. Affective Education Model prevention programs focused on clarifying values, building self-esteem and a sense of self-worth, and teaching general skills such as assertiveness, communication, and problem solving. While these programs did not work either—indeed, in some instances the concern was that they even generated interest in the behaviors they were attempting to discourage—one positive outcome was that researchers began to pay more attention to exploring why young people smoke. They also recognized that no program would work without addressing the underlying reasons for this behavior. A third approach to prevention, known as the Social influences Resistance Model, evolved in the 1980s. These programs drew on previous efforts and on the unfolding understanding of the complex issues involved in tobacco use by young people, while focus on recognizing, managing, and resisting the social influences that encourage tobacco use. These programs emphasize not only the impact of factors in the immediate environment—the role of peers and friends, siblings and parents—but also the influence of the wider community and culture, including the mass media and tobacco industry marketing. It is also considered important that students develop an understanding of the norms regarding tobacco use—that most people, including most young people, don’t smoke regularly and that smoking is increasingly looked upon negatively by many people of all ages. Insight into the addiction process, the short and long-term consequences of tobacco use, and the process of cessation are often included. Anti-tobacco education continues to be a “work in progress.” While we continue to do research and to learn, we know that: ✷
✷
The peak years for first trying to smoke are the sixth and seventh grades, between the ages of 11 and 12, with a considerable number of young people starting earlier. Therefore, prevention programs in school need to be initiated in middle school or even earlier) and should be continued throughout the high school years. Beginning in high school is too late. The effectiveness of programs is dose related. A greater number of educational contacts over a longer period of time yield larger and more enduring smoking prevention effects.
✷
School programs are more effective when they are part of a broader, community strategy, when mass media elements are included, and when family members are involved.
✷
While some kinds of information may not be useful in tobacco prevention—such as a focus on long term health consequences using scare tactics—information about the tobacco industry’s influence and about secondhand smoke exposure seems to be important to young people.
✷
The impact of social influence programs does not seem to be reduced when these programs include more than tobacco—for example, when these programs seek to address other substance use behaviors often linked in the behavioral development of young people.
✷
Various personnel—staff, students—have successfully delivered these programs. These programs have been successful in urban, suburban and rural schools serving diverse populations.
✷
For school programming to be effective it needs to include tobacco-free policies involving faculty, staff, and students and relating to all school facilities, property, vehicles and events.
✷
Special programs—guest speakers, special events—cannot be substituted for repeated, intensive, focused classroom programming.
Can self-esteem, the ability to make healthful decisions, the skills needed to resist peer and other pressures be taught? Can they be taught in a few sessions in a tobacco-related curriculum? Is the school the best place to convey these important lessons? These are not easy questions and we do not minimize the challenges. But evidence suggests that intensive, sustained school-based programming can make a difference. Why tailor a program to Deaf/Hard-of-Hearing youth? We have sought to develop a tobacco prevention curriculum for Deaf children and adolescents that can help to ensure that these youngsters grow up to be “smoke free.” Our program incorporates what is today known regarding effective anti-tobacco
Introduction 10
Introduction for Teachers education. It is the first-ever effort of its kind to provide Deaf youth with a comprehensive tobacco-prevention program that is tailored to their cultural and linguistic needs. We developed this program because we are committed to the belief that the ongoing effort to reduce and eliminate tobacco use among young people needs to reach all youngsters.
place in some Deaf/Hard-of-Hearing educational settings. We recognize that tobacco use is only one of many extremely important health issues that need to be included, where possible, in what is an already full academic curriculum. To address this issue we have sought to take steps to organize our curriculum in ways that can facilitate its usefulness and place a minimal burden on the school staff.
We also believe that Deaf youngsters are at risk for tobacco use. We know that children and adolescents that struggle with issues of social acceptance and self-esteem, who experience communication barriers, and who face difficulties when it comes to school performance, are at great risk for tobacco use and other risk taking behavior. We recognize that Deaf youth often face these and other challenges. Data regarding tobacco use among Deaf youngsters is sparse. But in a survey we conducted among over 400 Deaf/Hard-ofHearing high school and college students in California, we found that there is considerable experimentation with cigarette smoking in this population. Among the 226 high school participants in our study, 45% reported ever having smoked cigarettes. The rate was 65% among the 241 college students we interviewed. Anecdotal reports from educators, community agencies, and health care providers confirm that tobacco use is a problem among Deaf/Hard-of-Hearing youngsters.
How is our curriculum organized?
In seeking to craft our program we have called on the expertise of educators with long experience in Deaf education and in curriculum building for this population, as well as on researchers in the field of tobacco prevention and control.
However, we also recognize that these are overarching themes and the way they are approached should vary for students of different ages. In recognizing that material should not simply be repeated from year to year we therefore propose a variety of examples and different projects and activities. We also make recommendations in each module that can assist faculty in choosing themes and topics for classroom discussions and activities that make best sense in diverse settings, and, in particular, where student requirements vary, even at a single grade level.
We have adopted a Social Influences Resistance Model approach to the particular needs of this student population, ensuring that all aspects of the program are appropriate and meaningful for Deaf youth, with varying needs, at each grade level. We have sought to utilize many visual aids and illustrations. We have emphasized hands-on activities. In some instances we have included a greater focus on “information”—for example the health consequences of tobacco use—than would likely be provided to hearing youth. We do this because experts in education for this population have emphasized to us that Deaf/Hard-of-Hearing youth may lack access to this information through the incidental health communication that reaches hearing young people via mass media and in the doctors office. This focus on the health implications of tobacco use is certainly not a substitute for other key elements of the program. We utilize the D.A.R.E. resistance framework because of its
We have established basic themes which we address at every grade level. These include: Self-esteem and self-concept The influence of friends and peers Decision-making The influence of tobacco industry marketing The health effects of tobacco use The addiction cycle Anti-tobacco efforts and social action We take the approach of returning to these themes at each grade level. We do so because we believe that these are basic issues that deserve to be revisited throughout the middle and senior high school years. We also recognize that students may not be exposed to six years of programming and thus “depending” on prior introduction of material in previous years would not be appropriate.
We have had as a guiding principal the view that this curriculum can be utilized—in whole or part—in a range of educational environments. It can be implemented in residential programming, in a classroom in a Deaf school, or in a mainstream setting. There are modules that can be used in teaching math, science, social studies and other subjects. They can be utilized in a self-contained classroom or as part of a school-wide effort. Elements of the program—or the program as a whole—can be introduced on a “stand alone” basis. Or tobacco prevention can be incorporated into educational programming that targets Introduction 11
Introduction for Teachers
How the Lessons are Organized Topic
5th
Self-Esteem and Self-Concept
5-1
Friends and Peers
5-2
Decision Making
Grade Level
7th
8th
9th
10th
11th
12th
7-1
8-1
9-1
10-1
11-1
12-1
7-2
8-2
9-2
5-3 5-4
7-3 7-4
8-3
10-3
11-2
12-2
Media and Other Influences to Use Tobacco
5-3 5-4
7-6 7-7
8-5
9-3
Resisting Influences to Use Tobacco
5-5
8-4
9-7
8-6
9-4
8-7
Health Effects of Tobacco Use
6th
6-1 6-2
6-3 6-4
Addiction
Anti-Tobacco Efforts and Social Action
diverse risk taking behaviors that are of critical importance to young people today and that are certainly of concern among educators of Deaf youth—other substance use, AIDS education, safe sex and more. We have sought to create a “user friendly” tobacco prevention curriculum that teachers can integrate into their work without having to do additional research or to search for other materials. The curriculum for each grade level has a cover sheet that lists needed materials and preparations for each lesson. Using the curriculum will require some advance planning. For example, you may need to contact a speaker or arrange for equipment. Most
7-5
10-2
12-5
11-7
12-6
10-4
11-3
12-3
9-5
10-5
11-4
12-4
9-6
10-6 10-7
11-5 11-6
12-7
materials and all the worksheets for the students are provided on the accompanying CD, but you may have to make copies or transparencies, or adapt materials for use with technologies such as the SmartBoard. All of the images used throughout are also included on the CD as digital files, and can be inserted into documents or PowerPoint slides as needed. Homework assignments may also be completed as classroom activities. To minimize the burden on faculty we have not included detailed references to the extensive body of tobacco-related research that serves as the framework for this program. However, we realize that teachers may seek more information, or may want to direct students to the resources available in this field. With this in Introduction 12
Introduction for Teachers mind we have provided a brief list of references as a starting point. We would be pleased to provide additional references, citations, and materials. Please contact us at: Debra S. Guthmann, Ed.D. California School for the Deaf, Fremont dguthmann@csdf-cde.ca.gov (510) 794-3684 Barbara Berman, Ph.D. Division of Cancer Prevention and Control Research UCLA School of Public Health and Jonsson Comprehensive Cancer Center bberman@ucla.edu (310) 794-9283 A Word about Smoking Cessation It used to be thought that smoking cessation was only an adult issue. We now know better. Many young people who start to smoke want to quit, but find that they have become addicted tobacco users and that it is hard to stop. Important strides have been made in identifying cessation strategies that are effective among young people. Dissemination—getting these programs to the teenagers that need them—is a challenge that needs to be faced. Providing school-based cessation programming for these children and teenagers is one of the critically important ways in which this can be done. While we introduce cessation in Lesson 12-6, provision of a cessation program is beyond the scope of this prevention curriculum. We encourage educators and health care providers serving Deaf and Hard-of-Hearing youth to recognize the importance of such programming, and to seek ways to provide this vital service for their students. Contacting local and State Health Departments and
the Centers for Disease Control and Prevention (CDC) is one way to begin. So too is contacting local chapters of voluntary agencies such as the American Cancer Society, the American Heart Association, and the American Lung Association. For example, the ALA currently has two evaluated cessation programs for young people—NOT-ONTOBACCO® and Tobacco-Free-Teens® that can be adapted for use among Deaf/Hard-of-Hearing students. Evaluation of the Curriculum We developed and evaluated our curriculum through a research project funded by the State of California Tobacco-Related Diseases Research Program. As part of this research effort we asked a group of skilled teachers of Deaf/Hard-of-Hearing young people to help us draft the curriculum. We then asked educators at two Schools for the Deaf to adopt our curriculum, put it to use, adapt the content as necessary, and to share with us their experiences. We asked these teachers to help us understand if the program was useful, what parts of the curriculum “made sense” in the setting in which they teach, and what advice they would give to other educators seeking to use this as a learning tool. What did we learn? Our curriculum received praise. Over 75% of the faculty evaluating specific elements of the program rated both the content of the curriculum and suggested classroom activities as “excellent.” Over 80% described the ease of use, appropriateness for grade level, and appropriateness for deaf youth as “excellent.” Other comments regarding specific aspects of the curriculum are on the pages that follow.
Introduction 13
Introduction for Teachers The curriculum provided useful tools, and was well-organized and well laid-out for demonstrating the concepts of tobacco use and prevention. “There is plenty in the curriculum. Nothing needs to be added. The content is good…” “Curriculum was WOW, very beneficial!” “I was dazzled by the curriculum, the color, [and] the pictures. It is very user friendly.” “It’s easy to follow and easy to use.” “The [curriculum] allowed for great flexibility for me to go to different grade levels to get information and activities that I needed.”
The emphasis on graphic and visual elements was seen as very valuable. “The graphics provided for this lesson are great! I’ve used them all.” (10-2) “This lesson is one of my favorites. It is very visually ‘impactive’ with a lot of good graphics.” (10-4) “Pictures are worth a thousand words…this generated discussion.” (11-3) “The picture and articles with information were powerful and students were responsive to them.” (12-3) “Students loved the pictures.” (12-5) “Visual activities worked for both high and low functioning students.”
Specific lessons and content elements were described as particularly valuable and appropriate for the students. “Advertisements were good visuals for both higher level class as well as lower level classes.” (9-3) “(I) used the journal idea to create class discussion.” (7-7) “The stat(istics) help to make points.” (7-7) “Students really liked the interview process.” (12-4) “Kids with good language skills really enjoyed the “Lights, Camera, Action” activity.” (8-3) “Students liked the role play.” (8-3) “The students really enjoyed refusal skills roulette.” (8-4) “Tobacco ads on CD were very helpful. They loved interviewing the staff.” (8-5) “The class can benefit from this content.” (9-1) “They liked the inventory list and ‘What’s My Line.’”(9-1) “Vocabulary words were helpful. (The) DARE worksheet was good. Not everyone remembers DARE. (I) had to review (it).” (11-2)
Introduction 14
Introduction for Teachers The teachers who used the curriculum felt that it did a good job of conveying the risks of tobacco use, the activities of the tobacco industry, and other important tobacco-related issues – of teaching the subject matter. “Students talked about family member smoking in home or car, and asked what to do about the situation. Good lesson to introduce myths of smoking, and how smoking is often viewed by young people.” (7-4) “The notion of (the) ‘smoking is cool’ activity is great. It made students think what the advertisement is trying to portray.” (7-7) “Students were surprised at the variety of tobacco products. They would not have recognized them.” (8-5) “Students enjoyed making anti-smoking advertisements.” (They) made antismoking advertisements that we thought Deaf might like.” (9-7) “The graphic of (the) addiction cycle in this lesson was a great asset to have. I liked the list of withdrawal symptoms. It was good to repeat the point of why young people start smoking.” (10-5) “Excellent coverage on how tobacco can affect many parts of the body.” (12-3) “It was helpful to break down the topic on addiction such as cycle, withdrawal, etc.” (12-4) “Students related to quitting smoking and the activity trying to quit. They were also interested in finding info from school and surveying our own students.” (12-6) “Students don’t often get to see anti-tobacco messages, so this is a good time and place to show them the messages.” (12-7)
The curriculum was praised for the ways in which it generated good discussions and created learning opportunities in areas well beyond tobacco education. “This is an excellent starter topic, and helps students see their own strengths.” (7-1) “(The lesson) helped students consider ‘sensitive issues’, e.g., family smoking and what students can do (about it)” (7-4) (7-6) “The information on the addiction cycle was used in another situation, especially about drugs. The lessons are worthwhile to repeat for each grade level.” “Teachers used the curriculum as a jumping off point for the more meaty discussions.” “Students liked to share their life-experience stories.” “Also useful were problem-solving discussions to talk about how to deal with difficult issues faced by students. i.e., what to do when you are ‘stuck’ with parents who smoke in the house.” “Lots of sharing and reflecting…Reflection is a big part of retention and education. Reflection is the top of the educational pyramid. If they can reflect and share opinions that is the top.” “(This lesson) elicits good discussion among those with good communication skills.” “Discussing different consequences… helped students to get the big picture and see the future.” (8-6) “We had a good discussion on friendship.” (7-2) “My lower level class discussions were less productive but still got the point.” (10-1)
Introduction 15
Introduction for Teachers
We also received some constructive criticism and were informed of way that educators enhanced or could enhance the curriculum. Changes were made or suggested to maximize the value of the planned activities: “I used other sources and added what I needed.” “Emphasis could be made on refusal skills because tobacco could be a gateway to other risky behavior.” In a number of instances homework and individual assignments were done together as a classroom activity. “Instead of doing the warning label worksheet (designed as an individual activity), we did the activity as a whole class. Students would come up with ideas of how warning labels should be.” (7-5) “Students designed their own warning label to place on cigarette boxes.”
To ensure non-threatening content and student safety… “Rather than ask students about their own characteristics, “I think I’d like to hand out inventories/”What’s My Line” that are filled in (for) a fictional person and (which can then) generate a discussion on how this person can improve selfesteem.” (9-1)
To enhance communication… “(It is) difficult to express in written form. (I) did it through the air.” (8-2) “I made a Power Point (presentation for the lesson).” (8-2). “used the journal idea to create class discussion.” (8-3). “needed to explain the sarcasm behind the pictures.” (9-7) “A Power Point presentation was developed for each lesson making the class more visually impacting. That helped [keep] the students’ attention. Some students like to see the information in English, which was presented on the screen.” (Praised the lesson but added) “I used Microsoft Galley Clib of fish and hook to illustrate my point of getting hooked and addiction…” (10-5). “(I) want to try digital camera to generate images of emotion and have students generate (through pictures) things that make them feel this way.“ (9-1) One teacher put together pictures of different physical systems (respiratory, nervous, skeleton, muscular, etc.) and showed how smoking may have affected each system. The values of cigarettes in the 1980’s were not used because students could not relate to that period of time. So, the teacher obtained a catalog from Toys R Us and had the students compare the current value
of cigarettes to different products from that store. It was suggested that experiential speakers be invited to take part and to discuss ways to stop smoking. Teachers sharing their own experiences would also be helpful. Teachers need to capitalize on other technologies such as the board maker and V-Com’s CD’s with signs in .gif and .mov formats.
Introduction 16
Introduction for Teachers To maximize the value of lessons for students at varying skill levels… “Levels of function were sometimes low so I used various grade levels in the curriculum and made modifications.” “For 9th grade, many of the kids can’t read so I used various grade levels in the curriculum and signed information in ASL.” “Facts are easier to teach to children with learning difficulties than abstract concepts such as feelings and self-esteem.” “Students could not initiate/identify each tool. I role played each with the word as a demonstration…(and) only show two tools at a time. (I) let them pick one.” (9-1) “Homework…(was) appropriate for advanced students.” (11-1) “Matching, scrabble words, word search, and spelling worksheets are best for special needs.” (11-3) “Replace some definitions with …pictures.” (11-4) “I had to bring everything down a few levels to help them understand.”
Reflecting on the 8th grade curriculum she taught, one teacher indicated that “it may be better to do the self-esteem [and other early lessons] after the content lessons. The content lessons were more of a “hook” for the students.” Also, the suggestion was
made that the self-esteem and decision making lessons be embedded into the other content lessons, that counselors be invited to co-teach and help out with the self esteem lessons, and that self-esteem be included as an important theme in all levels.
Educators expressed that effectiveness relies on preparing in advance and sharing successful adaptations with colleagues … “The curriculum should allow for and communicate that teacher discretion is the key in terms of content and order of presentation.” “The goal for next year is to break the lessons down more, and do different lessons in different classrooms. Some of the lessons may be appropriate in reading class, i.e. media. Some of the lessons on different body systems may be well taken in biology/science class.”
We will further evaluate the impact of our program through survey data collected among students and faculty, including faculty plans for providing tobacco education programming in the future. This information will be published in the research literature and communicated to educators serving Deaf/Hard-ofHearing youth.
We welcome comments from educators who adopt this curriculum. Please contact Dr. Debra S. Guthmann at: Dguthmann@csdf-cde.ca.gov for more information about where to obtain a copy of this curriculum at no cost. We thank you for your help and support in this effort!
Introduction 17
Additional Resources for Teachers
Additional Resources: You can use the following resources to obtain additional information about the issues of tobacco use prevention and youth. They can also be ideal sources for students who are interested in conducting additional research, or who may want to become involved in the anti-tobacco movement in their school or community.
The Centers for Disease Control and Prevention The Centers for Disease Control and Prevention is the lead federal agency for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. The CDC maintains the following resources for educators and students:
Tobacco Information and Prevention Source (TIPS) www.cdc.gov/tobacco/index.htm
An excellent resource for tobacco-related information that is ideal for educators and students.
Healthy Schools Healthy Youth!
http://www.cdc.gov/HealthyYouth/index.htm A resource for schools and educators that presents the latest information on school-based health education for youth.
Local Voluntary Organizations The following are all nationwide, community-based voluntary organizations that, as one part of their overall mission, engage in tobacco-related research, education, patient service and advocacy. All maintain local community offices that can be valuable resources in providing printed materials, or access to networks of volunteers who can present educational programs for schools and community groups. They can also make referrals to community-based programs addressing such issues as smoking cessation. Access the organizations, and find your local community office, at the following online addresses: The American Cancer Society at www.cancer.org The American Heart Association at www.americanheart.org The American Lung Association at www.lungusa.org
Local and State Departments of Health Contact your local and State Health Department to identify who is responsible for tobacco-related education. Most departments of health maintain websites that can be accessed through on-line search engines such as Google at www.google.com.
Resources 18
Additional Resources for Teachers
Reports of the Surgeon General www.cdc.gov/tobacco/sgr/index.htm
These are excellent, detailed reports on a number of issues relating to tobacco use. In the curriculum we have referred to the following specific reports, but all of these reports are of great value as well. They are all available at the web address above.
✷ U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
✷ U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
✷ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.
Non-Profit Advocacy Organizations Many of the following organizations were established to achieve specific anti-tobacco-related goals, including:
✷ Providing public education about the dangers and societal costs of tobacco use
✷ Advocating for changes in government policies to reduce tobacco use
✷ Exposing activities of the tobacco industry in marketing and extending the sale of tobacco products
✷ Encouraging social action to control and reduce tobacco use ✷ Providing resources for smoking cessation Campaign for Tobacco-Free Kids® www.tobaccofreekids.org
The Campaign for Tobacco-Free Kids is a private, non-profit organization committed to protecting children from tobacco addiction and secondhand smoke.
www.WhyQuit.com WhyQuit is an online forum devoted to providing support for nicotine dependency cessation, and youth dependency prevention.
Resources 19
Additional Resources for Teachers
Non-Profit Advocacy Organizations (continued) The American Legacy Foundation www.americanlegacy.org
The American Legacy Foundation a national, independent public health foundation that develops national programs to address the health effects of tobacco use through grants, technical training and assistance, youth activism, strategic partnerships, counter-marketing and grass roots marketing campaigns, public relations, and community outreach to populations disproportionately affected by the toll of tobacco. The foundation sponsors the following major activities:
✷ The Truth® Campaign www.thetruth.com
The Truth Campaign is a major national tobacco youth prevention and education effort that uses advertising, grassroots and promotional events, and the interactive Web site (www.thetruth.com) to give teens the facts about tobacco use and tobacco marketing and encourage them to get involved in the effort to inform their peers.
✷ Streetheory®
www.streetheory.com Streettheory is a national effort to assist and facilitate the work of the statebased youth activism programs. The web site (www.streetheory.org) provides a central reference tool and repository for youth activists and their ideas for prevention and education.
✷ Circle of Friends: Uniting to be Smoke-Free ww.join-the-circle.org
This program is a national grassroots social movement to support for women struggling to quit smoking, and to highlight the toll of tobacco-related disease on American women, their families and communities.
Americans for Nonsmokers’ Rights www.no-smoke.org
Americans for Nonsmokers’ Rights is the leading national lobbying organization dedicated to nonsmokers’ rights, taking on the tobacco industry at all levels of government to protect nonsmokers from secondhand smoke and youth from tobacco addiction. Their web site (www.no-smoke.org) provides a wealth of information about the dangers of secondhand smoke, and serves as a resource for advocacy efforts to reduce tobacco use and secondhand smoke exposure. The organization also includes the American Nonsmokers’ Rights Foundation, an educational nonprofit organization that creates comprehensive programs for school-age youth on issues of smoking prevention and their right to breathe smoke-free air.
Resources 20
Additional Resources for Teachers
Facts and Figures A number of organizations regularly compile statistics on youth tobacco use and make these available to the public on a recurring basis. Other resources include one-time publications whose presentation of information and data are unique and valuable contributions to the discussion on tobacco use and youth.
Monitoring the Future
www.monitoringthefuture.org Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of some 50,000 8th, 10th and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991.) In addition, annual follow-up questionnaires are mailed to a sample of each graduating class for a number of years after their initial participation. The study is housed in the University of Michigan’s Institute for Social Research, and the research data are made available on their web site (www.monitoringthefuture.org).
The Youth Behavioral Risk Factor Surveillance System www.cdc.gov/HealthyYouth/yrbs/index.htm
The YRBSS was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the United States. These behaviors, often established during childhood and early adolescence, include tobacco use, unhealthy dietary behaviors, inadequate physical activity, alcohol and other drug use, sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, and unintentional injuries and violence. The youth survey data are available online at www.cdc.gov/healthyyouth/yrbs/index.htm. ✷
Berman BA, Eckhardt EA, Kleiger HB et al. Developing a tobacco survey for Deaf youth. American Annals of the Deaf, 2000; 145(3):245-55)
✷
Campaign for Tobacco-Free Kids. Trust Us, We’re the Tobacco Industry. 2001. Available online at: www.tobaccofreekids.org/campaign/global/framework/docs/TrustUs.pdf
✷
Glantz SA. Tobacco: Biology and Politics. Health EDCO. 1992.
✷
Kluger R. Ashes to Ashes: America’s Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris. New York: Random House, 1996.
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Lynch BS, Bonnie RJ., Editors. Growing Up Tobacco Free. Institute of Medicine. National Academy Press, Washington, D.C. 1994.
✷
McKay J, Eriksen M. The Tobacco Atlas. Geneva: World Health Organization. 2002.
✷
Meister K, Bowman KC, Ross GL, et al. (Ed.) Cigarettes: What the Warning Label Doesn’t Tell You. Information Tobacco Companies Don’t Want Teens to Know About the Dangers of Smoking. New York: American Council on Science and Health. 2003. The title can be read or downloaded from the following site: www.acsh.org/publications/pubID.188/pub_detail.asp
Resources 21
5th Grade Lessons:
Needed Materials and Preparation Lesson 5-1
✷ Worksheet: “Who Am I?” Idea Sheet ✷ Poster board
Lesson 5-2
✷ A Jar of Dreams by Yoshiko Uchida ✷ Fourth Grade Rats by Jerry Spinelli These titles are suggestions only; you should feel free to select any other titles that may be equally appropriate. Both titles are available through Amazon.com.
Lesson 5-3
✷ Worksheet: “What are Advertisers Trying to Sell Me?” ✷ Collection of Advertisements (on the companion CD)
Lesson 5-4
✷ Worksheet: “How Would They Decide?”
Lesson 5-5
✷ Tobacco advertisements (from the companion CD)
5th Grade Lessons Materials List
Lesson 5-1: Who Am I?
Lesson 5-1
Who Am I? Introduction: This lesson serves as an introduction to the concept of self-esteem by asking students to think of the characteristics that define them as individuals, with unique backgrounds, interests, strengths and talents.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Identify a range of characteristics, perhaps including family, hobbies, talents, friends, traits, likes and dislikes, that can be used to describe themselves ✷ Present these characteristics in a visual format in front of the class ✷ Become aware as a class of the diversity amongst themselves
Materials: ✷ Worksheet: “Who Am I?” Idea Sheet ✷ Poster board
Key Terms: character traits: aspects of personality or individual attributes that students use to describe themselves, e.g., friendly, a fast learner, shy, talkative, quiet, outgoing, a good friend. talents: particular abilities or skills that students may have, such as the ability to draw or dance, or to do well in sports. hobbies: particular activities that one enjoys doing, including playing video games, watching animé, collecting dolls, or reading.
personal favorites: likes and dislikes, favorite foods, best-liked book or television show, favorite movie star, and so forth. background: place of birth, number of siblings, ethnicity, nationality or other characteristics. aspirations: what one hopes for oneself; a goal or objective, usually referring to larger life issues of happiness and satisfaction.
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Lesson 5-1: Who Am I?
Procedures: 1. Begin a class discussion with a simple question, e.g., “Who has a favorite food, and what is it?” or “What’s your favorite color and why?” The point of the resulting discussion is to point out the diversity that exists within a single classroom.
2. From the discussion, ask students to create a collage. The images on the collage should reflect who they feel they are: their backgrounds (family, friends, ethnicity, deafness, nationality, etc.); their interests (hobbies, likes and dislikes); particular skills or abilities (physical, intellectual, artistic, emotional, etc.); and aspirations. Distribute the “Who Am I?” idea sheet to encourage creative thinking in how best to portray one’s self visually.
Teacher’s Note: This assignment may require a lengthy preparation time as students gather materials for their collages. Plan for, at minimum, one week’s time to complete the lesson. The exercise is a nice way for students to get to know each other, and thus makes for a nice lesson plan at the beginning of the school year.
Have the students collect images from magazines or the web, use personal photographs, or make drawings. Encourage students to be creative and perhaps even a little abstract as to the types of images they select, but tell them that they must be able to explain the meaning behind each image as it refers to their selves.
3. When the collages are complete, display them in the classroom. Have each artist
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talk about his or her own work, and the meanings behind the images they selected.
4. As a variation, have students do the collages “in secret.” Place the collages around the room without the identity of the author being known. Have the class view each collage in turn, and discuss what they think they can learn about the person from the images he or she selected. Have the artist elaborate on the information gleaned by the class.
5. Ask students: “How many of you learned something new about your fellow students that you didn’t know before? How many of you discovered something you have in common with another student in the class that you didn’t realize before?”
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Lesson 5-1: Who Am I?
Procedures (continued) 6. Explain to your students that there are many traits and qualities you see in the collages that they should feel good about. These are things that contribute to “self-esteem.” Talk about the diversity of backgrounds, interests and skills portrayed in the collages. Ask any students if they “censored” themselves—that is, left off any interests, likes or dislikes, etc., because they thought they might be considered “uncool” or not well-received by the group.
7. Display the collages on the wall, and have students add elements to the posters over time as they learn more about each other.
Page 5.1.3
Lesson 5-1 Worksheet: The “Who Am I?” Idea Sheet
Name
“Who Am I?” Idea Sheet For your collage activity, think of different ways to show visually who you are. Consider the following list for ideas:
Hobbies Skills and activities you enjoy Family or friends who are important to you Favorite book or movie Birthplace Your ethnic or cultural background Favorite foods Pets Favorite places Most admired person Favorite teacher What you want to be when you are an adult Your favorite interests Most memorable vacation
Lesson 5-2: Fitting In
Lesson 5-2
Fitting In Introduction: The goal of this lesson is to examine the “flip side” of the differences between people that were explored in Lesson 5-1, including the anxiety and stress that may result from feeling different, as well as the external pressures that are often felt as children seek to conform to expectations for behavior.
Teacher’s Note: This lesson suggests stories as a means to introduce these topics to your class. Two readily available books are recommended, but you may know other stories, or worked with other books, that cover the same topic areas. Feel free to substitute as you see fit. This is also an issue with respect to reading level, which may vary a great deal between and within classroom groups. The stories can be assigned as take-home reading, or read in class as a group, as you see fit for your students. The stories are entrées to discussions of the pressures of fitting in, and how they alter how we perceive ourselves, as well as our behavior towards others.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Recognize that differences between people can be valued, but may be a source of anxiety and stress that alters how people look at themselves ✷ Recognize that others’ expectations can easily shape one’s own behavior as a part of “fitting in.” ✷ Explain the term “peer pressure”
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Lesson 5-2: Fitting In
Materials: The following titles are suggestions only; you should feel free to select any other titles that may be equally appropriate. Both titles are available through Amazon.com. A Jar of Dreams by Yoshiko Uchida From the back cover: Growing up in California during the depression isn’t easy for
eleven-year-old Rinko. She desperately wants to fit in and be like everyone else, but instead she is ridiculed and made to feel different because she is Japanese. But when Aunt Waka comes to visit, and brings with her the old-fashioned wisdom of Japan, she teaches Rinko the importance of her Japanese heritage, and the value of her own strengths and dreams, in this warm and touching story.
Fourth Grade Rats by Jerry Spinelli From the back cover: Suds wishes he were still in third grade so he could keep on
being an angel. But his best friend, Joey, is proud to be a rat, which he calls the next step up to being a man. According to Joey, fourth grade rats aren’t afraid of spiders, don’t carry babyish lunch boxes, and they don’t cry. What rats do is push little kids off the swings, say no to their mothers, and eat real meat (like baloney). Becoming a rat doesn’t sound too good to Suds.
Key Terms: expectations: socially-defined standards for behavior that shape an individual’s behaviors. Expectations can be both positive, as in to do well in school or to treat others with respect; or they can be negative, as in to engage in behaviors such as tobacco or drug use.
people the same age seen in the community, and portrayed in various media such as magazines, in film and on television. peer pressure: the influence that friends and peers often exert to shape one’s opinions, perceptions, desires and actions.
peer: generally meant as others of a similar age. Friends are usually peers, but not all peers are friends. The term goes beyond schoolmates to include
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Lesson 5-2: Fitting In
Procedures: 1. Have the students read Yoshiko Uchida’s A Jar of Dreams, or read the book as a classroom activity. Alternatively, have the classroom read Fourth Grade Rats by Jerry Spinelli.
2. If they read A Jar of Dreams: Ask students to think about the diversity in their classroom that they discovered in Lesson 5-1. Have them discuss how Rinko saw herself as being different from those around her.
Teacher’s Note: As in Lesson 5-1, you should plan on undertaking this lesson across multiple class sessions, unless you have very skilled readers who can read the stories ahead of time and be prepared for class discussions.
Ask students: In what ways did Rinko feel she was different from other children around her? Did these differences make her feel good or did they make her feel badly? How did they influence how she tried to behave? Explain to students that the desire to “fit in” is a strong one, and often shapes how we think of ourselves and how we think we should act. How did the arrival of Rinko’s aunt change things? What did Rinko come to appreciate about herself? If your students read Fourth Grade Rats:
Ask Students: In what ways did Suds feel pressured to be a rat? In what ways did Joey exert pressure on Suds to change his attitudes and behavior? Explain to students that the desire to “fit in” is a strong one, and often shapes how we think of ourselves and how we think we should act. Did Suds want to change his behavior? What kind of encouragement did he get from others to change his behavior? What things kept him from wanting to change his behavior? Explain to the students that what Suds is feeling is a very strong case of peer pressure to act in ways that run counter to the ways he knows he should act.
3. Ask students to explore ways in which people are expected to behave in certain ways; the way they dress, the things they should like; the ways in which they should behave. Who enforces these expectations, and how? Prompt with exam-
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Lesson 5-2: Fitting In
Procedures (continued) ples of friends and peers; parents; teachers; police; societal rules, etc.
4. Ask students to consider the following: We often talk about the ways in which expectations of, or pressure from, others might cause someone to undertake “bad” behaviors. If necessary, prompt your students with examples: exerting pressure on someone to do something wrong, such as stealing or lying, or using drugs or tobacco. Are there situations in which expectations of others help to reinforce “good” behaviors? For example, parents have expectations for how their children should behave; teachers have expectations for how students should perform in class.
5. Explain to your students that for young people, peer pressure is an especially powerful shaper of behaviors, attitudes, and beliefs. Explore the ways in which these expectations among peers are enforced: eye-rolling, exclusion, teasing, punishment, rewards, etc. Ask children to provide examples of both positive and negative peer pressure.
Journal Exercise: Have you ever felt bad about being different from those around you? How did it make you feel? How did you deal with it? Have you ever felt pressured by your friends to do something you didn’t want to do? What happened?
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Lesson 5-3: The Power of Persuasion
Lesson 5-3
The Power of Persuasion Introduction: In Lesson 5-2, students explored how their perceptions of themselves, and the behaviors they undertook, were often influenced by the expectations of their peers. In this lesson, students will be asked to think about how their perceptions and desires are shaped by other forces, namely advertising.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Identify advertising as another influence that shapes expectations and behaviors ✷ Identify how advertisers manipulate these expectations to shape buyers’ preferences, desires, and ultimately, purchasing behaviors
Preparation: Collect advertising-supported magazines that would appeal to young people. Titles might include Sports Illustrated for Kids, Girls’ Life, Tiger Beat, Nickelodeon Magazine, Teen People, or specialty magazines for hobbies such as skateboarding or video gaming.
Materials: ✷ Worksheet: What Are Advertisers Trying to Sell Me? ✷ Collection of Advertisements (on the companion CD)
Key Terms: advertising: one of the primary means by which marketers disseminate their messages. marketing: persuasion to buy a product or accept an idea by presenting it in a favorable light that shows its advantages or attractions.
perception: one’s view of, or attitude toward, an idea, behavior, product or other object, that is shaped through knowledge, experience, observation, and communal and peer norms.
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Lesson 5-3: The Power of Persuasion
Procedures: 1. Remind your students that in the previous lesson (5-2), they discussed the power of friends and peers in shaping attitudes and behaviors.
Ask students: What other factors inuence your attitudes and behaviors? Begin by prompting for some of the most obvious inuences, including parents, and teachers. Extend the discussion to look at the role of advertising by asking how they learn about what toys are popular; what snacks look good to eat; and what clothing styles are in fashion.
2. Ask students: Where do you see advertising? Make sure that answers include television, the internet (including social networking or blog sites such as myspace.com, xanga.com, whyville.net, etc.), magazines, as well as on billboards, in store displays, etc.
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For discussion, ask the following questions: Why do we have advertising? What is the purpose of advertising? Who makes these advertisements? How do they work?
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3. Explain that advertisers often use different Tools of Persuasion to sell their products. These tools often include humor, adventure or excitement, friendship, beauty, popularity, family, or star power to sell their products. As you explain each of these tools, write them on the board.
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Lesson 5-3: The Power of Persuasion
Procedures (continued) 4. For each of the ads, ask your students: What is the ad selling? What do you think the advertiser wants you to do? L53_BeautyAd
What is happening in the advertisement? What tool of persuasion is the advertiser using? ▲
Who do you think the advertisement is aimed at? Boys? Girls? Adults?
Lip Smacker Lip Gloss; beauty, friendship
Do you like the advertisement? Why or why not? How does it make you feel? Would you want to buy the product? Why or why not?
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How does the advertiser want you to feel if you buy this product?
Lipsmacker Lip Gloss; beauty, friendship, excitement, fun, popularity
Lunchables: family (mother’s concern for kids); excitement
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Lipsmacker Lip Gloss; beauty, family
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Krux Skateboard Trucks; humor
Whyville.net networking site; popularity, fun, friendship L53_Ads_Lipsmackers
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Target: friendship, beauty
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Matrix Clothing; Celebrity star power (Rick McCrank, skateboarder)
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Lesson 5-3: The Power of Persuasion
Bobby Jack Brands; fun, humor
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5. Distribute the magazines to your students. Have the students leaf through the magazines and select one advertisement to tear out. Divide the class into small groups of about four students each. Distribute the “What are Advertisers Trying to Sell Me?” worksheets. Ask each group to work together to analyze each of the advertisements that the students in the group selected, using the worksheet and the examples in Step 3 as guidance.
6. After each group has had a chance to analyze its ads, have each student present one of their ads to the class, using the worksheet as a general framework. As part of the discussion, ask the students if they think their ads are particularly effective; that is, do they think it will make people who see the ad want to buy the product?
7. Present the tobacco ads shown here (and supplied on the companion CD). Guide your class through the same type of analysis for these advertisements.
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Lesson 5-3: The Power of Persuasion
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Lesson 5-3 Worksheet: What Are Advertisers Trying to Tell Me?
Name
“What are Advertisers Trying to Sell Me?� Cut out or copy an advertisement from your favorite magazine, and then answer the questions below.
What product is the advertisement selling?
What is happening in the advertisement? What tools is the advertiser using?
Do you like this advertisement? Why?
Who do you think the advertisement is aimed at? Boys? Girls? Adults?
How do you think you will feel if you buy this product?
How do you think you will feel if you do not buy this product?
Lesson 5-4: How Do I Make a Good Decision?
Lesson 5-4
How Do I Make a Good Decision? Introduction: In this lesson, students will explore decision-making in the context of structured situations in which they will be asked to consider both the positive and negative consequences of choices. These will be presented in terms of the peer and social influences introduced in the previous lessons.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Define what decisions are in terms of choices and consequences, both positive and negative ✷ Apply a decision-making framework to decisions
Materials: ✷ Worksheet: “How Would They Decide?”
Teacher’s Note: This lesson serves as a brief introduction to the decision-making model of the Drug Abuse Resistance Education (D.A.R.E.) program, the pioneer prevention effort established in 1983. Your students may or may not have been previously exposed to the principal D.A.R.E. programming components (Define, Assess, Respond, Evaluate), but the concepts are fairly straightforward, and are covered briefly here.
Key Terms: consequence: something that follows as a result; the consequence of one’s decision decision: a choice arrived at after consideration of options and consequences
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Lesson 5-4: How Do I Make a Good Decision?
Procedures: 1. Ask students: What are decisions? What does it mean when we say we have a decision to make?
2. Ask your students for examples of types of decisions they make every day. Write these on the board. Explain that many of these decisions are often very ordinary: Should I wear my hair up or down? Should I wear this shirt or that one? Should I get up, or should I sleep in? In each case, help the students to define what are the actual choices that they are confronting. What options are they choosing between?
3. Ask students how they make their choices. What kind of considerations go through their minds as they seek to decide among options?
Teacher’s Note: It is likely that most of the decisions your students will suggest are fairly inconsequential ones, as befits their age. Most of the major decisions that affect their lives are probably made by their parents or other adults: where they live, where they go to school, what they’ll study, etc. Point out, however, that children like them may still face decisions that may be more significant—for example, choosing to do something that may “get them into trouble” with others.
4. Explain that when we are faced with a decision, most of us go through a mental process without really thinking about it. We often pick a choice, and then see what happens. If we choose poorly, sometimes the consequences are not so bad. What happens if the weather is cold outside, and you choose to wear a t-shirt instead of a sweatshirt to school? However, sometimes the consequences may be more serious. Your friend wants you to steal something. You want to skip class because you didn’t study for the test today.
Ask students: How might you avoid making a poor choice? Explain to students that they can make better decisions if they consider the options and consequences of their decisions more carefully.
5. Ask the class to work through the process of decision-making. How do they make a decision? As they provide suggestions, write these on the board. Guide their discussion to cover the following areas:
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Lesson 5-4: How Do I Make a Good Decision?
Procedures (continued) Define the decision to be made. Assess the options the decision presents, and the consequences of each option. Respond by making your choice. Evaluate your decision. Did your choice have the consequences you desired?
Teacher’s Note: The “Define” and “Assess” components can be the most difficult for students to fully grasp. Encourage them with examples to be as thorough as possible. For example, a request by a friend to skip class and smoke a cigarette is more than just a choice between trying a cigarette and not trying it. It is also, among other things, a choice between doing something you know is wrong or doing the right thing and refusing; and between looking “cool” in the eyes of your friend or not. And the consequences may include not only impressing the “cool” crowd, but also getting caught; disappointing your teachers, parents or other friends; or getting hooked.
6. Divide the class into smaller groups. Pass out the “How Would They Decide?” worksheets, one to each group. Using the D.A.R.E. framework outlined briefly above, have the class complete the worksheets for each of the situations. Encourage the groups to be as complete as possible. Have them imagine how the actors would decide in each of the cases, and ask them to predict what consequences might result from those decisions. Again, encourage them to think of all sides, both positive and negative, with respect to the consequences of the decisions. Have the groups reconvene, and discuss the findings of each group.
Journal Exercise: Have you ever made a decision that had a negative consequence? What did you learn from that experience? If you had to face that same decision again, how would you act differently?
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Lesson 5-4 Worksheet: How Would They Decide?
“How Would They Decide?” John and Miguel are fifth graders and good friends at school. Lately, John has been teasing Hector, a 4th grade student. Hector is a new student at the school, and does not have many friends. One day, John tells Miguel, “Hey, let’s steal Hector’s backpack and throw it in the trash can.” What does Miguel do? 1. What decision must Miguel make? 2. What are his choices? 3. For each choice, what do you think will happen? 4. What do you think Miguel should do, and why?
Yujin is at the mall with her girlfriends. As they pass a store selling earrings and hair pins, one of her girlfriends suggests that Yujin stand guard while she steals something. 1. What decision must Yujin make? 2. What are her choices? 3. For each choice, what do you think will happen? 4. What do you think Yujin should do, and why?
Lesson 5-5: Why Not Smoke? Why Not, Indeed!
Lesson 5-5
Why Not Smoke? Why Not, Indeed! Introduction: In this lesson, students are asked to think about the consequences of smoking in the context of the decision-making process they studied in Lesson 5-4.
Lesson Objectives: By the end of the lesson, students will be able to: âœˇ Discuss tobacco use in the context of evaluating consequences
Materials: âœˇ Tobacco advertisements (from the companion CD)
Key Terms: addiction: extreme physiological and psychological dependence on a substance such as tobacco, alcohol or other drug that has progressed beyond voluntary control. People who are addicted often feel sick when they stop using this substance.
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Lesson 5-5: Why Not Smoke? Why Not, Indeed!
Procedures: 1. Ask students if they know anyone who smokes. 2. Ask students what they think of smoking. 3. Ask students if they know any of the consequences of smoking? 4. Prepare a chart. Divide into two columns. On one side, write the following questions: “Why might someone want to smoke?” On the other, write: “Why might someone decide NOT to smoke?”. Ask students to go to the chart, think about any aspect of smoking that they can think of, and write it in the appropriate column. Depending on the experience of your students or their exposure to smokers, you may have to prompt some responses. You should make sure that on the want to smoke side, someone writes, “makes you look older,” “makes you look cooler,” “makes you look more mature,” “helps a person relax,” etc. On the decide NOT to smoke side, in addition to the health effects (“causes “causes cancer,” “makes you cough,” etc., make sure that students include some of the social effects of smoking (“smells bad,” “bad breath,” “smelly clothing,” “burn down the house,” “can get addicted” etc.) as well as the economic (“costs money,” “people get sicker and miss more work or school,” etc.). If your students do not raise these issues, you should probably prompt for them.
5. Ask students to consider the balance of the two columns. You and your students should have produced a list that is heavily tilted toward the column listing the disadvantages of smoking.
6. Ask your students to review this information, and ask them, “So who would ever start smoking? And why?” Explain that even though there is an overwhelming weight to the decide NOT to smoke side, that statistics say that at least some of the students in the class will take up smoking some time as they grow older. Ask them why they think this might be so.
7. Re-introduce some of the tobacco advertisements from Lesson 5-3. Ask students to look at the advertisements and compare them with the information on the chart. Explain that, especially for young people, the desire to appear mature, popular or cool is very strong. How do these ads appeal to those desires?
Ask students: Tobacco companies claim that their advertising is aimed only at adults. Look at the advertisements. What do you think? Do you think any of these advertisements would be interesting to young people like you?
8. Ask students to examine the want to smoke side of the chart. Ask your students if they can think of alternative ways to look more mature, feel “cool,” relax, etc., without resorting to smoking (or using other drugs)?
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Lesson 5-5: Why Not Smoke? Why Not, Indeed!
Procedures (continued) 9. Direct students to think back to the Decision-Making exercise in Lesson 5-4.
Ask students: If someone asked you to smoke, and you were faced with the decision of choosing “yes” or “no,” what consequences would you consider before you make your choice?
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Lesson 5-5: Why Not Smoke? Why Not, Indeed!
Procedures (continued)
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6th Grade Lessons:
Needed Materials and Preparation Lesson 6-1
✷ A bag of chocolate kisses ✷ Worksheet: What Does Peer Pressure Look Like?
Lesson 6-2
✷ Peer Pressure Role-Play Cards
Lesson 6-3
✷ Floor tape in blue and red, and perhaps a third color ✷ Plastic sandwich bags ✷ Several sheets of blue and red construction paper, torn into small strips ✷ Access to clocks or other timing devices capable of counting off seconds ✷ Drum or other device for conveying a physical beat
Lesson 6-4
✷ Mechanical smoker A mechanical smoker is a device that provides a graphic demonstration of the chemical residue that is left in the lungs as a result of smoking. The device is available through Boreal Laboratories (www.boreal.com). Although the device can be expensive (currently about $98.00 in 2007), it is good for 100 demonstrations. It does, however, require the burning of a cigarette (not included) which may be forbidden on some school campuses, even for demonstration purposes. Check with your administration for your school’s policies. ✷ Small square of wire mesh (as for a window screen) ✷ An aluminum or other tray to catch sand ✷ A few handfuls of sand and a few handfuls of brown rice ✷ Yellow Play-Doh ✷ 2 red PVC pipes (or cardboard wrapping paper tubes) 2” in diameter and about 24” in length, cut lengthwise and hinged with Velcro or tape
6th Grade Lessons Materials List
Lesson 6-1: What is Peer Pressure?
Lesson 6-1
What is Peer Pressure? Introduction: This lesson examines peer pressure through the use of a classroom exercise, and is meant to spark a discussion of the ways in which one recognizes and addresses such pressure.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Identify different strategies that peers can bring to bear on one’s own behavior
Materials: ✷ A bag of chocolate kisses ✷ Worksheet: What Does Peer Pressure Look Like?
Key Terms: peer: generally meant as others of a similar age. Friends are usually peers, but not all peers are friends. The term goes beyond schoolmates to include people the same age seen in the community, and portrayed in various media such as magazines, in film and on television. peer pressure: the influence that friends and peers often exert to shape one’s opinions, perceptions, desires and actions.
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Lesson 6-1: What is Peer Pressure?
Procedures: 1. Divide the class into small groups of about five students each. Randomly select one person from each group to leave the room and wait outside.
2. Meet with the selected children outside the room and tell them that the others at the table will try to convince them to eat a piece of chocolate, but that no matter what their group may say, their task is to avoid eating the chocolate kiss. Instruct them not to let the others in their groups know that they should not eat the candy.
3. While the selected students wait outside, return to the groups in the classroom. Give each group enough chocolate kisses for each member (including the student outside) and instruct them that their job is to convince the student outside to eat the chocolate kiss. They may use whatever arguments they think will work (persuasion, teasing, bribery, guilt, etc.), but they are not allowed to touch the student. Tell them that the first group to get the student to eat the chocolate candy will win extra credit or a reward of some type.
4. Have the selected students return to the room. Allow the activity to continue for at least 10 minutes.
5. Stop the activity. Ask the chosen students to explain how they felt. Did they feel confident they could resist? Were they tempted to ignore the instructions and eat the candy? Did they feel uncomfortable? In what ways? Ask the group members to explain some of the different ways they tried to convince the student to eat the chocolate. As they discuss their strategies, write them on the board, using the following general categories: ✷ Direct Order “Eat the chocolate!” ✷ Insults “C’mon, don’t be a nerd, just eat the chocolate!” (name calling, teasing, making fun of someone) ✷ Coaxing “It’s sooo delicious, just try it!” “If you eat it, we’ll be your friends...” (to persude with flattery, gentle urging, appeals to friendship, promises or even lies) ✷ Making Someone Feel Left Out “C’mon, everyone’s eaten it but you!” ✷ Guilt “C’mon, if you don’t eat it, the other table will win!” ✷ Non-verbal clues eye-rolling, turning one’s back on the other, etc. In what ways did the chosen student counter these strategies?
6. Explain that these students have just experienced an example of both receiving and exerting peer pressure. Peer pressure is when friends, classmates, or other people one’s age try to influence what one does, the way one acts, or how one thinks. Everyone has to deal with peer pressure—even adults. Ask the students for
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Lesson 6-1: What is Peer Pressure?
Procedures (continued) other situations in which they might experience this type of pressure. Relate this example to the use of tobacco, alcohol or drugs.
7. Ask your students if peer pressure can sometimes be used to reinforce positive behaviors? (e.g., doing one’s best in school, being on time to class) What about dissuading someone from doing something bad? (e.g., convincing someone NOT to smoke or use drugs)? What kind of peer pressure strategies can be used in these situations?
Homework: Distribute the What Does Peer Pressure Look Like? worksheet. Explain to the students that they should put themselves in a position of trying to convince a friend to join you and some others to try smoking a cigarette. How would they do it? If their friend was hesitant, how would they convince their friend to join them? Have them consider the different types of peer pressure strategies you discussed in class, and ask them to provide one example of each type. Make sure they bring the completed homework to be used in Lesson 6-2.
Journal: Do you think you would feel peer pressure differently if you were at a school where you were the only Deaf student? Would it be harder to resist peer pressure in that situation than if you are in a school where all the other students are Deaf?
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Lesson 6-1 Worksheet: What Does Peer Pressure Look Like?
Name
What Does Peer Pressure Look Like? Answer the following question in your own words: 1.
What is peer pressure?
2.
What would you say? Give one example of what you might say if you were trying to get your friend to smoke a cigarette.
Direct Order: L61_SayNo
Insult: Coaxing: Making Someone Feel Left Out: Non-Verbal: Guilt:
Lesson 6-2
Why Does Peer Pressure Work? Introduction: This lesson builds on the previous introduction to peer pressure, providing a more in-depth look at peer pressure and the strategies young people can use to counter it.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Recognize both the negative and positive aspects of peer pressure ✷ Understand why people give in to peer pressure ✷ Recognize when peer pressure is being applied to them ✷ Counter peer pressure with specific refusal skills
Materials: ✷ Peer Pressure Role-Play Cards
Key Terms: peer: generally meant as others of a similar age. Friends are usually peers, but not all peers are friends. The term goes beyond schoolmates to include people the same age seen in the community, and portrayed in various media such as magazines, in film and on television.
L62_Decisions03
L62_Decisions02
peer pressure: the influence that friends and peers often exert to shape one’s opinions, perceptions, desires and actions. refusal skills: tools that one can use against friend or peer pressure to do something that one finds undesirable, unsafe, or wrong.
L62_Decisions01
Page 6.2.1
Lesson 6-2: Why Does Peer Pressure Work?
Procedures: 1. Review the homework from Lesson 6-1 with students. Ask them for their definitions of peer pressure. Make sure that they understand that peer pressure is a social force that is exerted by an individual or group to conform to a group norm.
2. Ask students: Is all peer pressure bad? Explain that not all peer pressure is bad. Peer pressure can often reinforce society’s expectations for certain kinds of behavior; for example, to wake up early and show up on time for class; not to cheat on an exam; or to keep from doing something harmful or illegal. Sometime the peer pressure can be very subtle. Ask your students to think about the clothes they wear, the things they like to talk about with their friends, the things they like to do—all of these are influenced a great deal by what their peers think and do. This isn’t always a bad thing—the need to feel a part of a group is very powerful, especially for young people who are starting to break away from their families and establish relationships with people their own age.
L62_Decisions02
3. Pose the following situation for your students: Imagine that there is a group of you having fun at the mall. You pass by a store, and one of your friends suggests that the group try and steal something. What would you say? What if everyone else in the group thought this would be a fun idea? Elicit from your students the understanding that peer pressure can be at work in both a positive and negative way in such a situation. If some of the other kids respond to the initial suggestion in a dismissive way (“Nah, that sounds really stupid.” “Yeah, you go right ahead, we’ll visit you in jail.”), they are exerting positive peer pressure to keep the group from shoplifting.
L62_Shoplift
On the other hand, if most of the kids think this sounds like a fun idea (“What, are you chicken?” “C’mon, it’ll be fun!”), one could be facing negative peer pressure to do something they know is wrong.
4. Ask students: So how do you know when peer pressure is bad or when it is good? Sometimes it is easy. If peer pressure is being used to get someone to do something illegal, harmful to others, or harmful to that person’s own self; if the action
Page 6.2.2
Lesson 6-2: Why Does Peer Pressure Work?
Procedures (continued) is something that will cause others to be upset or feel bad about themselves, it is probably negative peer pressure. But sometimes it may be a little more difficult. Ask your students to consider the following situations: ✷ Your friends tell you that one of them has a cigarette, and they want to try smoking it after school. They ask you to join them. ✷ Your friends are fooling around during lunch period. One of them sees the fire alarm on the wall and dares you to set it off. ✷ Your friend was seen at the school library last night where some books were vandalized; he now wants you to tell everyone he was with you last night instead.
L62_HideCigs
Explain that in situations like these, we sometimes might feel conflicted. We might know that what we are being asked to do is wrong, but we also want to go along with our friends, or demonstrate our loyalty.
5. Review the second homework question from Lesson 6-1 with the students: “Why do kids give in to peer pressure?” Explain that sometimes we feel pressure from friends or peers to do something we don’t want to do, or think that we shouldn’t. Refusing to go along with your friends can be very difficult and uncomfortable, but being aware of when and how peer pressure is being applied, and how to refuse, can make a difference.
6. Review with the class the types of peer pressure strategies they encountered in doing the chocolate kiss activity. ✷ Direct Order “Eat the chocolate!” ✷ Insults “C’mon, don’t be a nerd, just eat the chocolate!” (name calling, teasing, making fun of someone) ✷ Coaxing “It’s sooo delicious, just try it!” “If you eat it, we’ll be your friends...” (to persude with flattery, gentle urging, promises or even lies ) ✷ Making Someone Feel Left Out “C’mon, everyone’s eaten it but you!” ✷ Guilt “C’mon, if you don’t eat it, the other table will win!” ✷ Non-verbal clues eye-rolling, turning one’s back on the other, etc.
7. Explain to your students that there are also different ways to respond to peer pressure. Have them examine the following:
Page 6.2.3
Lesson 6-2: Why Does Peer Pressure Work?
Procedures (continued)
1. Be Direct 2. Change the subject
L62_Refusal01
L62_Refusal02
3. Think of a clever response 4. Make a joke
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5. Blame an adult 6. Avoid the subject and walk away
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Page 6.2.4
Lesson 6-2: Why Does Peer Pressure Work?
Procedures (continued) 8. Use the Role Playing cards and have your students practice saying “no” to different types of peer pressure strategies. Cut out and place the cards in two separate bags: one for peer pressure strategies, and one for refusal skills. Select two students. One will reach into the bag and draw out a peer pressure strategy; the other will draw from the refusal skills bag. Their task is to use those cards in addressing the following problems. Repeat this role-play with subsequent pairs of students. Try to convince someone to steal something from a store. Try to get your friend to lie for you about where you were last night. Try to convince your friend to try sniffing glue. Try to get your friend to play a dirty trick on the new kid in school. Try to get your friend to skip class.
8. Use the same Role Playing cards, but have the students role-play situations in which peer pressure is exerted to encourage desirable behavior. Try to convince someone to come study for tomorrow’s test instead of chatting on the internet. Try to convince a friend NOT to smoke. Try to tell your friends NOT to pick on the new student.
Page 6.2.5
Lesson 6-2: Peer Pressure Role Play Cards
Direct Order “Do it!” including threats
Coaxing persuading with flattery, gentle urging, promises or even lies
Non-verbal Eye-rolling, dirty looks, mean gestures, etc.
PRESSURE PRESSURE PRESSURE
PRESSURE PRESSURE PRESSURE
Peer Pressure Role Play Cards
Insults Name-calling, teasing, making fun of someone
Make the person feel left out Guilt Make the person feel guilty if they don’t do what you want them to do
Lesson 6-2: Peer Pressure Role Play Cards
Be direct
Think of a clever response
Blame an adult
REFUSAL REFUSAL REFUSAL
REFUSAL REFUSAL REFUSAL
Peer Pressure Role Play Cards
Change the subject
Make a joke Avoid the situation and walk away
Lesson 6-3: Around and Around It Goes
Lesson 6-3
Around and Around It Goes Introduction: This lesson provides a lively introduction to the cardio-respiratory system, demonstrates the functions of the heart and lungs, and provides the basis for an understanding of how smoking compromises the overall health of the system.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ Identify the functions of the heart and lungs in the cardiovascular system ✷ Explain oxygen exchange in the body
Teacher’s Note: You may want to coordinate this lesson with your students’ science instructor or science curriculum.
Materials: ✷ Floor tape in blue and red, and perhaps a third color ✷ Plastic sandwich bags ✷ Several sheets of blue and red construction paper, torn into small strips ✷ Access to clocks or other timing devices capable of counting off seconds ✷ Drum or other device for conveying a physical beat
Key Terms: aorta: the largest artery in the body, carrying oxygen-rich blood to the body. artery: the muscular blood vessels that carry oxygen-rich blood away from the heart and to the body. blood: a specialized fluid body tissue that carries in it the red blood cells that transport oxygen to the body’s cells. carbon dioxide: the end-product, or waste product, of the body’s metabolic processes involving oxygen. Carbon dioxide is transported via the blood and eliminated from the body in the lungs through exhalation.
heart: a muscle about the size of a clenched fist that contracts and relaxes about 70 times each minute when the body is at rest to pump blood into the lungs and again throughout the body. lung: a pair of spongy, sac-like organs in the chest that, together with the heart, work to enrich the blood with oxygen while removing carbon dioxide wastes. oxygen: a common chemical element in the air we breathe, and which the body requires to perform its normal functions. vein: the blood vessels that carry oxygen-depleted blood from the body’s tissues back to the heart, and then to the lungs.
Page 6.3.1
Lesson 6-3: Around and Around It Goes
Procedures: 1. As an introduction to the heart, have students divide into pairs. Show students how to find each others’ pulses by placing one’s fingers lightly on the underside of the other’s wrist, on the thumb side.
2. Have students count the number of beats for 30 seconds. Have them double this number to arrive at the number of beats per minute. Have the students record this number. Have the students switch positions and do this again. Go around the class to discuss everyone’s findings.
L63_Pulse
3. Have one student jump in place for one minute, and then repeat the procedure above. Once again, have the students switch positions. Again, discuss the findings, as everyone’s heartbeat should have increased a great deal.
4. Ask students: What is happening here? What is the pulse, and why can we feel it? Point out that the heart is working to pump blood throughout the body. This pumping action causes a wave of pressure that forces blood through the body, and that can be felt as a pulse.
L63_Heart
5. Ask students: Why, or what, is the heart pumping? Why does the heart pump faster after you’ve been jumping around? The key points to elicit are the concepts of blood; that the heart pumps this blood throughout the body; the blood carries oxygen; and that working muscles require more oxygen, which is why the heart must pump faster.
6. Ask students: So what is oxygen? How do you get oxygen? Use these questions to prompt a discussion of breathing and the function of the lungs in oxygenating the blood; that this oxygen is transported throughout the body in the blood that is being pumped by the heart; and that the cells of the body use this oxygen. together with nutrients from the food we eat, to function, much like the way a car uses air and gasoline to run. And in the same way that a car emits exhaust as a waste product, the body also produces a waste product, called carbon dioxide, or CO2, in a process called oxygen exchange. This CO2 waste is then carried back to the lungs where it is exhaled.
Page 6.3.2
Lesson 6-3: Around and Around It Goes
Procedures (continued) Teacher’s Note: Some of the concepts introduced here are quite complex, but are understandable to children through common experience. To discuss oxygen exchange, for example, you might want to ask what would happen if someone breathed with a paper bag over his or her nose and mouth. Isn’t it just air going in and air coming out? Most students will be very familiar with this exercise and will be able to tell you the discomfort that will result. Use this experience to point out that what you breathe in (oxygen) is very different from what you breathe out (CO2), and that this process of oxygen exchange is what is happening throughout the body as a person breathes in and out. You might also want to ask students the color of blood. The obvious answer is red. However, you can point out that as oxygen in the blood is used up, the blood itself can take on a bluish color. This is the reason for expressions such as “holding your breath until you are blue in the face.”
7. Ask students: So how does blood flow through your body? Explain that blood flows through a system of tubular pipelines both big and small throughout the body. One system carries blood from the heart to the body; these are called arteries, and carry oxygen–rich blood to the body’s tissues. The biggest artery is called the aorta. The other system carries the oxygen-depleted blood back to the heart and lungs; these are called veins.
8. On the floor, lay out three stations with tape
Teacher’s Note: There are many websites that display animations of the heart at work, and the operation of the circulatory system. Search in any online search engine for the terms “heart pump animation,” “circulatory system animation” or other related terms for a large selection of graphics that can visually display the concepts introduced in this lesson.
according to the diagram below. The first station will represent the lungs, the second station the heart, and the third station the rest of the body. Use red and blue tape to “connect” the stations as shown in the diagram.
9. In this exercise, students will act the part of blood cells, picking up oxygen (red strips of paper) at the lungs, and exchanging them for blue strips of paper (carbon dioxide) at the heart and body stations, and then circulating back to the lungs to exchange their blue strips again for red. Station two students at the lung station, one at the heart, and one at the body. Supply one of the students at the lung station with a large bag of red paper strips, and the two students at the heart and body stations with large bags of blue paper strips. Give all other students, who will be the “blood cells,” a plastic sandwich bag.
Page 6.3.3
Lesson 6-3: Around and Around It Goes
Procedures (continued) Walk them through the following procedures: At the lungs, students will be given two red strips, representing oxygen, to put in their plastic bag. As the heart “beats” (which can be depicted using a drum), the student moves to the heart, where one of the red strips is surrendered in exchange for a blue strip. At the next heartbeat, the student moves on to the body station where the second red strip is exchanged for another blue strip. At the next heartbeat, the student returns to the heart station, and at the next beat back to the lungs, where the two blue strips are surrendered, and the student waits to pick up two more red strips to start the process over again.
L63_HeartDetail
For variations, you can increase the number of body stations to include the brain as a stop. You can also vary the timing of the drum beats to depict a body at rest versus a body in strenuous activity. Ask your students what happens when the body is working harder? Prompt for the answers: The body requires more oxygen; to get more oxygen, the heart must pump faster and work harder; and the person needs to breathe faster (pant) to get more oxygen into the lungs.
10. Review the notions of oxygen exchange in the lungs to replenish the blood with oxygen; and the exchange that occurs in the tissues where oxygen is used and converted to the waste product CO2. Explain why this is exchange is so crucial for health. What would happen if this exchange process was impaired?
Ask students: When you hold your breath, what do you think is happening? How does holding your breath make you feel? What does it do to your heart rate? Why?
11. Fun facts: a. The heart pumps more than 1,500 gallons of blood a day. b. If you laid out the blood vessels in an adult body end to end, they would stretch more than 60,000 miles. c. A heart beat of 80 beats per minute will beat more than 40 million times per year.
Homework: A Heart Journal: Have students record their heartbeats at different times of the day—when they wake up in the morning, when they are resting during the day, after they’ve eaten, after exercising, before getting ready for bed, etc. Have them record their heartbeats along with the time of day and what activities they were doing.
Page 6.3.4
Lesson 6-3: Around and Around It Goes
Around It Goes Floor Map
Lesson 6-4: Take a Deep Breath
Lesson 6-4
Take a Deep Breath Introduction: This lesson extends the previous lesson to look specifically at the oxygen exchange process in the lungs, blood flow though the vessels, and the adverse impacts that smoking has on these processes.
Lesson Objectives: By the end of the lesson, students will be able to: ✷ State a basic understanding of the oxygen exchange process in the lungs ✷ Identify the impact of smoking on the lungs and blood vessels ✷ Understand that smoking results in the intake of chemicals that can affect the body
Materials: ✷ Mechanical smoker (see Teacher’s Note) ✷ Small square of wire mesh (as for a window screen) ✷ An aluminum or other tray to catch sand ✷ A few handfuls of sand and a few handfuls of brown rice ✷ Yellow Play-Doh ✷ 2 red PVC pipes (or cardboard wrapping paper tubes) 2” in diameter and about 24” in length, cut lengthwise and hinged with Velcro or tape
Teacher’s Note: A mechanical smoker is a device that provides a graphic demonstration of the chemical residue that is left in the lungs as a result of smoking. The device is available through Boreal Laboratories (www.boreal.com). Although the device can be expensive (currently about $98.00 in 2007), it is good for 100 demonstrations. It does, however, require the burning of a cigarette (not included) which may not be permitted on some school campuses, even for demonstration purposes. Check with your administration for your school’s policies.
Key Terms: alveoli: small, sac-like structures in the lungs where oxygen exchange occurs blood vessels: the tubular system that carries blood throughout the body cilia: tiny hairlike structures that line the lungs and airways, that help move germs, dirt and mucus out of the lungs.
tar: “Tar” is the term given to the chemical residues left in the lungs as a result of smoking. These residues are irritants to lung tissue, can damage the cell structures responsible for ridding the lungs of dirt and germs, and are the chief casue of cellular damage that leads to diseases such as chronic bronchitis, emphysema and lung cancer.
Page 6.4.1
Lesson 6-4: Take a Deep Breath
Procedures: 1. Review with the class the material from the previous lesson. The principle concepts are that the heart beats to pump blood throughout the body; that the blood is carrying, among other things, oxygen that the body’s tissue needs; and that this oxygen is picked up in the lungs through the act of breathing.
2. Ask students: What happens inside your lungs when you breathe? What happened with your breathing when you jumped up and down in the previous lesson? Why do you think you had to breathe harder? Did you have to think about breathing harder? Explain to students that their lungs are the organs that draw in the oxygen that the body needs to survive. As the body requires more oxygen—for example, during the jumping exercise, when the body’s muscles are working hard to create movement—the lungs must work harder to take in the oxygen the body needs.
3. Ask students: As you inhale, what goes in? (Answer: oxygen from the inhaled air.) What comes out? (Answer: carbon dioxide waste from the body.) Explain that the lungs draw in air as they expand and contract through breathing. Point out that the air is drawn down the wind pipe, or trachea, where it divides into two branches called bronchi. These bronchi continue to divide into smaller and smaller branches, much like a tree, until the tubes are as thin as a hair. These tiny tubes are called bronchioles. There are about 30,000 bronchioles in each lung. At the end of each bronchiole is a clump of tiny air sacs called alveoli. They look like clusters of small grapes, and there are about 600 million of these alveoli in your lungs. It is said that one person’s alveoli, if taken from the lungs and spread flat, would cover a tennis court.
L64_Alveoli
Each of the alveoli in the lungs are surrounded by a fine network of tiny blood vessels, called capillaries. As a person inhales, oxygen passes through the alveoli tissue and into the blood stream, and trades places with the carbon dioxide waste, which leaves the blood and passes through the alveoli back into the lungs. As the person exhales, the carbon dioxide waste is expelled from the body. This process is called gas or oxygen exchange.
Page 6.4.2
Lesson 6-4: Take a Deep Breath
Procedures (continued) 4. Ask students: What else is in the air we breathe? In addition to oxygen, air contains many other gases, and other matter such as dirt, germs and dust. What happens to these materials in the lungs? The lungs produce a mucus-like substance that lines the tissue, and helps to trap particles of dirt and other foreign material. The lungs and airways are also lined with tiny hair-like structures, called cilia, which move back and forth to push the dirt up and out of the lungs. Whenever a person coughs or clears their throat, they are actually clearing some of this material out of their body.
Ask students: How many of you know someone who smokes? What is one thing you might notice about people who smoke? Why do you think they have to cough? Explain that when a person smokes, the heat and smoke particles can be very irritating. The smoke also damages the cilia that move mucus out of the lungs, making it more likely that germs, dirt and other contaminants (together with the mucus) will get trapped in the lungs. Explain that, especially for someone who has smoked for many years, or who smokes a great deal, the cilia cells become so damaged, they lose almost any ability to keep the lungs and airways clean. The result is the deep, hacking cough known as “smoker’s cough.” The deep cough is a result of the lungs trying to clear much of this gunky mucus.
5. In addition, when a person smokes, the smoke itself contains many harmful chemicals that can hurt the lungs. The smoke also leaves behind in the lungs a sticky residue commonly called tar. Use the mechanical smoker to demonstrate the accumulation of tars in the lungs. Tar is a dark, sticky film that coats the inside of the lungs, turning them from a healthy pink to a dark, sickly brown.
6. These tars cause damage to the alveoli where oxygen exchange takes place. Ask student volunteers to hold the wire mesh over an aluminum tray. Have another student take a cup of sand and pour it through the wire mesh into the aluminum tray below. Explain that this is how oxygen typically crosses through the alveoli and into the blood stream. Now have a student pour a cup of brown rice onto the mesh. Explain that in the lungs, the tar from cigarette smoke coats the alveoli. Have a student pour a second cup of sand on top of the rice. Show that the sand flows much more slowly, if at all, and explain that the tar makes it much more difficult for the oxygen exchange to take place. Thus, the lungs become much more inefficient at drawing in the oxygen the body needs to function.
7. In some people, the damage to the alveoli becomes so great that they develop emphysema, a disease in which the alveoli are progressively destroyed. No matter how deeply a person with emphysema inhales, their lungs cannot absorb any oxygen. Explain that for people with emphysema, even simple tasks like walking
Page 6.4.3
Lesson 6-4: Take a Deep Breath
Procedures (continued) across a room is impossible because the body cannot take in enough oxygen to accomplish even that small degree of activity.
8. The chemicals in tobacco smoke can also damage the lung tissue and cause lung cancer, a disease that causes the destruction of healthy lung tissue. Smoking is the number one cause of lung cancer, and lung cancer is the leading cause of cancer death in this country.
9. Ask students: Who knows what else in the body gets damaged by smoking? Explain that when the blood absorbs oxygen in the lungs, it also absorbs many of the chemicals that are in tobacco smoke. These chemicals can cause atherosclerosis, a gradual clogging and narrowing of the arteries that carry freshly oxygenated blood to the body’s tissues and organs. Use the PVC pipes or cardboard tubes, opening them to show the students the smooth insides. Explain that in a young healthy person, the inside of their blood vessels is smooth like the tubes. In the second tube, use clumps of Play-doh and smash them into the interior walls of the tube. Explain that smoking promotes the buildup of deposits on the insides of the blood vessels that interfere with blood flow, or may even stop the blood flow altogether. Close each of the tubes, and then ask the class to crumple small pieces of paper into small balls that can pass through the tubes. Have them slide these balls into the tubes and have them observe the difficulties the balls have in passing through the Play-doh impregnated tube. Explain that if a blockage occurs in one of the arteries that supply oxygen to the heart, the result can be a heart attack, where heart tissue dies because of a lack of oxygen. The narrowing of blood vessels can also lead to high blood pressure and strokes, in which narrowing or a clog results in either the blockage of blood to parts of the brain, or where damaged blood vessels break, resulting in bleeding in the brain. The result is that brain tissue can die, often leading to paralysis or death.
Journal: If people know that smoking is bad for them, why do so many start smoking anyway? Knowing the facts, would YOU want to start smoking?
Page 6.4.4
7th Grade Lessons:
Needed Materials and Preparations Lesson 7-1
* Worksheet: What I Like About Me (transparency and hard copies) Small jars, cups or empty yogurt cups Grapes, or bags of M&M's, jelly beans or similar items Overhead projector/Smart Board
Lesson 7-2
Video or DVD of a TV show or movie that illustrates friendship (one of the Harry Potter series, or Lord of the Rings Trilogy) TV/VCR or DVD player * Role-play scenario cards: Being a Friend * Worksheet: Wanted: A Friend * Poster: Wanted: A Friend
Lesson 7-3
Captioned video or DVD or a television show or movie that illustrates friendship, or a story or book TV/VCR or DVD player Blank index cards * Worksheet: D.A.R.E. Decision-Making Process
Lesson 7-4 Lesson 7-5
No materials are needed. * Mechanical Smoker * Video: Smoke Free TV * Journeyworks Publishing Pamphlets: How Tobacco Affects Your Body * Wrappers from cigarette packaging * Worksheet: Warning Label * Worksheet: Smoking in the Home
Lesson 7-6
* Worksheet: Interview with a Smoker Contact your local chapter of the American Cancer Society if you need a guest speaker who is a smoker or former smoker Prepare a script for students who seek to interview smokers or former smokers
Lesson 7-7
* Tobacco advertising samples (provided on CD) * Worksheet: Why Do We Do What We Do?
* These materials are included in the supply kit that accompanies
this curriculum, or in the case of handouts and worksheets, as PDF files on the accompanying CD. The PDF format should allow you to print the files directly from computer to printer, or you can print a single copy and make duplicates for your class.
7th Grade Lessons Materials List
Lesson 7-1
What is Self-Esteem? Introduction: This lesson introduces students to the concept of self-esteem, and asks them to consider how self-esteem issues relate to behavior and decision-making.
Lesson Objectives: By the end of Lesson 7-1, students should be able to: W
Define self-esteem as the feelings they have about themselves
W
Identify characteristics they like about themselves
W
List factors that can affect self-esteem
W
Identify ways that self-esteem affects decision-making
W
Identify ways to boost self-esteem
Materials: W
Worksheet: "What I Like About Me"
W
Small jars, cups or empty yogurt cups
W
Grapes, or bags of M&M's, jelly beans or similar items
W
Overhead transparency/Smart Board
Key Terms: character traits: aspects of personality or individual attributes that students use to describe themselves, e.g., friendly, a fast learner, well-organized, someone with a sense of humor, trustworthy, a good friend.
self-esteem: one’s sense of confidence and satisfaction in oneself; self-respect.
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skills: particular abilities or talents that students may have, or particular activities that they enjoy.
decision-making: the processes used in making a choice, especially with regard to behavioral choices.
Page 7.1.1
Lesson 7-1: What
is Self-Esteem?
Procedures: 1.
Use an overhead projector or Smart Board to display the worksheet, "What I Like About Me" (or write the following “jar headings” on the board). Distribute hard copies of the worksheet to students and ask them to identify the parts of
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themselves that they really like, including:
W
Skills: Abilities, talents, or particular activities you enjoy. Examples: Good on the computer; Like math and science; Enjoy dancing; Play basketball; Can draw well; Acts in school plays.
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W Character Traits: Terms you use to describe yourself, or how others describe you. Examples: Nice person; Good sense of humor; Friendly; Cool; Fast learner; L71_FamilyFriendsJar
Hard-working. W Family & Friends: People who love you, people whom you love, people whom you can trust. Examples: Love my mom; Family loves me a lot; Favorite aunt; Cool brothers and sisters; Good group of friends; Caring L71_AccomplishmentsJar
teacher; Best friend. W Accomplishments: Achievements of which you are proud, or which you enjoy. Examples: Earned an “A” in Science; Made the baseball team; Finished my chores; Was elected Class President; Knitted a sweater; Finished a model car kit. L71_PhysicalJar
W Physical Traits: Aspects of your appearance or physical self that you like. Examples: Tall; Nice smile; Curly hair; Athletic; Graceful; Skilled hands. W Other: Any other aspect of one’s self that one is proud of, or enjoys.
Page 7.1.2
Lesson 7-1:
What is Self-Esteem?
Procedures (continued) 2.
Ask students to complete the worksheet, listing what they like about themselves. Explain that the jars represent different parts of themselves. Ask them to “fill” these jars with items that make them feel good about themselves. Encourage students to come up with other jar labels (examples: hobbies, places where I feel special, etc.). Ask students to think about and include the parts of being a Deaf person that they enjoy or admire.
3.
Teacher’s Note: As an alternative, you may want to conduct this as a group exercise. You might ask the class to assemble a “class-level” self-esteem inventory. Be prepared to prompt for positive characteristics, especially in situations where self-esteem may be low.
Distribute jars or cups to students. Ask students to take one M&M or Jelly Bean for each item on their list and put the candies into their jar or cup. (You may use alternate materials if jars and candies are not available.)
4.
Ask students to review their lists and think about how this list makes them feel. Allow students to read their lists to the class. Encourage students to add to their list if they think of other traits, characteristics, experiences or people that shape how they feel about themselves.
5.
Have students discuss their inventories, and how they relate to self-esteem.
Ask students: How would you feel if you had no M&Ms or jelly beans in your jar, or no items written on the worksheet? How would you feel if
L71_NoBeans
you had 50 items written down? Define this feeling as self-esteem. Explain that people who are able to recognize good things about themselves have high self-esteem. People who are not able to recognize these good things about themselves have low self-esteem. Self-esteem is how we feel about ourselves.
6.
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Have students discuss the relationship between self-esteem and behaviors. Explain that self-esteem is an important factor in the decisions people make.
Ask students: Imagine a person who is good at playing basketball, and who plays on the basketball team. What kind of decisions do you think this person would make when it comes to behaviors like getting plenty of sleep? choosing the types of foods they eat? drinking? smoking? or going to parties? L71_BBall1
Page 7.1.3
Lesson 7-1:
What is Self-Esteem?
Procedures (continued) Imagine a person who feels that they have no friends, or feels that they can do nothing well. What kind of decisions do you think that person will make when it comes to behaviors like joining clubs or getting together with others? trying new activities? doing things they think will impress other people, like
L71_depressed
drinking, smoking or partying? How might people with high self-esteem act differently than people with low self-esteem? In what ways do you
Teacher’s Note: Be prepared to discuss that people often act in unexpected ways. For example, a person who starts for the school’s basketball team might be more careful to stay healthy and well-rested, and thus avoid behaviors such as drinking, drug use or smoking that might affect their performance. On the other hand, a basketball player who is a star athlete at school, popular and the center of attention, may feel bolder about doing things such as drinking, smoking, or partying.
think your own self-esteem affects decisions that you make?
7.
Help students recognize more skills and strengths to add to their list. Have them consider their regular daily activities and things they enjoy doing.
Journal Exercise:
Teacher’s Note: Be prepared to discuss, for example, that people who feel inferior, unliked, or without friends, may do things to try to impress others or to look cool, such as drinking and smoking. They may turn to drugs, alcohol, or tobacco to deal with their loneliness or unhappiness.
What do you like about yourself? Which of these characteristics is your favorite and why?
Page 7.1.4
Lesson 7-1 Worksheet: What I Like About Me!
Name __________________________________
What I Like About Me! In the jar below, list the things you like about yourself. Include your skills, your hobbies, your friendships, your appearance, people you love, people who love you, and anything else you enjoy about yourself! Placed in your jar, they make up who you are! L71_SelfEsteem_small
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My Self-Esteem Jar _________________________________________ _________________________________________ _________________________________________
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_________________________________________ _________________________________________ L71_FamilyFriendsJar
_________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________
L71_AccomplishmentsJar
Lesson 7-2
Friendship and Self-Esteem Introduction: The previous lesson explored how self-esteem often factors into behavioral choices and decision-making. In this lesson, students are asked to consider the relationship between self-esteem and friendship, and how “being a good friend” can also affect one’s decisions and behaviors.
Lesson Objectives: By the end of Lesson 7-2, students should be able to: W
Identify characteristics of a friend
W
Identify strategies for making friends
W
List ways that friendships can affect self-esteem
W
Explore the complexities of friendship and decision-making
Materials: W
Captioned video or DVD of a television show or movie that illustrates friendship.
W
TV/VCR or DVD player
W
Role-play scenario cards: “Being a Friend”
W
Homework Worksheet: “Wanted: A Friend”
W
Homework Poster: “Wanted: A Friend”
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Key Terms: caring: a characteristic of friendship; showing thoughtful concern for another.
loyalty: a characteristic of friendship; showing fidelity or allegiance to another.
friend: differentiated by degree, e.g., “good friend” versus “casual friend” versus “acquaintance”; characteristics of a “good friend” versus a “bad friend.”
reliability: a characteristic of friendship; dependable; one who can be relied on for help, care, companionship, etc.
friendship: the characteristics that describe the state of being friends, and the sometimes complex and contradictory interactions of these characteristics that can shape one’s behaviors or decisions.
supportive: a characteristic of friendship; being an advocate for, or backer of, another. sympathetic: a characteristic of friendship; showing compassion, empathy, or favorable inclination to another.
Page 7.2.1
Lesson 7-2: Friendship
& Self-Esteem?
Procedures: 1.
Show a portion of a videotape of a television program or movie that the class is familiar with. Have the class discuss how the program illustrates friendship.
Ask students: Who are friends on the show? How do you know they are friends? Do they always treat each other well? Do they sometimes get angry with each other? What happens? How is the relationship between the friends different from the relationship they have with others around them, such as family members, casual acquaintances, or strangers?
2.
Ask students to describe the characteristics of a friend based on their own experiences with friends. As students suggest characteristics, write them on an overhead projector or Smart Board. Ask the students to discuss how many of the characteristics they saw exhibited in the video/DVD. Ask students to identify how their own friendships are different from, or similar to, the friendships portrayed in the television show. Ask the students to describe the basis of their own friendships. L72_cookies
3.
Have students discuss the relationship between friendship and self-esteem.
Teacher’s Note: Several examples can be suggested for discussion:
Ask students: How do friendships affect the way you feel about yourself? How do you think friends might affect your own behavior, or decisions you might make? What about someone who
W If you have good friends, you may be less likely to worry about what others might say about you. W Some people feel they need to impress others to make friends. This may lead them to undertake risky or other behaviors that make them look “cool.” W Good friends may encourage you to do better or study harder in school, but they can also encourage you to take part in behaviors you otherwise might not try.
feels they don’t have any friends? How do you think that person would feel about himself or herself? How do you think that might affect the way that person behaves?
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Page 7.2.2
Lesson 7-2:
Friendship & Self-Esteem?
Procedures (continued) 4.
Have students discuss how they make friends. Ask your students to imagine that they have just moved to a new school where they do not know anyone. Ask your students to identify strategies they could use to make friends in their new school. Write these ideas on the board. If needed, suggest the following prompts: W
start a conversation
W
ask a question
W
give a compliment
W
join a club or group (meeting someone with similar interests is a good way to make a friend)
5.
W
offer to help someone, let them know you want to be friends
W
get involved in a project
Divide the class into pairs and ask them to role play using the Being A Friend role-play scenarios. For each pair of students, designate one as Person #1 and the other as Person #2. Take one pair of role-play scenario cards and hand the first to Person #1 and the second to Person #2. Ask your students, as they role-play, to play either good friends or people who are not acting as good friends.
Situation #1: Person #1: You and your friend were planning to hang out together this evening. But now you want to go to a party with some of the most popular people at school. You know your friend is not invited. Person #2: You and your friend have planned to hang out with each other this evening.
Teacher’s Note: The object of these exercises is to demonstrate ways in which friends can show loyalty, reliability, sympathy, support and caring towards friends. Your students may ask questions about what happens when these values conflict. For example, loyalty and trustworthiness might conflict with caring in the situation where you discover a friend has been using drugs, or is smoking. These conflicts lead to difficult decisions and choices (“Do I talk to my friend? Do I tell him to stop? Do I tell anyone else—a friend, a teacher, his parents?”). Encourage your students to pose these types of questions as they work through these role plays.
Situation #2: Person #1: You have promised to help your friend study for tomorrow’s math test, but someone else has just invited you to see a movie instead. Person #2: You need help to pass tomorrow’s math test. Your friend has promised to help you study, but he wants to go see a movie with another friend instead.
Situation #3: Person #1: You are at the mall with your friend. You see them shoplift a small item. Person #2: You are at the mall with your friend. You shoplift a small item at the store. You tell your friend not to tell anyone, and then you dare them to shoplift something too.
Page 7.2.3
Lesson 7-2:
Friendship & Self-Esteem?
Procedures (continued) Situation #4: Person #1: You have been smoking after school behind the gym with some of your friends the past several weeks. Person #2 is your good friend who does not smoke, and who doesn’t hang out with your smoking friends. Person #2: Person #1 is your good friend who has been smoking recently with a new group of smoking buddies. Your friend’s mother has been asking you if something different has been going on with her child.
Situation #5: Person #1: You smoke marijuana at your house after school when your parents are away at work. Person #2: You are Person #1’s good friend, and don’t think she/he should be smoking marijuana. If fact, you think you should tell an adult about Person #1’s marijuana use. Have students discuss how these situations demonstrate loyalty, reliability, sympathy, support and caring towards friends. Discuss where (and why) these are not present. Illustrate from the role-playing situations where these values are in conflict.
6.
Have students consider the complexities involved in being a good friend. Now that they have seen how good friends and people who are not friends act, do they think it is always easy to be a good friend? Are there times when being a good friend means making friends angry or upset? What happens to friendship when this occurs?
7.
Ask students to discuss how being Deaf influences their friendships. How easy is it to make friends with another person who is Deaf? How about with a friend who is hearing? How many of your students have friends who are Deaf? How many have friends who are hearing? Are friendships with Deaf friends different from those with hearing friends? In what ways? In what ways are they the same?
Homework: Have students complete the “Wanted: A Friend” Worksheet. OR Have students draw a “Wanted: A Friend” poster.
Journal Exercise: What characteristics do you like the most about your best friend? What characteristics do you think you offer to your own friends?
Page 7.2.4
Lesson 7-2 Poster: Wanted: A Friend!
Name __________________________________
Poster: Wanted: A Friend! L72_Friends_small
Instructions: Create a poster for the theme “Wanted: A Friend” that illustrates the characteristics you seek most in friendship. You may use this sheet, or a larger piece of paper if you’d like. Feel free to explore different techniques— drawing, painting, collage using magazine pictures or found objects, mosaic— be creative!
Lesson 7-2 Role Plays: Being a Friend
Role Play Cards
Being a Friend Instructions: Cut out the following role-play scenarios. For each scenario, select a pair of students and hand one role to each student. You may encourage students to play the roles of “good friends” or “not so good friends”—that is, ask them to respond to each other as they believe ideal friends would behave, or as someone who does not necessarily have the others’ best interests at heart.
! Friendship and Self-Esteem Role-Play Scenario #1 Person #1 You and your friend were planning to hang out together this evening. But now you want to go to a party with some of the most popular people at school. You know your friend is not invited. L72_RolePlay1
Friendship and Self-Esteem Role-Play Scenario #1 Person #2 You and your friend have planned to hang out with each other this evening.
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Lesson 7-2 Role Plays: Being a Friend
Role Play Cards
Being a Friend
!
Friendship and Self-Esteem Role-Play Scenario #2 Person #1 You have promised to help your friend study for tomorrow’s math test, but someone else has just invited you to see a movie instead.
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Friendship and Self-Esteem Role-Play Scenario #2 Person #2 You need help to pass tomorrow’s math test. Your friend has promised to help you study, but he wants to go see a movie with another friend instead.
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Friendship and Self-Esteem Role-Play Scenario #3 Person #1 You are at the mall with your friend. You see them shoplift a small item.
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Friendship and Self-Esteem Role-Play Scenario #3 Person #2 You are at the mall with your friend. You shoplift a small item at the store. You tell your friend not to tell anyone, and then you dare them to shoplift something too.
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Lesson 7-2 Role Plays: Being a Friend
Role Play Cards
Being a Friend
!
Friendship and Self-Esteem Role-Play Scenario #4 Person #1 You have been smoking after school behind the gym with some of your friends the past several weeks. Person #2 is your good friend who does not smoke, and who doesn’t hang out with your smoking friends.
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Friendship and Self-Esteem Role-Play Scenario #4 Person #2 Person #1 is your good friend who has been smoking recently with a new group of buddies. Your friend’s mother has asked you if something different has been going on with her child.
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Friendship and Self-Esteem Role-Play Scenario #5 Person #1 You smoke marijuana at your house after school when your parents are away at work.
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Friendship and Self-Esteem Role-Play Scenario #5 Person #2 You are Person #1’s good friend, and don't think she/he should be smoking marijuana. If fact, you think you should tell an adult about Person #1’s marijuana use. L72_RolePlay5
Lesson 7-2 Worksheet: Wanted: A Friend!
Name __________________________________
Wanted: A Friend! Instructions: What are the qualities you seek in a friend? What qualities must someone have to be a good friend? Write your answers in the spaces below. You can use some of the qualities shown below. Then add your own!
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L72_kids
__________________________________________________________ __________________________________________________________
“Loyal and kind”
________________________________________________
“Good listener”
_________________________________________________________________ _________________________________________________________________
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_________________________________________________________________
“Helpful and caring”
________________________________________________________________ L72_skateboard
_________________________________________________________ _________________________________________________________ ________________________________________________________ L72_videogame
________________________________________________________
“Fun to be with”
_________________________________________________________________________
“Adventurous”
_________________________________________________________________________ L72_minigolf
__________________________________________________________
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________________________________________________________ ________________________________________________________ ________________________________________________________
“Patient and understanding”
“Reliable and trustworthy”
Lesson 7-3
Decision-Making Introduction: This lesson provides students with a structured set of tasks to undertake in making decisions. The goal is to encourage students to use a conscious decision-making process when confronted with behavioral choices.
Lesson Objectives:
Teacher’s Note:
By the end of Lesson 7-3, students should be able to: W
Identify and describe difficult decisions they have made
W
Describe the process they used to make decisions
W
Learn the D.A.R.E. Decision Making Process
W
Apply the D.A.R.E. Decision Making Process to a decision
W
Apply the D.A.R.E. Decision-Making Process to smoking
Š1996 D.A.R.E. America
Materials: W
Captioned video or DVD of a television show or movie that illustrates friendship, or alternatively, a story or book
W
Index cards
W
Worksheet: D.A.R.E. Decision-Making Process
This lesson uses the decision-making model of the Drug Abuse Resistance Education (D.A.R.E.) program, the pioneer prevention effort established in 1983. Given the widespread use of D.A.R.E. programming in the elementary grades, it is likely that your students will have been previously exposed to the D.A.R.E. decisionmaking model. If not, the concepts underlying the model are relatively straightforward and are reviewed in the curriculum.
Key Terms: D.A.R.E. Decision-Making ProcessŠ1996: A series of steps taught to youth to help them define important decisions and analyze the options and consequences involved in each decisional choice. The components of the D.A.R.E. process are as follows:
(D) define the decision: What is the decision to be made? What are the issues? Do you understand them? (A) assess: What options are being considered for the decision? What are the consequences of each of the different options, for yourself as well as others around you? (R) respond: Choose which option is the safest for you, or has the most favorable impact. (E) evaluate: How good was the decision that was made? What were the impacts?
Page 7.3.1
Lesson 7-3:
Decision Making
Procedures: 1.
Ask your students to explain what a decision is.
Ask students: What do we mean when we say we made a decision, or we have a decision to make?
2.
Ask your students for examples of decisions. Write these on the board. Points to make: There are many different kinds of decisions. Some may be important while others are relatively unimportant. Some decisions may affect relationships (with parents, friends or others); some may affect our future (such as
L73Decisions
the decisions to study harder, to use alcohol, tobacco or drugs, or to quit school). Some decisions are private and some are public. Some decisions require a great deal more thought than others.
Teacher’s Note: It is likely that most of the decisions suggested by the students will be fairly insignificant ones— What should I bring in my lunch today? Which pair of pants should I wear? Should I do my homework or play video games for awhile? Be prepared to point out that while many of the most important decisions in their lives (where they go to school, where they live, etc.) may be made by their parents or others, there are still a number of important decisions that they themselves make that often affect their relationships or their futures.
3.
Give each student an index card. On the front, ask them to write down an important decision that they have made. On the back, ask them to write brief statements about how they came to their decision. They will be asked to share this decision with their classmates.
4.
Ask students to share what they have written with the class. Ask each student to explain: W
What decision they had to make
W
Why the decision was important
W
Who was affected by the decision
W
What they considered in making the decision
W
How the final decision was made
Page 7.3.2
Lesson 7-3: Decision
Making
Procedures (continued) 5.
Hand out the D.A.R.E. Decision-Making Process worksheet. Explain that making a decision can be easier if you have a plan. The D.A.R.E. process is a way to plan for making decisions. Any time a decision needs to be made, the D.A.R.E. process can be used. Use a decision relating to smoking or other drug use to describe the four-step process. Complete the worksheet with your class to illustrate the process. W
Define the decision to be made. Be as specific as possible. For example:
L73DARE
A friend has whispered to you that he has brought some cigarettes to school, and suggests that you and he try them behind the gym. You aren't interested, but you know the school wants you to tell a teacher if you hear any information about cigarettes, drugs or weapons on campus. What decisions do you have to make? Point out that the decision isn't simply, “Yes, I will smoke with my friend” or “No I will not.” Rather, there are several decisions: “Should I smoke with my friend or not? Should I tell him smoking is against the rules? Should I tell him he shouldn't be smoking because it is bad for his health? Should I tell a teacher?” W
L73_Smoke
Assess the options and consequences of each choice. What are the options that are involved in the decision? For example: i
I can go with my friend and smoke a cigarette behind the gym.
i
I can go with my friend, but refuse to smoke the cigarette.
i
I can try to convince my friend to get rid of the cigarette.
i
I can refuse to go with my friend.
i
I can tell a teacher about my friend's plan to
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smoke the cigarette.
Page 7.3.3
Lesson 7-3: Decision
Making
Procedures (continued) Each option may have several consequences: For example: i
I can go with my friend, but refuse to smoke the cigarette. Consequences:
i
My friend will be happy that I am going with him.
i
My friend may think I'm a coward if I don't smoke.
i
My friend may convince me to smoke even though I don't really want to.
i
We may get caught.
i
My other friends might find out.
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W
Respond by choosing what you feel is the best option.
W
Evaluate your choice. Did your choice have the consequences you thought it would? Do you think you could have made a better decision?
6.
Using the following scenarios, ask students to form groups of two or three. Give each group ten minutes to apply the D.A.R.E. process to one of the decisions. Have each group select one spokesperson
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to explain to the class how the group made its decision. It will be important to emphasize use of the D.A.R.E. process. Check to see that students understand the appropriate steps.
Teacher’s Note:
Scenario #1: Terry has asked you to smoke a cigarette with him after school today.
Scenario #2: You are at your friend's house, and her parents are away for the afternoon. She asks if you want to try some beer.
When discussing consequences with your students, make sure that they understand that consequences can be positive (a good thing) as well as negative (a bad thing).
Scenario #3: You and a friend planned to go see a movie together this afternoon, but another person you like has asked you to go to the park to play basketball.
Scenario #4: You have a group project to do in school, for which you are supposed to find a partner. You want to work with your friend, but another student approaches you and asks you to be her partner.
Page 7.3.4
Lesson 7-3: Decision
Making
Procedures (continued) Scenario #5: You have a test tomorrow that you haven't really started studying for, and a friend asks you if you want to spend the afternoon watching a DVD instead.
Journal Exercise: Go back to the decision you wrote on your index card. Would your decision have been the same if you had used the D.A.R.E. process? Why or why not?
Page 7.3.5
Lesson 7-3 Worksheet: The D.A.R.E. Decision-Making Process
Name __________________________________
Decisions, Decisions! The D.A.R.E. Decision-Making Process Worksheet
Instructions: Making decisions can be easier if you have a plan. Use this worksheet to help Justin and Marie make some decisions about using tobacco. Once you’ve completed the worksheet, think about important decisions you’ve had to make, and how you would think about them now. Justin and Marie, a brother and sister, have just moved to a new town and will be attending a Deaf school for the first time. They are both worried about making new friends. They are also nervous because this is the first time that they will be attending a school where everyone signs. Justin has heard that his new school is holding tryouts for the baseball team this afternoon. “I’ve always liked baseball,” he thought. “Maybe I can make some new friends if I try out for the team.” At the tryouts, Justin meets several older boys who are already on the team. They are friendly, and the group starts to chat as they walk to a distant corner of the field. One of the boys pulls out a small tin can, opens it and passes it around. Justin watches as the boys take a pinch of something from the can and place it in their mouths between their cheek and gums. “What’s that?” Justin asks. “Oh, it’s just chewing tobacco,” one of the boys answers. “We like to chew during practice. It’s like a little energy boost.” As the boys continue to chat, Justin can see little brown pieces of tobacco on their teeth, and their breath smells bad. Marie has met several new girls in class, and that afternoon she sees them walk behind the gym to share a cigarette. They notice Marie and wave her over, and offer her a puff on the cigarette. One of the girls says, “We’ll be going over to my house after school. No one’s home so we have the house to ourselves. Wanna come along?” Justin and Marie don’t know what to think of their situation. Justin would like to make new friends and be a part of the baseball team. Maybe the other boys would accept him as part of the team if he chewed tobacco with them. Justin knows he doesn’t want to smoke, but chewing tobacco doesn’t look so bad. Marie likes the new girls she has met. They are friendly. And although she knows smoking is bad for you, it doesn’t look that bad when her friends do it. What decisions do Justin and Marie have to make?
Fill out the D.A.R.E. steps on the following page.
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Lesson 7-4
Decision-Making, Tobacco and Other Substance Use Introduction: This lesson draws on the prior three lessons to illustrate the roles that self-esteem, friends and peers play in the decision to smoke or not.
Lesson Objectives: By the end of Lesson 7-4, students should be able to: W
Identify the characteristics of smoking (age at first use, age at addiction, reasons for smoking, smoking with whom, proportion of youth who smoke) that make tobacco use a relevant issue for students their age
W
Identify the role of self-esteem in the decision to engage in behaviors such as smoking
W
Identify the role of friends in the decision to smoke or not
Key Terms: addict: One who has an addiction. addiction: Extreme physiological and psychological dependence on a substance such as tobacco, alcohol or other drug, that has progressed beyond voluntary control. People who are addicted often feel sick when they stop using this substance.
Page 7.4.1
Lesson 7-4:
Decision Making, Tobacco and Other Substance Use
Procedures: 1.
Ask students the following questions. W
How many of you know an adult who smokes?
W
How many of you know someone who smokes but would like to quit?
W
How many of you know someone who has tried to quit smoking, but found that they could not stop?
W
Teacher’s Note: If anyone seems uncomfortable answering, tell them that they do not need to mention any names. The purpose of the discussion is to make students aware that they are at an age of high risk for both smoking initiation AND addiction.
How many of you know someone your age who has tried smoking a cigarette?
W
How many of you know someone your age who smokes but would like to quit?
W
How many of you know someone your age who has tried to quit smoking, but found that they could not stop?
2.
If any students raise their hands, ask them to think about the people they know who smoke cigarettes: W
Do they know how old that person was when he or she started smoking?
W
Do they have any idea why that person started smoking?
W
Do they have any idea how that person started smoking? (e.g., whom they were with, where they were, where they got the cigarettes?)
3.
Write the following headings on the board: Reason for starting and How starting occurred. Whether or not students volunteer information from their personal experience, now ask the following questions, recording responses on the board: W
If you had to guess why people start smoking, what would you guess?
W
If you had to guess how people start smoking, what would you guess?
As students offer answers, guide the discussion along the following themes: Perceptions of smoking: Smoking is often viewed by young people as a way to appear mature, to cope with stress or depression, to bond with friends and peers, or to display independence and risk-taking. Note that young people can have these perceptions regardless of whether they've ever tried smoking or not. L74_coolguy
Page 7.4.2
Lesson 7-4:
Decision Making, Tobacco and Other Substance Use
Procedures (continued) Environmental circumstances: People are much more likely to start smoking if their parents smoke; if their older brothers or sisters smoke; and if their best friends smoke. Most initial smoking among adolescents occurs in the presence of friends. There are also perceived environmental norms (e.g., “Everyone smokes!” etc.). If you believe that everyone around you smokes, you are more likely to try smoking yourself. Experimental smoking:
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A stage of repeated but irregular smoking, during which the behavior may be socially reinforced (smoking at parties, after school, etc.). People who are experimenting with smoking often do not see themselves as smokers. They will often say, “I only smoke a little, how much harm can I be doing?” And they often add, “Sure I smoke at parties or a little bit with friends, but it’s not like I’m L74_partypeerpress
addicted or anything.” Unfortunately, most people who smoke regularly started smoking
while saying those same words. And the fact is, smoking, even just a little, can cause important health damage, even to a young person. And tobacco use can be so addictive, that people get hooked before they know it. Explain that smoking most often begins when people are young. The reasons people give for starting to smoke most often have to do with those around them (e.g., smoking among family members, friends or peers); with the sense of self that they believe smoking confers (e.g., makes them feel mature, makes them look cool, helps them deal with stress, makes them feel independent or rebellious, etc.); and social reinforcement (e.g., smoking at parties or with friends).
4.
Write the following headings on the board: Age for starting smoking and Age of addiction Ask your students the following questions, recording their answers on the board: W
Teacher’s Note: Many of the following facts use proportions. Make sure your students understand the meaning of phrases such as “8 out of every 10 people.”
If you had to guess the age at which most adult smokers started smoking, what age would you say?
W
If you had to guess at what age most people become addicted to smoking, what age would you say?
Page 7.4.3
Lesson 7-4:
Decision Making, Tobacco and Other Substance Use
Procedures (continued) After you have written the students’ various estimates on the board, explain the following facts: W
Smoking starts at a young age. More than 8 out of every 10 adult smokers say they started smoking before the age of 18.
W
Most smoking starts in the 6th or 7th grade. The peak time at which smoking starts—that is, when people try their first cigarette—is between the 6th and 7th grades, or between the ages of 11 and 12. (Write these ages alongside the estimates listed on the board and circle.) Discuss with the class the differences or similarities between these facts and their estimates.
W
Scientists who study smoking say that about one out of four teenagers had smoked at least one whole cigarette before age 13, and that by the end of high school, about six out of every ten students have tried smoking.
W
Many of those who “just try” smoking go on to become regular, daily smokers. More than one out of every three young people who ever try smoking a cigarette become regular, daily smokers before leaving high school.
W
Each day in this country, more than 4,000 young people try their first cigarette. And each day, another 2,000 teens under the age of 18 become regular, daily smokers.
Key Points for Students: W
The reason why we start talking about smoking and tobacco use NOW, is that you are at the age when most smoking starts. You are at the age when most young people try their first cigarette.
W
Second, although kids express many different reasons for starting to smoke, once they’ve become addicted, the main reason for continuing to smoke is because they find it difficult to stop. So someone may start smoking because they think it makes them look cool, or because it's something their friends like to do at parties or after school. But once they’re addicted, the reasons they smoke are less about looking cool or fitting in, and more about having to—because they're addicted.
Teacher’s Note: This is the first time the concept of addiction is being introduced to the students. While the process of addiction is covered in more detail in the older grades, you may need to explain the concept briefly to your students. Draw on analogous situations with which they may be familiar (e.g., I'm addicted to pizza), but take care to emphasize that tobacco and other substance addiction involves physical addiction—where a person feels nauseous, irritable, dizzy, anxious, or a host of other unpleasant physical symptoms if they cannot smoke a cigarette, drink an alcoholic drink, or use a drug to which they’ve become addicted.
Page 7.4.4
Lesson 7-4:
Decision Making, Tobacco and Other Substance Use
Procedures (continued) 5.
Ask your students: W
So why is this so dangerous? What do you think most kids are thinking when they try a cigarette?
W
Do kids think about what the cigarette is doing to their body?
W
Do kids worry that they will become “addicted” to smoking— that is, they will be unable to stop even if they want to?
W
Do you think they think that by trying just one cigarette, they will grow up to become a smoker?
6.
Follow any discussion with the following facts: W
Cigarettes can quickly become addicting. Cigarettes can become powerfully addicting in a very short period of time. This means that a person may find it very difficult to stop smoking even if they no longer want to smoke. Young people who start experimenting with smoking may experience the symptoms of addiction—
Valuable Resource: Other facts and figures regarding smoking and young people can be found at: http://tobaccofreekids.org/research/ factsheets/index.php
such as strong urges to smoke, or feeling anxious or irritable if they aren't smoking—within only weeks or even days after smoking first begins. W
Tobacco addiction is a serious problem, even among young people. How important is this for young people like you? Approximately one out of every ten 8th graders is a current smoker. By high school, nearly three out of every four regular smokers have already tried to quit smoking, and failed.
W
Most smokers never intended to become smokers. If you ask a high school student who smokes every day if they think they will still be smoking in five years, almost all of them say no. But if you talk to them again when they are adults, most will still be smoking.
W
The younger you start to smoke, the greater the danger. The younger you start to smoke, the greater the risk of getting lung cancer and other smoking-related health problems when you are an adult. About 1 out of 3 young people who become regular smokers before they graduate from high school will eventually die from a disease related to smoking.
Page 7.4.5
Lesson 7-4:
Decision Making, Tobacco and Other Substance Use
Procedures (continued)
L74_cartoon
Journal: Ask students to consider the following statement: “The earlier a young person first tries smoking, the more likely they will become a regular smoker who is addicted.� How do your students think that this statement relates to them as young people?
Page 7.4.6
Lesson 7-5
Tobacco: What Is It, and What Does It Do? Introduction: This lesson introduces some of the physical consequences of tobacco use and addiction. The lesson assumes students will have some rudimentary knowledge of physiology and anatomy (e.g., the function of the lungs, the circulatory system, familiarity with body organs such as the bladder, kidneys, etc.).
Lesson Objectives: By the end of Lesson 7-5, students should be able to: W
Define and identify types of tobacco use
W
Identify health effects of smoking on the body
W
Identify healthy alternatives to smoking
W
Create a warning label for cigarette packs
Materials: W
Mechanical Smoker demonstration
W
Video: Smoke Free TV
W
Journeyworks Publishing Pamphlet: How Tobacco Affects Your Body
W
Four wrappers from cigarette packaging (Supplied in Teacher’s Kit)
W
Homework: Warning Label Worksheet
W
Homework: Smoking in the Home Worksheet
Key Terms: circulatory system: The heart and the network of arteries and veins that pump and carry oxygenated blood to the body's tissues, and transport carbon dioxide wastes from the body. nicotine: The active ingredient in tobacco products that is the chief cause of physical addiction through its effects on brain chemistry.
tar: “Tar” is the term given to the chemical residues left in the lungs as a result of smoking. These residues are irritants to lung tissue, can damage the cell structures responsible for ridding the lungs of dirt and germs, and are the chief cause of cellular damage that leads to diseases such as chronic bronchitis, emphysema and lung cancer.
respiratory system: The lungs and airways leading to them in the body that are responsible for oxygen intake and the expelling of carbon dioxide wastes.
tobacco: Refers to manufactured products of tobacco, including cigarettes, cigars, smokeless (or chewing) tobacco, pipe tobacco, bidis, kretek and others.
Page 7.5.1
Lesson 7-5: What
is Tobacco?
Procedures: 1.
Ask students: What is smoking, and how does it affect your health? Use the Mechanical Smoker machine to show the mechanics of smoking, and to demonstrate the build-up of smoking residue on the lungs. Point out the residue on the inside of the machine, and explain how inhaling cigarette smoke into the lungs leaves this residue behind. This residue contains chemicals, including tar and nicotine that cause both health effects AND addiction. Show students pictures of the lungs from smokers versus those from a healthy non-smoker. Ask them to describe the differences they see. A healthy lung normally has a smooth surface. Compare the healthy lung with this diseased lung of a smoker. This lung shows lung cancer, the grayish-white bumps on the lung.
L75_HealthyLung
2.
L75_LungCancer
Have your students discuss what they know about the effects of smoking on the body. Encourage them to tell as much as they know, including the body parts/organs affected, as well as the illnesses that result (examples: lungs/lung cancer; heart/coronary heart disease; high blood pressure; stroke; etc.) Write the heading Smoking Cigarettes on the board. Underneath, write a list of the students' responses.
3.
Using the video, Smoke Free TV, ask the students to find: W
at least three consequences of tobacco use listed in the video;
W
the different ways in which tobacco is used; and
W
healthy alternatives to smoking.
After the video, ask the students to list the different types of tobacco use they saw (e.g., cigarettes, chewing tobacco, cigars, pipes, bidis, kreteks, etc.).
Page 7.5.2
Lesson 7-5:
Procedures (continued)
What is Tobacco? Teacher’s Note:
Review with the class some of the health consequences of
The following are only some of the many consequences of smoking. They have been simplified here for the purposes of this discussion. You may want to coordinate these lessons with Biology or Science lessons.
smoking that were mentioned in the video. As you review, have the students make notes on their Health Impacts of Smoking Charts, or fill out the form on an overhead or Smartboard. For Example: W
Circulatory system:
Teacher’s Note: You may need to explain how the circulatory system works: the system of arteries that carries blood and oxygen from the lungs to the body's organs and tissues, and the veins that return the blood to the lungs for more oxygen.
L75_HeartDetail
The chemicals found in tobacco have many effects on the body's circulatory system—that is, the heart and the system of arteries and blood vessels that carry oxygen and nutrients to all of the tissues of the body. Smoking encourages a
L75_Atherosclerosis
process call atherosclerosis, or narrowing of the arteries and blood vessels. This reduces the flow of blood and oxygen to important organs, including the brain and heart. Over time, this narrowing can lead to a heart attack (if the heart tissue is deprived of the oxygen it needs to keep beating), or a stroke (caused by a blockage of a blood vessel in the brain or neck, leading to tissue damage or death in the brain.)
Page 7.5.3
Lesson 7-5: What
is Tobacco?
Procedures (continued) W
Respiratory System:
Teacher’s Note: You may need to explain briefly the function of the lungs: As a person inhales air into the lungs, the lung tissue extracts oxygen from the air and transfers it into the bloodstream, which carries it to every cell in the body. At the same time, carbon dioxide, a waste product of the body, is removed from the bloodstream and exhaled.
L75_Lungs
Chemicals that collect in the lung can damage lung tissue. This damage interferes with the lung's ability to transfer oxygen to the blood, and deprives both the lungs and the rest of the body tissues of the oxygen they need to be healthy and function normally. To keep clean, lungs also produce mucus that traps much of the dirt, germs and smoke that you breathe every day. This mucus is moved out of the lungs by tiny hair-like structures in the lungs and airways. For smokers, the chemicals in smoke can damage these structures and their ability to remove the mucus and the entrapped contaminants. As a result, the mucus and contaminants are more likely to remain trapped in the lungs. This can lead to coughing or excessive phlegm. Smoking can also make asthma worse. Over time, the damage caused by exposure to these chemicals can lead to lung diseases such as emphysema, chronic bronchitis, and lung cancer. W
Mouth and throat tissues: The chemicals that cause damage to lung tissues can also damage tissue in the mouth, leading to gum disease, mouth sores and tooth loss. These chemicals can also lead to cancer of the mouth and throat.
W
Other organ systems: Over the long term, smoking has also been linked to cancer of the bladder, kidney, pancreas and other important organs in the body.
Gum ulcers caused by smokeless tobacco.
Page 7.5.4
Lesson 7-5: What
is Tobacco?
Procedures (continued) 4.
Valuable Resource:
Explain to the class that many of these health effects occur over a long period of time, and that the full impact of smoking
Other facts and figures regarding smoking and young people can be found at:
may not be felt for many years. Ask the class whether learning about these health effects of
http://tobaccofreekids.org/research/ factsheets/index.php
smoking will affect the decision to smoke by people their age. Do they think young people think about heart disease that
Check This Out!:
may not occur until they are perhaps 40 or 50 years old? What about cancer? What does that mean to someone their age?
5.
Explain that one of the difficult things about educating young people about tobacco is that many of the health impacts seem
A wonderful interactive animated presentation of the effects of tobacco on different organ systems in the body can be found at:
to be so far off into the future that they don't seem to matter. However, there are some immediate health impacts, even for
http://www.cdc.gov/tobacco/sgr/ sgr_2004/sgranimation/flash/ index.html
young people. Some of these impacts are: W
Cigarette smoking during adolescence can slow the rate of lung growth, and may keep your lungs from ever reaching their full potential.
W
Young smokers are much more likely to experience shortness of breath, coughing spells, phlegm production, wheezing, and worse overall endurance and health. Often young smokers have more difficulty exercising because they have a hard time getting enough oxygen when they breathe hard.
W
Young smokers are less physically fit than their non-smoking peers. Smoking hurts one's endurance, which is especially important for sports such as soccer and basketball.
W
Smoking can contribute to the onset of asthma, or can severely aggravate an existing asthma condition.
W
Smokeless tobacco can lead to mouth sores and gum disease, even at a young age.
W
Both smoking and smokeless tobacco can lead to bad breath, yellowed teeth, stained fingers, dulled taste buds, and a dulled sense of smell.
W
One unseen impact is that young people who start smoking at a younger age are more likely than later starters to develop a long-term addiction to tobacco.
W
Teens who use tobacco are more likely to practice other harmful behaviors, including using alcohol and other drugs, being involved in fights, carrying weapons, or practicing high-risk sexual behaviors.
Page 7.5.5
Lesson 7-5: What
is Tobacco?
Procedures (continued) 6.
Review with the class some of the reasons discussed in the film as to why young people might take up smoking. These might include: W
dealing with depression or boredom
W
stress
W
to look cool
W
to feel mature
W
to be accepted
W
to be different
W
to break the rules
Ask students how “cool” they think it is to smoke. Do they like being around smokers? Would they like to date someone who smokes? Would they like to live with someone who smokes when they grow up? Ask the students to suggest healthy alternatives to smoking that they know about or that they learned in the film, and that can address some of the reasons for using tobacco listed above. L75_kissposter
7.
Review with the class some of the reasons why young people continue to smoke once they have experimented with cigarettes and started. As students list their reasons (e.g., pressure from friends, etc.), be sure that the concept of addiction is included-that is, they continue to smoke because they find it difficult or unpleasant to stop.
8.
Have the wrappers from four packs of cigarettes on a table. W
Ask students to look at all of the packs to find what kind of information is on the label.
W
Ask students to look carefully at the packs to find something exactly the same on each pack—the Surgeon General’s Warning.
W
Explain that the government requires a warning on all packs of cigarettes because of the danger involved with smoking.
W
Ask students what they think of these warnings. Are these warnings useful? Do you think people read them? If they think these warnings are effective for young people their age, why or why not?
Page 7.5.6
Lesson 7-5: What
is Tobacco?
Procedures (continued) Homework: Ask students to write their own warning label to try to teach other people about the dangers of smoking. Distribute the Smoking in the Home Worksheet. Ask your students to take these worksheets home, and to start a discussion with their family members using the questions listed on the worksheet. Ask them to record their family members' answers.
Journal: Think about all of the harmful effects of smoking. Which one concerns you the most and why?
Page 7.5.7
Lesson 7-5 Worksheet: Warning Labels!
Name __________________________________
Warning Label Worksheet Instructions: Below are the four warning labels that the government says must be placed on every package of cigarettes. Can you think of any other messages that you think would be more effective for young people like you? Write your own warning label to keep people from smoking. Think of messages that would be especially relevant to you. Feel free to use pictures if you’d like.
My Warning Labels:
Lesson 7-5 Worksheet: Smoking in the Home
Name __________________________________
Smoking in the Home Instructions: The purpose of this assignment is to find out about smoking in your own family, and to understand your family’s views towards smoking. Ask your family members the following questions (or write down the answers if you already know them). If your family members’ answers vary, write down the different answers you receive.
1.
Does anyone in your family smoke? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
2.
Has anyone in your family smoked in the past, but quit? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
3.
What do your parents think about smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
4.
What would your parents say if you smoked? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
5.
Are there any rules in your home about smoking? For example: No one is allowed to smoke inside our home You can only smoke in the bathroom You can only smoke outside You can smoke if children aren't around. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Turn to the Next Page
Lesson 7-5 Worksheet: Smoking in the Home
Smoking in the Home 6.
What about when your parents were children? Did any of their parents (your grandparents) or brothers and sisters (your aunts and uncles) smoke? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
7.
What did your parents think about smoking when they were your age? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Lesson 7-6
What Do People Think About Smoking? Introduction: The previous lesson asked students to gather information about smoking in their own family as part of a homework assignment. This lesson uses this information as a starting point for discussing family influences on smoking (or non-smoking) behavior.
Lesson Objectives: By the end of Lesson 7-6, students should be able to: W
W
Discuss their findings from their interviews with family members about smoking Understand what the term “nonsmokers’ rights” refers to
Materials: W
Interview with a Smoker worksheet (for homework).
Plan Ahead! This lesson's homework assignment calls for students to interview a smoker or former smoker. You will need to assess how easily students can find access to such an individual, and determine whether or not these individuals would be willing to discuss their habit (or former habit) with students. Alternatively, the homework can be turned into an in-class group interview with a guest speaker who is a smoker or former smoker. You will need to identify a suitable person ahead of time. One possible resource for guest speakers is your local chapter of the American Cancer Society. Make sure that students obtain permission to speak with individuals about their smoking behavior. You may need to prepare a script that explains who the students are, and the purpose of the interview assignment.
Key Terms: family rules: In the context of the home, any regulations a family imposes to control where or when smoking occurs in the home. These might include a complete prohibition on smoking (e.g., “No smoking in our house at all”), restrictions on time (“No smoking when the kids are around”) or restrictions on place (“only on the back porch,” or “only in the bathroom”).
non-smokers’ rights: Non-smokers have sought to achieve smoke-free places where people are not exposed to secondhand smoke. By mobilizing political support through education and legislation, this movement has produced laws and policies which prevent smoking in many places such as schools, government buildings and workplaces.
secondhand smoke: Secondhand smoke is the exhaled smoke from the lungs of a smoker, as well as the smoke that disperses from a lit cigarette, cigar or pipe. It is also commonly referred to as environmental tobacco smoke, or ETS. Inhaling secondhand smoke is often called “passive smoking.”
Page 7.6.1
Lesson 7-6:
What Do People Think About Smoking?
Procedures: 1.
Using the worksheet Smoking in the Home (from Lesson 7-5) as a guide, ask students to share their findings with the class.
2.
Use a large bulletin board or SmartBoard to compile the following information: W
How many students have a family member or other person who smokes at home?
W
How many students live with someone who has quit smoking?
W
How would parents feel if they knew their child was smoking?
W
How many families have rules about smoking in their home?
W
Do they think that attitudes about smoking are changing from one generation to another?
3.
Have your students discuss the following questions: W
Do you think young people who have parents who smoke are more likely to smoke than those whose parents don't smoke? Why or why not?
W
What influence do you think parents have in discouraging their children from smoking? Is there anything parents can do?
W
In what family situations do you think it is most likely that a young person would take
Teacher’s Note: Students may point out that having a family member who smokes has also shown them some of the dangers, or unpleasant consequences, of smoking. In these discussions, make sure to point out the following: W Children who have parents who smoke are more likely to smoke than those whose parents do not smoke. W If someone takes up smoking and decides to quit, quitting is more difficult if other household members continue to smoke.
up smoking? The least likely? W
Some people think that adults who smoke are showing children a bad example. What are your feelings about this?
4.
Ask your students: W
Why do people establish rules preventing cigarette smoking at home?
Secondhand smoke, also known as environmental tobacco smoke (ETS) or passive smoking is when a person inhales the tobacco smoke of another person who is smoking. This smoke contains the same harmful chemicals that are inhaled by the smoker, and can damage the health of nearby non-smokers. One important reason for establishing household rules about smoking is because one persons smoking in a home can harm the health of non-smoking family members (especially children).
Page 7.6.2
Lesson 7-6:
What Do People Think About Smoking?
Procedures (continued) 4.
Ask your students: W
What about rules that restrict smoking in other places— such as in workplaces, bars, restaurants, or public buildings? Why do you think these rules were created?
Point out that as people have learned more about the dangers of secondhand tobacco smoke, there has been a push for more protection of non-smokers’ rights to clean (smoke-free) air.
Homework: Distribute the Interview with a Smoker worksheet. Ask students to find a smoker and administer the accompanying questionnaire. Alternatively, this can be introduced as a group exercise. If at all possible, a Deaf person should be recruited for the interview. Modify the questions as appropriate if the interviews are conducted with a former smoker.
L76_passivesmoke
Teacher’s Note: Make sure that students obtain permission to speak with individuals about their smoking behavior. You may need to prepare a script that explains who the students are, and the purpose of the interview assignment.
Page 7.6.3
Lesson 7-6 Worksheet: Interview with a Smoker
Name __________________________________
Interview with a Smoker Instructions: The purpose of this assignment is to see what smokers themselves think about smoking, and to find out the circumstances of their starting to smoke.
1.
When and how did you start smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
2.
Do you consider yourself to be addicted to smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
3.
How long have you smoked? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
4.
How did you first start smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
5.
Did you think you would become a regular smoker when you started? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Lesson 7-6 Worksheet: Interview with a Smoker
Interview with a Smoker 6.
Have you ever tried to quit smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
7.
If so, why did you try to quit? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
8.
How did you try to quit? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
9.
What did it feel like when you tried? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
10.
If not, do you think you will ever try to quit? When? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
11.
What would you say to someone who wants to try smoking? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Lesson 7-7
The Decision to Smoke: Why We Don’t Always Make Good Choices Introduction: The prior lesson asked the students to interview a smoker (or ex-smoker) as part of a homework assignment. This was designed to allow students to ask questions as to why smokers started smoking, and why they continue(d) to smoke. The primary point of the lesson is for students to recognize the multiple factors that influence the individual decision to smoke: from peer pressure, the desire to look cool, depression or stress, curiosity, etc., even in the face of knowledge of the harms of smoking and other tobacco use.
Lesson Objectives: By the end of Lesson 7-7, students should be able to: W
Recognize that multiple factors influence all decisions and behavior
W
Recognize that multiple factors influence the decision to use—or not use— tobacco products
W
Recognize that addiction becomes the major reason for continuing to smoke once one becomes a regular smoker
Materials: W
Interview with a Smoker homework worksheets
W
Tobacco advertising samples (provided on CD)
W
Why Do We Do What We Do? Worksheet
Key Terms: family influences: In the context of smoking, families are known to exert several influences on a young person's attitudes towards smoking and decisions to start smoking or not. These influences include whether or not parents or siblings smoke, and the attitudes of family members (particularly parents) towards smoking and other tobacco use.
Page 7.7.1
Lesson 7-7:
The Decision to Smoke
Procedures: 1.
Using the Interview with a Smoker worksheet as a guide, ask students to share their findings with the class. Use a large poster or bulletin board to compile the following information:
2.
W
What was the average age at which smokers started smoking?
W
How many smokers started out intending to become a smoker?
W
How many smokers have tried to quit?
W
What were the reasons most smokers tried to quit?
W
How did most smokers feel when they tried to quit?
Review the results in light of the information offered in Lesson 7-4: W
More than 8 out of every 10 adult smokers say they started smoking before the age of 18.
When did you first start smoking?
L77_Stat1
W
More than 7 out of 10 young people who are regular smokers or smokeless tobacco users report that they continue to use tobacco because they find it hard to quit.
Why do you continue to smoke?
L77_Stat2
Page 7.7.2
Lesson 7-7: The
Decision to Smoke
Procedures (continued)
W
More than 9 out of 10 young people who smoke daily experience at least one symptom of addiction withdrawal (eg, difficulty concentrating, irritability, cravings) when they've tried to quit.
What happens when you try to stop smoking?
L77_Stat3
W
The earlier young people begin using tobacco, the more heavily they are likely to use it as adults. Most young people who smoke regularly are already addicted to nicotine, the principal habit-forming chemical in tobacco.
W
Most young people who smoke say they intend to quit in the future and yet are unable to do so.
W
The first try of a cigarette or chewing tobacco by young people occurs most often with peers.
W
Smoking often begins as an attempt to enhance self-image;
L77_Peers
that is, to feel more mature, "look cool," or as a way to bond with others.
3.
Ask your students to list the different kinds of factors that influence the decision to smoke that they have considered in class over the past lessons. Write the following terms on the board, and review the meaning of each type of influence:
L77_Boasting
W
Self-esteem
W
Friends
W
Family
W
Knowledge and information
W
Decision-making processes
Page 7.7.3
Lesson 7-7: The
Decision to Smoke
Procedures (continued) Teacher’s Note:
Ask your students to discuss how each of these
Be prepared to add the following if students do not bring them up:
factors influences young people's decisions: to smoke; or not to smoke. Discuss with your students which of these factors and forces do they think are most powerful? Least important? in influencing the decision to smoke or not.
4.
Ask the class to think of other types of influences that have an impact on their decisions and
Peers: the behaviors of peers-other people their age whom they might not even know but see around them at school, in the movies, on TV, etc.-may make behaviors such as smoking seem "cool." Advertising: Advertising influences the social perceptions of smoking and links the behavior to self-image.
behaviors.
Cost: Cost can serve as a barrier to smoking.
Explain that one of the reasons commonly given
Laws and Restrictions: These can limit access to cigarettes, or ban smoking in certain areas, which may help to limit smoking or tobacco use.
by young people for why they smoke is that smoking helps them look “cool.” Yet, most young people say that seeing people smoke turns them off; most dislike being around smokers; and most would rather date people who don't smoke. Even teens who smoke regularly don't think smoking is cool-most say that they
Movies and TV: These can have influence with respect to modeling behaviors. If tobacco use is portrayed as attractive, rebellious, mature, cool, etc., these portrayals can influence the perception of tobacco use.
wish they had never started. So where does the notion of “smoking is cool” come from? Use this opportunity to introduce the role of advertising in shaping our perceptions of behaviors such as smoking. Show some sample cigarette ads showing smiling, happy adults smoking in fun outdoor situations, with friends, or in romantic locations. This is the way tobacco companies get people to associate activities such as smoking with positive images.
L77_CamelRelax
Source: www.trinketsandtrash.org
What ideas about smoking do these advertisements give you? Do you agree with them? L77_CamelMotocross
Source: www.trinketsandtrash.org
L77_NewportFun
Source: www.trinketsandtrash.org
Page 7.7.4
Lesson 7-7: The
Decision to Smoke
Procedures (continued)
L77_Cambridge
s
Why might you start to think that smoking is relaxing and peaceful when you look at these advertisements? L77_ParliamentBeach
L77_KoolNature
Source: www.trinketsandtrash.org
L77_MarlboroCowboy
Source: www.trinketsandtrash.org L77_VSlimsAppeal03
s
Source: www.trinketsandtrash.org
Why do some people think smoking is “manly?” Why do you think they might associate smoking with being a “strong, independent woman?”
L77_VSlimsAppeal
Source: www.trinketsandtrash.org
L77_KoolRacing
Homework: Distribute the Why Do We Do What We Do? worksheet.
Page 7.7.5
Lesson 7-7 Worksheet: Why Do We Do What We Do?
Name __________________________________
Why Do We Do What We Do? Instructions: John is a 7th grade student who is deciding whether to try smoking or not. List how each of the factors below might affect his decision to smoke, or not to smoke.
“Hmm, I think I’ll try smoking.”
“Nah, I don’t want to smoke.”
Self-Esteem
Self-Esteem
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
Friends
Friends
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
Family
Family
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
Lesson 7-7 Worksheet: Why Do We Do What We Do?
Why Do We Do What We Do? Instructions: John is a 7th grade student who is deciding whether to try smoking or not. List how each of the factors below might affect his decision to smoke, or not to smoke.
“Hmm, I think I’ll try smoking.”
“Nah, I don’t want to smoke.”
Peers
Peers
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
Knowledge
Knowledge_________________ ___________
____________________________ ____________________________ ____________________________ ____________________________ ____________________________
____________________________ ____________________________ ____________________________ ____________________________
Rules
Rules
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
8th Grade Lessons:
Needed Materials and Preparations Lesson 8-1
* Worksheet: My Self-Improvement Plan
Lesson 8-2
* Worksheet: Where Do Those Ideas Come From?
Lesson 8-3
* D.A.R.E. Decision-Making Model * Worksheet: Big Movie Script
Lesson 8-4
* Refusal Skills Roulette game (two cube-shaped boxes that serve as a pair of dice, on which sentences are written on each side)
Lesson 8-5
* Pictures of packages from various types of tobacco products Clothes hangers, string, blank index cards * Tobacco product samples (pictures on CD) * Tobacco advertising samples (pictures on CD) * Worksheet: Staff Interview Form
Lesson 8-6
* Journeyworks, Inc. Pamphlet: Smokeless Tobacco: Spit it Out! * The ABCs of Smoking booklet and transparencies * Worksheet: Smokeless Tobacco * Cigarette packages wrappers showing the Surgeon General's warning messages * The Big Dipper video
Lesson 8-7
* Worksheet: The D.A.R.E. Decision-Making Process * Mechanical Smoker * Graphic: the Addiction Cycle
* These materials are included in the supply kit that accompanies
this curriculum, or in the case of handouts and worksheets, as PDF files on the accompanying CD. The PDF format should allow you to print the files directly from computer to printer, or you can print a single copy and make duplicates for your class.
8th Grade Lessons Materials List
Lesson 8-1
Our Character Traits and Self-Image Introduction: This lesson introduces the concepts of self-image and self-esteem, and explores the ways in which these are linked to behavioral choices. The conclusion students should come away with in this lesson is that our behaviors are very often shaped by how we see ourselves, and by how we think others see us. At the same time, the way we behave towards others is often shaped by how we see them. This leads directly into Lesson 8-2, which examines peer influence and peer behavior.
Lesson Objectives: By the end of Lesson 8-1, students should be able to: W
Recognize that character traits can be seen from three different perspectives: i i i
How they see themselves How they see other people How other people may see them
W
Understand that these different perspectives often influence their own behaviors, including how they behave towards others.
W
Identify some of their own strengths and characteristics they like about themselves
W
Choose one area they would like to improve and identify strategies toward this goal
W
Identify why this improvement is important to them
L81_SelfEsteem00
Materials: W
Self-Improvement Plan Worksheet
Key Terms: self-improvement: taking action to make ourselves better. strengths: Aspects of one's self of which one is proud or takes satisfaction, such as a particular skill, talent, behavioral trait, aspect of one's personality, or other special qualities. traits: Characteristics of one's personality or behavior.
Page 8.1.1
Lesson 8-1:
Our Character Traits and Self-Image
Procedures: 1.
Write the words positive characteristics on the chalkboard. Ask each student to name a person they know that they admire, and to describe the traits or characteristics that cause them to admire this person. As students list these traits, list them under the positive characteristics heading on the board.
2.
Explain that each person has positive characteristics. Positive characteristics are our strengths. These characteristics many include many things such as physical abilities (strong, good at sports), skills and talents (good at drawing, musical, creative, good skateboarder), personality attributes (friendly, confident), intelligence (smart, clever), communication skills (easy to get along with, someone to talk to), and more. Any positive aspect of a person can be considered
L81_Traits01
their strength. An important part of good mental health is to recognize our strengths. Often people are quick to identify their weaknesses, but they have a hard time realizing what their strengths are. Often, our strengths help us improve in those areas in which we are not very strong.
L81_Traits02
For example, a person who is a hard worker may not be a very good basketball player. But by practicing and working very hard—by using this strength—this person can become a better basketball player.
3.
Review with students the words that were used to describe people they admire. Ask students to add more positive characteristics to the list of traits they admire.
4.
Use the list of characteristics and traits in the following discussion: Ask students to think about these types of characteristics in themselves. Explain that these traits are rarely "all or nothing," but rather a matter of degree. Provide several examples as follows: W
Shy
W
Outgoing
W
Quiet
W
Talkative
W
Smart
Teacher’s Note: Be prepared to discuss, as appropriate, that the traits one might find positive in one particular circumstance (e.g., leadership of a student group) may be viewed negatively in another (e.g., the ability to exert power over others in, for example, a youth gang or bullying group). Point out that these characteristics can be seen as positives in some contexts and negatives in others. For example, being considered "brainy" might be complementary in the classroom, but more of a put-down ("nerd") outside the class; being "easy-going" might be a nice characteristic in a friend, but might be considered a negative comment about someone when describing their attitude on the playing field.
Page 8.1.2
Lesson 8-1: Our
Character Traits and Self-Image
Procedures (continued) W
Popular
W
Athletic
W
Artistic
W
Friendly
W
Easy-going
W
Nice
W
Wild
W
A leader
Point out that the way people feel or act sometimes varies with their situations. For example, some people may be shy when they are with strangers, or with hearing friends, but more outgoing with deaf friends or people they know well.
5.
Use the following five scenarios to discuss: W
How we see ourselves might influence our own behavior.
W
How we see others might influence how we behave towards them.
W
How others see us might influence how they treat us.
Scenario #1: W
Your teacher has asked you to join the school's Debate Club, but you don't think you're smart enough. Would the way you think of yourself influence the way you might respond in this situation?
Scenario #2: W
You like to think of yourself as wild and crazy, and your friend has just dared you to shoplift an item at the store. How might you react? What if you thought of yourself as an honest person?
Page 8.1.3
Lesson 8-1: Our
Character Traits and Self-Image
Procedures (continued) Scenario #3: W
There's a new girl at school that everyone talks about behind her back, saying she is weird and stuck up. One day she tries to start a conversation with you. Would you be anxious to start up a conversation with her? How would you act towards her?
Scenario #4: W
There's a new girl at school that everyone says is really cool. One day she tries to start a conversation with you. Would you be anxious to start up a conversation with her? How would you act towards her? Would your reaction be different from that in Scenario #3?
Scenario #5: W
You've gotten into trouble for breaking rules at school before, but you've decided to try and make a stronger effort to stay out of trouble. You've heard that last night, someone went into the teacher's lounge and trashed the room. Who do you think the authorities will question? Why? Do you think it is fair if they suspect you?
6.
Discuss with students that it can be difficult to change oneself, even when this is something we really want to do. But explain that while it is difficult, we can improve and change ourselves. It often requires considerable thought and effort to make the changes we want to make.
Page 8.1.4
Lesson 8-1: Our
Character Traits and Self-Image
Procedures (continued) Homework: Using the Self-Improvement Plan worksheet, ask students to W
Write one of their traits or characteristics that they would like to improve or change
W
Write why this improvement is important to them
W
Complete the statements as to how they feel this improvement can change their behavior or the behavior of others towards them.
After each student has recorded the area they would like to improve, ask them to write down two or three things they can do to help them achieve this goal. What difficulties might be encountered in making this change? Ask your students to consider how they can use their strengths to make this change.
Journal: Identify a person whose strengths you admire. What are their strengths? Why do you admire these characteristics?
Page 8.1.5
Lesson 8-1 Worksheet: Self-Improvement Plan
Name __________________________________
My Self-Improvement Plan My strengths are: (Use the back of this paper if you have more)
1. _________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________
One area I would like to improve is: ___________________________________________________________________________
I would like to improve because: ___________________________________________________________________________
To make this improvement, I can do the following:
1. _________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________
Making this improvement can change the way other people think about me by:
1. _________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________
Lesson 8-1 Worksheet: Self-Improvement Plan
My Self-Improvement Plan Strengths I have that will help me make these changes are:
1. _________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________
Lesson 8-2
Friends, Peers and Others Introduction: This lesson encourages students to recognize all of the different influences around them that may influence their decision-making. These include not just friend and peer influences, but also the influence of others such as parents, siblings, teachers and coaches; the influence of marketing-what they see in stores, on billboards or in magazines; the influence of media-what they see on television, in the movies, on the internet; and the influence of relative strangers, such as movie stars, or sports heroes.
Lesson Objectives: By the end of Lesson 8-2, students should be able to: W
Identify the ways—both positive and negative—in which their behaviors can be influenced by friends and peers;
W
Identify the ways—both positive and negative—in which their behaviors can be influenced by others around them who are not friends or peers;
W
Recognize that many of their behavioral choices are often shaped by other forces such as marketing and advertising.
Materials: W
Where Do Those Ideas Come From? Worksheet
Key Terms: friend: someone whom we like and care about; in the context of this lesson, usually refers to others of a similar age.
peer influence: the indirect force that peers exert in shaping one's opinions, perceptions, desires and behavior.
peer: In the context of these lessons, generally meant as others of a similar age. Friends are usually peers, but not all peers are friends. The term goes beyond schoolmates to include people the same age seen in the community, and portrayed in various media such as magazines, in film and on television.
peer pressure: the more direct force that friends and peers often use to shape one's opinions, perceptions, desires and actions.
Page 8.2.1
Lesson 8-2:
Friends, Peers and Others
Procedures: 1.
Write the terms friends and peers on the board. Discuss with your students the meaning of each term. Facilitate the discussion by asking questions, such as: W
What do we mean by a peer? Are all of your friends peers? Are all of your peers friends?
W
What about your schoolmates? How about other 8th graders at other schools?
W
L82_Peers
What about kids your age that you see at the mall, but don't know? What about kids you see portrayed on television shows, music videos, or in the movies? In magazine advertisements?
W
What about an adult family friend? What about a teacher you like?
2.
Teacher’s Note: The sign used for the word “friend” should NOT be used for the word “peer.”
Ask your students to discuss the following questions: W
Thinking about your friends, in what ways do you think they influence your decisions. Let's take, for example, clothing. Do your friends have any influence over what clothes you want to buy and wear? In what ways can they influence your choices?
W
Who else influences what clothes you choose to wear? What about your parents and brothers and sisters? What about the school? What about other students you see around you but don't really know?
W
With clothing, how do you decide which styles are “cool” or “dorky”? How do you know?
Make sure that the students cover the following: W
The influence of their own circle of friends
W
The influence of others like themselves that they see at school, outside of school, on television, in the movies, in magazines and elsewhere
W
Family influences (e.g., parents choosing the clothes they wear, or forbidding them from wearing certain styles of clothing)
W
School influences (e.g., banning certain types of clothing)
W
Marketing influences, e.g., “I choose types of clothing based on what I see in advertisements.” L82_Advertising
Page 8.2.2
Lesson 8-2: Friends,
Peers and Others
Procedures (continued) Point out that all of these different influences come into play; sometimes they act together, sometimes they act in opposition (e.g., you want a nose ring because all your friends have them and it looks really cool on that person on TV, but your parents say, “No way!�)
Explain to your students: All of these relationships affect your choices, in many different ways. The influences may be direct (e.g., what your friends say to you) or indirect (e.g., what your friends wear, what you see others wearing, what you see advertised on television or at the mall). The key thing to recognize is that, consciously or not, these multiple and varying influences come into play whenever you make a decision. Point out that often it is their friends who can influence what styles of clothing they desire or choose to wear; but that what they see on others around them (their peers) may also have a great deal of influence as well. These influences are often called peer influences.
3.
Introduce the following term to the class: Peer Pressure: Social or other forces compelling someone to adopt a particular type of behavior, dress, or attitude to be accepted as part of a group, or so as not to be excluded from a group. Ask the class to discuss these concepts and to think of ways they have been influenced by peer pressure. Prompt the students using the following types of questions: W
What would people say if someone came to school with their hair dyed green? Would you ever do something like that? Why or why not?
W
Have you ever behaved a certain way because your friends around you were acting the same way? What if your friends were doing something you thought was wrong, and they wanted you to go along?
W
L82_Green-hair
What other types of situations can you think of where peer pressure comes into play?
W
In what ways do you think you are different from others? Is it hard to be different in this way?
L82_take-a-smoke
Page 8.2.3
Lesson 8-2: Friends,
Peers and Others
Procedures (continued) 4.
Explain that sometimes peer influence and peer pressure can have both positive and negative effects, sometimes influencing us to make positive decisions, and sometimes influencing us to make negative decisions. Ask students to come up with their own examples they have experienced in which peer influence or peer pressure led to positive decisions. For example: W
Seeing others doing well in class makes you study harder and do better yourself.
W
L82_Decisions02
Your close friends tell you that smoking smells bad and is a stupid habit.
W
In PE class, your best friend challenges you, saying he will beat your time in the one-mile run.
W
Your friends tell you that you have talent and really should try out for the school play.
W
Your close friends are planning to volunteer at a local children's hospital.
5.
L82_WannaCig
Ask students to come up with their own examples they have experienced in which peer influence or peer pressure might lead to negative decisions. For example: W
Everyone makes fun of the new girl at school because of the clothes she wears.
L82_Teased L82_Decisions01
W
Your friends dare you to jump off a high wall on your skateboard.
W
Your good friends have decided to take up smoking after school.
W
You want to join a new secret club at school, but you have to steal something from the nearby store to prove you can be a worthy member. L82_Friendsmoke
6.
Ask students to evaluate their experiences above, as well as the following examples. Is the peer pressure positive or negative? Why? Write the items on the board one at a time and discuss each one. Remember that socially, some of these may be very appealing to students; take time to discuss these issues as well.
Page 8.2.4
Lesson 8-2: Friends,
Peers and Others
Procedures (continued) W
Some kids from your class invite you to study with them.
W
Your roommate in the dorm asks you to watch a movie that won't end until 1:30 in the morning.
W
You are trying to lose weight A girl in your class asks you to go running with her.
W
You are interested in learning about computer graphics. An older boy will teach you if you help him improve his Science grades.
W
A kid in your class invites you to a party on Tuesday and someone you really like will be there. Your mom already told you that you are not allowed to go to parties on weeknights.
W
An older kid who you think is cool invites you to have a cigarette after school. You want to impress him.
W
You are not good at shooting free throws in basketball. A teammate offers to help you improve your foul shot if you come to practice early each day to work with him/her.
W
A neighbor your age who lives down the street is out with her friends one night. You don't know most of them, and they don't really sign, but they offer you a cigarette. If you smoke, maybe they will be your friends.
W
Some of your friends are going to get their tongues pierced. You know your Dad said, “No,� but you want to get your tongue pierced anyway.
7.
Encourage your students to think about influences beyond their friends, family and peer network-especially the influences of media and marketing. W
Why is it that a particular style or brand of clothing suddenly becomes popular?
W
Who is behind what you see in the malls, or what you see on television and in the movies?
Homework: Pass out the Worksheet, Where Do Those Ideas Come From?
Journal: Many teenagers wear similar clothing and hairstyles. What is positive about looking similar to your peers? What is negative about looking similar to your peers?
Page 8.2.5
Lesson 8-2 Worksheet: Where Do Those Ideas Come From?
Name __________________________________
Where Do Those Ideas Come From? “Hey, when I smoke, I feel older and cooler. Smoking is a nice way to relax and have fun!”
L82WS_Cool
“Yuck! Smoking is disgusting. It makes your clothes, hair and breath smell bad. And most smokers don’t seem very relaxed, and most don’t look like they’re having much fun.”
Young people commonly express these ideas about smoking. Where do you think these ideas come from? Is one statement more correct than the other? In what ways? Write your thoughts below:
L82WS_Stinks
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Lesson 8-3
Tobacco Use and the Influence of Others Introduction: The purpose of this lesson is to strengthen students’ understanding of the different influences that may affect decisions such as whether or not to smoke; and that the influences of peers and friends operate within a broader set of forces (e.g., familial rules and expectations, as well as social forces including prohibitions and regulations, tobacco marketing, communal attitudes towards smoking, etc.). The choice to use tobacco (or alcohol or drugs) is made amidst different, and many times conflicting, influences. Students should become aware that their decision to use (or abstain from) tobacco is often influenced by unrecognized forces, such as the imagery promoted by tobacco companies, family expectations, friend expectations and perceived peer norms.
Lesson Objectives: By the end of Lesson 8-3, students should be able to: W
Identify the influences (friends, peers, advertisers, family, society) that affect decision-making
W
Identify the ways that peer pressure affects decision-making
W
Review the D.A.R.E. Decision-Making Model
W
Identify reasons why young people choose to smoke or not to smoke
W
List healthy alternatives to smoking
Materials: W
Tobacco advertising samples (provided on CD)
W
Anti-tobacco advertising samples (provided on CD)
W
D.A.R.E. Decision-Making Model (See Lesson 7-3)
W
Big Movie Script Worksheet
Key Terms: alternatives: the options or choices one has when confronted with a decision. decision making: the process of assessing choices and consequences when considering a decision to be made.
Page 8.3.1
Lesson 8-3:
Tobacco Use and the Influence of Others
Procedures: 1.
Review with your students how friends and peers can influence a person's decisions.
Ask your students: How do you think friends and peers might influence a person's decision to smoke or not? For examples of friends and peers encouraging smoking: W
Friends may smoke themselves; may suggest smoking to you; may have attitudes that favor smoking (“That looks so cool!” or “Try it, it gives you a nice little buzz!”).
W
Peers: if you believe that most of the kids around you smoke; if you see a lot of kids around you smoking; if you see characters
L83_Friendsmoke
your age in movies or on TV who are portrayed as cool with cigarettes, drugs or alcohol use; if you view smoking peers as “cool” or looking “more mature.” For examples of friends and peers discouraging smoking: W
Friends may keep you from smoking; may express attitudes opposing smoking (“That stinks, yuck!” or “Smoking: What a stupid thing to do!”).
W
Peers: if you believe that most of your peers do not smoke; if you don’t see many peers around you smoking; if you see peers who choose not to smoke as making smart and independent decisions; peers in anti-smoking ads.
2.
L83_SmokingStinks
What about the influence of others besides friends and peers? For examples of others encouraging smoking: W
Influence of others around you: if a family member like a parent smokes; if parents argue their right to smoke (“So what if I smoke around my kids? It’s not like I’m putting a cigarette in their mouth!”); if another family member such as a brother, sister or cousin gets you started on smoking, or buys you cigarettes;
L83_FamilySmokes
if you see teachers smoking around you. For examples of others discouraging smoking: W
Influence of others around you: if your parents are firmly against smoking; if a family member has asthma, or someone you know has cancer from smoking; if your teachers or other adults you know used to smoke but quit. L83_FamilyNoSmoke
Page 8.3.2
Lesson 8-3: Tobacco
Use and the Influence of Others
Procedures (continued) 3.
What about other influences? For examples of other influences that encourage smoking: W
Other influences you might not be aware of: tobacco advertising in magazines, on billboards, at sporting events, on clothing or hats; favorite movie stars or sports figures who smoke or use smokeless (chewing) tobacco; candy cigarettes or cigars; smoking or tobacco use that looks attractive or cool in movies or on television. L83_KoolAd
Source: www.trinketsandtrash.org
For examples of other influences that discourage smoking: W
Other influences you might not be aware of: anti-tobacco advertisements; if a famous model or sports figure tells you that you shouldn't smoke; laws or rules against smoking on school grounds, or in restaurants, public places, work places, etc.
Ask your students: How do you think rules such as those prohibiting smoking at school, in restaurants, at the park, in offices, etc. might affect your decision to smoke or not? Do you think those rules have any impact on how “easy” it would be to find opportunities to smoke? How about laws
L83_JackieChan
Source: www.cdc.gov/tobacco/pubs1.htm#posters
designed to make it difficult for you to purchase cigarettes? What about smoking at school? Does anyone know if there are rules about smoking on campus? What happens to students who violate those rules? Has anyone ever seen anyone breaking those rules on campus? Students? Teachers? Staff? Do these rules make a difference? Are they important? In what ways?
4.
Provide your students with the following information: W
Every day 2,000 teenagers in the US begin to smoke regularly.
W
Still, most people in the United States—including most young people—do not smoke.
W
Scientists say there are many reasons why young people start to smoke. Four reasons that young people commonly give for starting to smoke are (write these on the board):
Teacher’s Note: This is an opportunity to raise the issue that smoking may seem "cool" because that's how the habit is often portrayed in advertising, in movies and on television. For tobacco companies that sell cigarettes, their goal is to associate the product with positive images. Thus, cigarette advertisements often portray smiling, healthy people engaged in fun activities; or romantic situations; or show their product linked to desirable qualities such as strong will, decisiveness, intelligence, independence, risk-taking or power. See Procedure 6 below.
Page 8.3.3
Lesson 8-3: Tobacco
Use and the Influence of Others
Procedures (continued) To be accepted To solve problems or relieve stress To have fun To appear older Ask students to list other reasons why they think teenagers decide to start smoking.
5.
Divide the class into four groups and ask each group to consider one of the four reasons for starting to smoke listed above. Ask the group to brainstorm positive alternatives to smoking that will help them accomplish these results (e.g., acceptance, problem solving/stress reduction, having fun, or appearing more mature) without resorting to tobacco use, drug use or alcohol. Share ideas with the group.
6.
Have students discuss their homework assignment from the previous lesson. Ask your students how their own perceptions of smoking affect their choice to smoke or not. For example, they may believe that smoking makes their breath smell bad or yellows their teeth; OR, they may think that smoking can make them look more sophisticated, older, or cool; or would impress friends or other people.
Ask your students: Where do these perceptions come from? For example, why would we think that smoking might make us look more sophisticated or older? More cool? More impressive to others? Why might we think that smoking is bad for us? Where does this information come from? What feelings or impressions do you get when you look at these advertisements? What associations do the people behind these ads want you to make with their product?
L83_Ad01
Source of all images: www.trinketsandtrash.org
L83_Ad02 L83_Ad03
L83_Ad04
Page 8.3.4
Lesson 8-3: Tobacco
Use and the Influence of Others
Procedures (continued) 7.
Point out that the D.A.R.E. process encourages us to think carefully about the different aspects of making a decision-from defining what our actual choices are and why the decision is important, to identifying the consequences of our possible decisions. If we understand how friends, peers, family and others influence our decisions, we can more clearly identify our choices, assess their consequences, and make wise decisions.
8.
Teacher’s Note:
Review the D.A.R.E. decision-making process.
If your class has never covered the D.A.R.E. decisionmaking process before, you may need to take some time to review the steps with your students. The model can be found in Lesson 7-3, which uses the decisionmaking process of the Drug Abuse Resistance Education (D.A.R.E.) program, the pioneer prevention effort established in 1983. Given the widespread use of D.A.R.E. programming in the elementary grades, there is a significant likelihood that your students will have been previously exposed to the D.A.R.E. decision-making model. If not, the concepts underlying the model are relatively straightforward and are reviewed in Lesson 7-3.
Hand out the Big Movie Script Worksheet. Describe the following situation to the class: You have been asked by a famous movie director to help make a movie. In the movie, the star, Cody, must make a very important decision. The director doesn't know the ending to the movie yet. He wants you to decide how the movie will end. Using the D.A.R.E. decision-making process, create an ending to the movie script. Read the script and write the ending. Remember you must show how Cody makes his decision. Students can plan the script in small groups or individually. The class
L83_DARE
will vote on how well each script uses the D.A.R.E. process.
Journal: Children of parents who smoke are at higher risk (twice as likely) to become smokers. Why do you think this is true? If most young people do not use tobacco products, where does the pressure to do so come from?
Page 8.3.5
Lesson 8-3 Worksheet: Big Movie Script
Name __________________________________
Lights! Camera! Action! Scene: As Cody leaves school on Tuesday, his friends Jim and Jon talk to him.
Jim:
Ellen's mom and dad are out of town, so she's having a big party tonight!
Jon:
This is great! My brother said he would buy us cigarettes and beer if we give him money. (At first Cody thinks this a party is a great idea. As John starts talking about cigarettes and beer, he realizes that the party might not be such a great idea.)
Lesson 8-4
Tobacco Use: Resisting the Influences to Smoke Introduction: This lesson is designed to help students learn ways to assess and resist the various types of influence to smoke.
Lesson Objectives: By the end of Lesson 8-4, students should be able to: W
Understand the concept of resistance, how they resist, and how others resist them;
W
Classify different types of resistance (i.e., passive, aggressive, assertive);
W
List and practice different ways of saying "No" to tobacco.
W
Gain an understanding why these resistance strategies may often be difficult in practice.
Materials: W
Refusal Skills Roulette game (Two cube-shaped boxes, to serve as a pair of dice, on which sentences will be written on each side)
Key Terms: refusal skills: tools which one can use against friend or peer pressure to do something that one finds undesirable, unsafe, or wrong. refusal strategies: ways of expressing refusal, divided here into three major types: passive, aggressive and assertive. Passive: refusal in a non-confrontational manner without actually saying “No.” Tends to be non-committal (“Um...maybe”), and often involves leaving an issue unresolved. Aggressive: refusal expressed by using confrontational strategies. Assertive: Refusal in a firm, clear, but non-threatening manner.
L84_SayNo
Page 8.4.1
Lesson 8-4:
Tobacco Use: Resisting the Influences to Smoke
Procedures: Teacher’s Note: 1.
Review with your students the ways in which different people and situations influence—or try to influence—behavior. Point out that the class has also discussed that it is up to each person to make his or her own decisions, and how using the D.A.R.E.
Refer to the D.A.R.E. decision-making model (Lesson 7-3 and 8-3) to consider the possible interpersonal "consequences" of refusing to do what others want us to do.
Model can help clarify this process.
2.
Discuss with your students why refusing to go along with others—including people whose ideas and opinions are important to us—can be difficult to do.
3.
Explain that when we want to refuse to do something that others want us to do, it is useful to have some ideas about how to refuse.
4.
Discuss the different types of resistance that people use. Ask your students to consider situations that may have relevance to everyday situations: For example: W
Your friends ask you to join them behind the gym to smoke cigarettes.
W
Your friend asks you to cover for him and tell his parents he was at your house last night.
W
Your friend wants you to try smoking.
W
Your boyfriend is pressuring you to have sex.
W
A teacher asks you to stay after school for extra tutoring.
W
Your friends dare you to shoplift a small item at a convenience store.
L84_SayNo
As students describe the ways that they resist (e.g., I ignore my friends’ invitation; I shrug my shoulders; I say, ‘Maybe next time.”; I giggle and then look away, etc.), write them on the board.
L84_Passive
Passive Resistance Explain to your students that some of these strategies can be termed passive resistance; when we avoid our friend, when we say “um...maybe” or simply shrug our shoulders or laugh when he asks us to try smoking, we are resisting passively. We avoid confrontation by neither agreeing or disagreeing, walking away, or ignoring the issue.
Ask your students: What other types of situations can you think of where you've used passive resistance?
Teacher’s Note: Advantages might include avoiding conflict; disadvantages might include not resolving the problem, or not making your decision clear to others.
Page 8.4.2
Lesson 8-4:
Tobacco Use: Resisting the Influences to Smoke
Procedures (continued) Aggressive Resistance L84_Aggressive
Some strategies can be termed aggressive resistance. These usually involve a more confrontational tone, such as taking a cigarette that someone has offered you and crushing it in your hands, saying, “Get that stuff out of my face!”
Ask your students: What other situations can you think of where someone might use aggressive resistance?
Teacher’s Note: Advantages might include being clear and forcefully direct; disadvantages might include sparking a fight or argument, or causing bad feelings.
Assertive Resistance A third resistance strategy is sometimes called assertive resistance. L84_Assertive
Assertive resistance usually involves making your resistance known in a direct but non-confrontational manner. For example, “No thanks, I don’t smoke,” or “Let’s NOT get into your parents’ liquor cabinet—why don’t we find something else to do instead?”
Ask your students: What other situations can you think of where someone might use assertive resistance?
5.
Teacher’s Note: Advantages might include being direct; disadvantages might include causing bad feelings.
What type of resistance strategy is most effective when confronted with pressure to do something—such as smoke a cigarette, try marijuana, have sex, get drunk—that we are afraid to do, or don't think we should do? Explain to the class that different situations may require different strategies. What is important to know is that there are several different ways to say “No.” Have your students examine the following techniques. How well do they think they would work in different situations?
1. Be direct
L84_Refusal01
Page 8.4.3
Lesson 8-4:
Tobacco Use: Resisting the Influences to Smoke
Procedures (continued)
2. Change the subject
L84_Refusal02
3. Think of a clever response
L84_Refusal03
4. Make a joke
L84_Refusal04
5. Blame an adult
L84_Refusal05
6. Walk away or avoid the situation
L84_Refusal06
Page 8.4.4
Lesson 8-4:
Tobacco Use: Resisting the Influences to Smoke
Procedures (continued) 6.
Encourage your students to think about resistance from another perspective: Often you are the one trying to convince someone else to do something they may not want to do. How might that person react to you? For example: W
You tell your friend to skip tomorrow's party and go with you to a movie instead.
W
You want to convince your mom to let you get your tongue pierced.
W
You ask your parents to let you go to a movie with your friends on a school night.
W
You hound your parents to buy you a dog.
Which of the strategies do your students encounter when they try to pressure others to do something?
7.
Discuss why it is sometimes difficult to undertake resistance strategies. For example, resistance may start an argument or fight; might hurt someone's feelings; might embarrass oneself; or might get someone in trouble.
8.
Present situations and ask how students would respond? Which types of responses are easiest? Which types are hardest? W
You are at the store. Your friend grabs a CD and hides it in her bag. She tells you to shoplift one as well.
W
You go to your friend's house where you find him
L84_Shoplift
in the garage, smoking marijuana. “Here,” he says, “Try some.” L84_Marijuana
W
Tom is a friend of yours. During a break in class, he hands you a pack of cigarettes. “Hey, be a pal,” he says. “Keep this for me until this afternoon.”
9.
Have students play Refusal Skills Roulette. L84_HideCigs
Page 8.4.5
Lesson 8-4 Game: Refusal Skills Roulette
Refusal Skills Roulette Directions: 1.
On each side of the first die, write the following:
Be Direct Change the Subject Think of a Clever Response Joke Walk Away Blame an Adult 2.
On each side of the second die, write the following:
“Why don't you smoke cigarettes with us, your mommy won’t let you?” “Want some pot?” “Come on, no one will know if we have sex, don’t you love me?” “I have some beer in my backpack, meet me after school to drink it.” “So what if you’re grounded? We can sneak you out through your window tonight.” “Hey there’s that new kid. He’s such a dork—let’s go steal his backpack.” 3.
Students will take turns throwing the dice and then using the situation and the strategy to respond. One variation of the game may be to have pairs of students role-play the various situations and resistance strategies.
4.
Discuss with your students how it felt to use the various strategies. Would they have chosen different strategies if they were able? Which ones, and why?
Lesson 8-5
What Encourages Tobacco Use? Introduction: This is the first of three lessons that build on the concepts developed in lessons 8-1 through 8-4. Lesson 8-5 introduces how these concepts are applied to tobacco use, exploring the pressures that encourage tobacco use. In Lesson 8-6 the influences that discourage tobacco use will be considered. In Lesson 8-7 we draw these themes together to expand on issues relevant to the tobacco use decision-making process, including addiction. Each lesson may require more than one class session.
Lesson Objectives: By the end of Lesson 8-5, students should be able to: W
Identify the various ways in which tobacco is used
W
Understand patterns of tobacco use for adults and youth
W
Understand these patterns, i.e., why young people use tobacco products, in light of the influences discussed in Lessons 8-1 through 8-4
W
Recognize that factors are "weighed" in favor of or against decisions as they are made
Materials: W
Examples of packages from various types of tobacco products (or pictures) (Cigarettes; chewing tobacco; pipe; cigar; bidis; kretek; waterpipes)
W
Clothes hangers, string and index cards for creating a hanging "balance" of push/pull factors for tobacco use.
W
Tobacco product samples (pictures on CD)
W
Tobacco advertising samples (provided on CD)
W
Staff Interview Forms
Key Terms: marketing: persuasion to buy a product or accept an idea by presenting it in a favorable light that shows its advantages or attractions; advertising. perception: one's view of, or attitude toward, an idea, behavior, product or other object, that is shaped through knowledge, experience, observation, and communal and peer norms.
Page 8.5.1
Lesson 8-5:
What Encourages Tobacco Use?
Procedures: 1.
Valuable Resource:
Review with your students the various types of tobacco products (cigarettes, chewing tobacco, pipe; cigar; bidis; kretek; waterpipes). Use the following pictures from the accompanying CD of images. Emphasize the tobacco products not normally thought of as tobacco, including bidis and clove cigarettes, and the new breed of flavored cigarettes.
Many of the photographs of tobacco packaging and advertisements in this curriculum are taken from Trinkets and Trash Services, a company formed to make tobacco promotionrelated information available for antitobacco educational purposes. Their website lists thousands of images. If you are interested in obtaining more images, visit their website at: www.trinketsandtrash.org
L85_CamelPacks
Source: www.trinketsandtrash.org
s
L85_Doral
Source: www.trinketsandtrash.org
Most students will be familiar with tobacco in cigarette form, such as the familiar Marlboro and Camel cigarette brands. Note the giveaway (free racing t-shirt) provided with the Marlboro cigarettes. And most will probably have seen cigars and cigarillos. L85_Cigars
L85_MarlboroPackage
Source: www.trinketsandtrash.org
L85_Cigarillos
Students may be familiar with smokeless (or chewing) tobacco, although many may have never seen it or its packaging. It is most commonly sold as loose tobacco leaf in tins... L85_Skoal
Source: www.trinketsandtrash.org
...or in pouches such as this Red Man tobacco package. Smokeless tobacco use is particularly common among baseball players. Note how one candy manufacturer is taking advantage of this to sell bubblegum. Who will buy this product? What do your students think of this type of marketing?
L85_ChewTin
Source: www.trinketsandtrash.org
L85_RedManChew
L85_BigLeagueChew
Source: www.trinketsandtrash.org
Source: Print Ad, National Geographic Kids
Page 8.5.2
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued) Other tobacco products include pipe tobacco... ...and even tobacco sold loose for hand-rolled cigarettes L85_HandrollTobacco
L85_PrinceAlbert
Source: www.trinketsandtrash.org
Source: www.trinketsandtrash.org
Increasingly common among young people are cigarettes that originated in India, including bidis... ...kretek... ...and clove cigarettes. L85_Bidis
Source: www.trinketsandtrash.org
Many young people smoke bidis, kretek and clove or herbal cigarettes in the mistaken belief that they are not “real” tobacco. In fact, they are made from tobacco, and are just as addictive and harmful to health as “regular” cigarettes and other tobacco products. L85_Kretek
One reason young people may believe these tobacco products are different is that they don’t really “look” like normal packaged cigarettes, nor are they marketed in the same way. Look at the colorful packaging, as well as the flavored varieties that are available: Grape! Wild Cherry! Lemon Lime! These sound like candy varieties. Who do your students think will find these colorful packages and exotic flavors appealing?
L85_CloveCigarette
L85_FlavoredTobacco
L85_BidiFlavors
Source: www.trinketsandtrash.org
Source: www.trinketsandtrash.org
Source: www.trinketsandtrash.org
Page 8.5.3
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued) 2.
Teacher’s Note:
Ask your students: W
This section presents information in terms of percentages. You may need to review briefly with your students the concept of “percentages”-e.g., 50% representing 50 out of 100, or half.
How many of you know peers—people your age—who have used any of these products?
3.
Ask your students: W
What percent of people your age do you think have ever smoked cigarettes—that is, they've tried smoking at least once?
W
What percent do you think have ever used smokeless (chewing) tobacco?
Write the answers on the board or on the transparency for each group.
Teacher’s Note: 4.
Show your students the following “ever smoked” data by age. Point out to your students how their estimates are the same as (or different from) the actual statistics. By 8th Grade:
Scientists make a careful distinction between ever use and current use. Ever use will always be greater than current use because significant numbers of people who try tobacco never go on to regular or even occasional use. Ever users may also include former smokers. Current users are those who are actively using tobacco, either on an occasional or regular basis. Current use is often measured by 30-day prevalence—that is, the number of people who have used a tobacco product within the past 30 days.
L85_8thGrade
By 10th Grade:
L85_10thGrade
Page 8.5.4
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued) By 12th Grade:
L85_12thGrade
A survey of over 200 Deaf high school students in California found that: W
45% have ever smoked
W
By college, 65% say the have smoked at least once.
Point out to your students how the rates of “ever smoked/chewed” increase as young people get older. Ask them to explain why this is the case (e.g., the older you are, the more opportunities you have to try smoking at least once.)
5.
Compare your students’ estimates with the figures given above. If their estimates were higher, explain that young people often overestimate the number of people who smoke, perhaps thinking that smoking is a more common behavior than it really is. Some people may be encouraged to try smoking if they believe that, “everyone else is doing it.” If your student's estimates were lower, explain that tobacco use and smoking are important problems for young people, especially for your students’ age group. Make sure your students understand that they are at an age of very high risk for starting tobacco use.
6.
Discuss with your class why young people smoke and use chewing tobacco. What forces encourage this decision? List these on the board. For example: W
“It makes me feel cool”
W
“To be accepted”
W
“It is something to do”
W
“It makes me look older”
W
“I need the energy boost it gives me”
Page 8.5.5
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued)
7.
W
“It helps me relieve stress”
W
“It is an easy way to have fun with my friends”
Ask your students: W
Do you think smoking makes someone look cool, older or more mature?
W
People say they smoke to reduce stress. Do you think this works? Why or why not? People say they smoke because they are depressed. Do you think smoking makes them less depressed? Why or why not?
W
Do you think there are other ways to deal with stress or depression?
W
Where do these ideas—that smoking or using tobacco makes you look older or more cool; or that it helps you relax and have a good time; or that it gives you energy—come from? Raise the issue of the role of tobacco advertising. Make the point that tobacco marketing can be very subtle. Note the various types of appeals built into the marketing materials (acceptance/popularity, beauty, thinness, feminine/masculine, mature, etc.). What kinds of situations do these cigarette advertisements depict? When students see these ads, what kind of ideas to they start to have about smoking? Do you think these advertisements might influence young people’s expectations for smoking? Ask your students to come up with adjectives to describe these scenes: for example, fun, excitement, friendship, exotic.
L85_NewportBiking
L85_CamelCasbah
Source: www.trinketsandtrash.org
L85_CamelParty
Source: www.trinketsandtrash.org
Then ask students where the idea that “smoking is cool” comes from.
Source: www.trinketsandtrash.org
L85_NewportParty
Source: www.trinketsandtrash.org
Page 8.5.6
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued)
What about the idea that smoking is relaxing?
L85_ParliamentHammock
Or that smoking is romantic? Notice the appeal to African Americans in this ad, and below:
Source: www.trinketsandtrash.org
L85_NewportRomance
L85_MeritYacht
Source: www.trinketsandtrash.org
Source: www.trinketsandtrash.org
L85_KoolPlayers
Source: www.trinketsandtrash.org
Virginia Slims is a cigarette brand that is marketed to women. What kind of women? What do you think from the ads below? Notice also the ethnicity of the women in these ads.
What about the notion of smoking as being “manly” and “masculine”? L85_CamelBond
L85_Marlboro01
Source: www.trinketsandtrash.org
Source: www.trinketsandtrash.org
L85_VSlimsVoice
Source: www.trinketsandtrash.org
Page 8.5.7
Lesson 8-5: What
Encourages Tobacco Use?
Procedures (continued) 8.
Introduce the concept of “balance”—that influences can both “push” and “pull” people as they make decisions, and these forces are “weighed” in decisions that are made. Distribute index cards to the class. Ask students to write down factors that they think encourage tobacco use. Examples of such “pull” factors might include, “makes me feel cool,” “makes me look mature,” “helps me fit in with friends,” “makes me feel better,” etc.). They should use one index card per factor. Indicate to the class that in the next session we will be looking at other factors that “push” the other way—that discourage tobacco use. Save these for use in Lesson 8-6.
9.
Advise your students that in the next session they will be talking about the opposite—influences that discourage tobacco use. Ask your students to think about such forces. For example, do they think that the rules that exist at school about tobacco use have any impact on the decision of students to smoke or not to smoke? Do the rules encourage use? Discourage use? Ask your students to imagine that they have just become the Superintendent (Principal) of the school. Their first job is to help students avoid smoking. How would they do this? What rules would they create about smoking? Explain the homework assignment. Indicate that the results of the survey will be discussed in the next class session.
Homework: Have each member of the class conduct an interview with one member of the staff (faculty, dorm staff, administration, school nurse, counseling staff), completing all questions on the Staff Interview Form.
Teacher’s Note: Advise your colleagues about this assignment (via e-mail, note, etc.). Indicate that they will be asked about their own cigarette smoking practices. You may want to assign groups of students to interview a particular staff person, or you can invite a school administrator or staff person to come to class as part of an in-class interview.
Journal: What difference does it make if your perception of people smoking is different than what is actually occurring?
Page 8.5.8
Lesson 8-5 Worksheet: Staff Interview
Name __________________________________
Staff Interview Form Name of staff person interviewed __________________________________
1.
What rules does the school have about smoking? other tobacco use? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
2.
Who is allowed to smoke on campus? at social events? at sports events? at events off campus? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
3.
What happens if someone—a student, teacher, guest—who is not allowed to smoke on campus is caught doing so? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
4.
What kind of help does the school provide to people who are addicted to tobacco? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
5.
Do you think rules about tobacco use in school: are strict enough. Why? _____________________________________________________ should be stricter. Why? In what ways?_________________________________________ should be less strict. Why? In what ways?_______________________________________
Lesson 8-5 Worksheet: Staff Interview
Staff Interview Form 6.
Have you ever smoked cigarettes? Yes No
If the person answers “Yes”: How old were you when you started? _______________ What were the reasons you decided to start? ___________________________________ __________________________________________________________________________ __________________________________________________________________________
Did people pressure you to smoke? Yes No Do you smoke cigarettes now? Yes No If No: How old were you when you quit? ______________ Why did you quit?___________________________________________________ ___________________________________________________________________ ___________________________________________________________________
If the person answers “No”: What were the reasons you decided not to start? ________________________________ __________________________________________________________________________ __________________________________________________________________________
Lesson 8-5 Worksheet: Staff Interview
Staff Interview Form Did people pressure you to smoke? Yes No Was it hard to say no? Yes No
Lesson 8-6
What Discourages Tobacco Use? Introduction: This lesson examines the factors that discourage tobacco use, including knowledge of the health effects and social consequences of tobacco use, anti-tobacco efforts, and rules and regulations restricting tobacco use and smoking.
Lesson Objectives: By the end of Lesson 8-6, students should be able to: W
Identify that tobacco use has undesirable health and other consequences
W
Learn about the health effects and social consequences of tobacco use
W
Recognize the forces seeking to keep young people from using tobacco products, including anti-tobacco advertising, taxation and rules and regulations.
Materials: W
Completed Staff Interview Forms (from session 8-5)
W
Journeyworks, Inc., pamphlet: Smokeless Tobacco: Spit it Out!
W
The ABC’s of Smoking pamphlet
W
Smokeless Tobacco Worksheet
W
Cigarette package wrappers showing the Surgeon General’s warning messages
W
The Big Dipper video
Key Terms: health consequences: the physiological results, both immediate and long-term, of tobacco use smokeless tobacco: chew, chewing tobacco and other tobacco products that are consumed orally, but not smoked.
warning labels: Information that is required on all tobacco packaging and advertising, describing some of the health hazards of tobacco use.
social consequences: the results of tobacco use that pertain to relationships with others; compliance with school and community laws and regulations; economic impact; and other non-health considerations.
Page 8.6.1
Lesson 8-6: What
Discourages Tobacco Use?
Procedures: 1.
Refer to the prior lesson to remind students that there are pressures to use tobacco products. On the other hand, what are some of the factors that discourage people from using tobacco products? Have students bring out their Balance project (begun in Lesson 8-5, Activity #8). Ask them to suggest some of the forces and factors that discourage tobacco use. Examples: W
Knowledge about the health consequences of tobacco use (e.g., it causes cancer, leads to heart disease and strokes, fear of addiction, etc.)
W
Social consequences of smoking (e.g., gives you bad breath, smells bad, gateway to other drug use, etc.)
W
Economic consequences (e.g., expensive habit)
W
Parents’ opposition
W
Rules and regulations that restrict the purchase of tobacco, or that restrict the practice of smoking or other tobacco use.
W
Anti-tobacco information and advertising (e.g., www.tobaccofreekids.org, the Truth campaign)
2.
Write the words Health Consequences on the board. Explain to your students that knowledge about the harmful effects of tobacco on the body can help make the decision not to smoke. Distribute the pamphlet The ABC’s of Smoking. Over the past 50 years, scientists have shown that the components of tobacco—the chemicals found in tobacco and in the smoke when tobacco is burned—can harm the body in very serious ways. Ask your class if they can list some of the most important health consequences of tobacco use. Classify the responses into the following categories:
Teacher’s Note: If your students have previously completed the 7th grade unit of this curriculum, they may have already studied the health and social consequences of tobacco use. If so, you may choose to present an abbreviated version of the material presented here.
Valuable Resource: Other facts and figures regarding smoking and young people can be found at: http://tobaccofreekids.org/research/ factsheets/index.php
Check This Out!: 3.
Effects on the respiratory system: The most common way people use tobacco is to burn it and inhale the resulting smoke, either from a cigarette, cigar, pipe, bidi, kretek, or waterpipe (hookah). This smoke causes a great deal of damage to the tissues of the respiratory system: that is, the lungs and airways leading to them.
A wonderful interactive animated presentation of the effects of tobacco on different organ systems in the body can be found at: http://www.cdc.gov/tobacco/sgr/ sgr_2004/sgranimation/flash/ index.html
Page 8.6.2
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) When a person inhales, their lungs fill with air containing oxygen. The lungs have tiny air sacs, called alveoli, where the oxygen is absorbed into the blood and exchanged with carbon dioxide, a waste product of the body that is exhaled as the person breathes out. This process is called gas exchange, and is the primary function of the lungs. The oxygen absorbed by the blood in the lungs is then carried to the heart, and all other tissues and organs of the body. When you inhale, the inside of your lungs and airways are
L86_Alveoli
exposed to air, including any germs, dust, dirt particles and other objects
Demonstration:
floating in the air. To clean away these foreign particles, your lungs and airways secrete mucus, which traps the particles. Little hair-like structures called cilia then push this mucus, with its trapped particles, out of the lungs and airways, where it can be coughed, spit, or otherwise passed out of the body.
Purpose: To demonstrate the paralyzing effect of cigarette smoke on the bronchial cilia Materials: A tennis ball and a basketball Procedure: Have students line up in two rows facing each other, with arms outstretched in front of them, and fingertips barely touching those of the person across from them. Starting at one end, place a tennis ball in the middle of the outstretched fingertips, and ask the students to move the tennis ball down the line, by wiggling ONLY their fingertips. Repeat with a basketball. Have students repeat the exercise, but this time forbidding the students from moving or wiggling their fingers at all.
So what does smoking do? Tobacco smoke can paralyze the cilia that move this mucus out of the lungs and airways, making it more likely that germs, dirt and other contami-
Explain: This is the way cilia act to move mucus and dirt particles out of the lungs and airways. When cilia are healthy, they can move mucus and trapped contaminants out easily. When exposed to cigarette smoke, however, the cilia become paralyzed, making it much more difficult to move these contaminants out of the body.
nants (together with the mucus) will get trapped in the lungs. The more A healthy lung normally has a smooth surface. Compare the healthy lung with this diseased lung of a smoker. This lung shows lung cancer, the grayish-white bumps on the lung.
L86_HealthyLung
Image Source: The ABC’s of Smoking
L86_LungCancer
Image Source: The ABC’s of Smoking
Page 8.6.3
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) Demonstration: Purpose: To demonstrate what it feels like to have emphysema. Materials: Coffee stirrers (hollow) or very small straws Procedure: Have students place a coffee stirrer in their mouths. Explain that for the next two minutes, they can breathe ONLY through the coffee stirrer. After students have recovered, repeat the exercise, but this time ask students to walk around the room and try to talk with each other, again without inhaling anything except through the straw. Explain: This is the way it feels ALL THE TIME if you have emphysema. No matter how hard you breathe, your body cannot get the oxygen it needs. Have students note how much worse it felt if they had to move around. Point out that any exertion—even just walking around—becomes very difficult for a person with emphysema. Note that the disease is progressive—that is, it gets worse and worse over time—and has no cure. The disease is almost always fatal, but not before a long period of wasting and fatigue.
and the longer you smoke, the greater the damage done to these cells until they lose almost all of their ability to clean the lungs. The result is often "smoker's cough," the hacking, mucus-laden cough that long-time smokers often experience, especially on awakening in the morning. If the lungs and airways become inflamed and clogged with mucus, this can lead to chronic bronchitis, making it difficult to breathe. When a person smokes, the tobacco smoke is inhaled into the lungs, where the smoke leaves behind a sticky residue called tar. Contact with this residue can damage the lungs, and over time may result in diseases such as lung cancer and emphysema. The smoke also damages the alveoli, the little air sacs where gas exchange in the lungs takes place. This damage means that your lungs become much less able to perform the gas exchange that brings oxygen into your body. In some people, this damage
Demonstration: Purpose: To demonstrate the effects of atherosclerosis (narrowing of the body’s arteries). Materials: Coffee stirrers (hollow) and wide drinking straws; styrofoam cups and bottled water. Procedure: Fill cups with equal amounts of water. Have students pair off, distributing a coffee stirrer to one half of each pair, and a wide drinking straw to the other half. On the word “Go,” the students will drink their cups of water as quickly as possible, as if taking part in a race. Explain: The chemicals in tobacco smoke cause the blood vessels in your body to narrow, going from wide-open tubes like the wide straws, and becoming narrowed like the coffee stirrers. Students can see how much harder they had to work to move water through the coffee stirrers. This work puts additional stress on the heart, which pumps blood through the body.
progresses to become a disease called emphysema, where the alveoli (air sacs) have been damaged to the point where oxygen can no longer be absorbed into the bloodstream.
Page 8.6.4
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) Smoking also causes the airways (the lungs and the tubes leading to them) to overreact to harmful substances, causing them to tighten up ("constrict"), and leading to wheezing and shortness of breath. This can be especially serious for those people who already suffer from asthma.
4.
Effects on the circulatory system: The chemicals found in tobacco have many effects on the body's circulatory system. Smoking encourages a process call atherosclerosis, or narrowing of the arteries and blood vessels. This reduces the flow of blood and oxygen to important organs, including the brain and heart. Over time, this narrowing can lead to a heart attack (if the heart tissue is deprived of the oxygen it needs to keep beating), or a stroke (caused by a blockage of a blood vessel in the brain or neck, leading to tissue damage
L86_Atherosclerosis
or destruction in the brain.)
5.
Mouth and throat tissues: The chemicals that cause damage to lung tissues can also damage tissue in the mouth, leading to gum disease, mouth sores and tooth loss. These chemicals can also lead to cancer of the mouth and throat.
6.
Other organ systems: Over the long term, smoking has also been linked to cancer of the bladder, kidney, pancreas and other important organs in the body.
s
L86_GumDisease
Tobacco use can lead to gum ulcers as in this picture here. Eventually, this tissue damage can lead to oral cancer, such as that featured in the anti-tobacco advertisement at right: L86_OralCancer
Page 8.6.5
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) 7.
What about smokeless (chewing) tobacco products? Since these aren’t burned and smoked, doesn’t that make them safer? Explain to your students that these
Teacher’s Note: One compelling story of a young victim of chewing tobacco can be found at:
products also contain harmful chemicals that can
http://whyquit.com/whyquit/ SeanMarsee.html
cause diseases such as oral cancer. Many young people believe that these types of tobacco are safe because they are not smoked, but this is an incorrect belief.
8.
The story can also be found on the accompanying CD (in the “WebPages” folder, titled “Sean Marsee’s Message”). You might want to consider reviewing this story as a class exercise, or having students read it as part of a homework or journal exercise.
Social consequences of smoking: Ask your students if anyone can think of any reasons—other
Optional Activity:
than harmful health impacts—that would discourage people from smoking. Possible prompts include:
Show the video The Big Dipper.
Personal appearance/grooming: e.g., bad breath,
This is a 1980’s video that is old, but it has excellent information and is captioned.
yellow teeth, discolored fingers, holes in clothing. Relationships with others: e.g., upsetting parents, disappointing teachers, putting off friends.
Rules and regulations: e.g., getting punished for breaking school rules, being asked to step outside restaurants, getting cited or ticketed in public places for violating no-smoking regulations. Financial considerations: e.g., the economic costs of smoking. Also, as the health consequences of tobacco use have become better known, more and more people in our society and elsewhere have come to recognize these dangers and have decided to actively fight against smoking. There are increasing numbers of rules about where one can and cannot use tobacco products. Smoking is now prohibited in many workplaces—including schools, hospitals, airplanes, and public buildings.
9.
Explain that one of the difficult things about educating young people about tobacco is that many of the health impacts seem to be so far off into the future that they don't seem to matter. However, there are some immediate health impacts, even for youths. What are these? W
Cigarette smoking during adolescence appears to reduce the rate of lung growth, and hence the maximum level of lung function that can be achieved.
Page 8.6.6
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) W
Young smokers are much more likely to experience shortness of breath, coughing spells, phlegm production, wheezing, and overall diminished physical health. Often young smokers have more difficulty exercising because they have a hard time getting enough oxygen when they breathe hard.
W
Young smokers are less physically fit than their non-smoking peers.
W
Smoking can contribute to the onset of asthma, or can severely aggravate an existing asthma condition.
W
Chewing tobacco can lead to mouth sores and gum disease, even at a young age.
W
Both smoking and chewing tobacco can lead to bad breath, yellowed teeth, stained fingers, dulled taste buds, and a dulled sense of smell.
W
One unseen impact-young people who start smoking at a younger age are more likely than later starters to develop a long-term addiction to tobacco. If you start smoking at a younger age, chances are you will have a much more difficult time quitting tobacco use later on, than someone who begins smoking at a later age.
Teacher’s Note: 10.
Have the wrappers from four packs of cigarettes on a table. W
Ask students to look carefully at the packs to find something exactly the same on each pack—the Surgeon General’s Warning.
W
Explain that the government requires a warning on all packs of cigarettes because of the danger involved with smoking. Ask students if they think these warnings are useful? Do they think people read them? Do they think these warnings are effective for young people
Your students may have looked at the Surgeon General’s warnings in the 7th grade curriculum here. Extend the exercise by asking students to design warning labels that they think would be effective for other young people their age, especially the Deaf. For additional information about warning labels, see the file L86_WarningLabelFacts.pdf on the accompanying CD.
their age? Why or why not? What messages do they think would work better? Are there any messages they can think of that could be aimed specifically at Deaf people? Should they warn about other diseases or consequences of smoking?
L86_SGLabels
Page 8.6.7
Lesson 8-6:
What Discourages Tobacco Use?
Procedures (continued) 11.
Have students take out the index cards from Lesson 8-5, on which they wrote the "pull" factors making smoking or other tobacco use seem attractive. Distribute additional index cards, and have students begin to write down “push” factors that would keep someone from wanting to smoke cigarettes, using the discussions above as a guide. Using string and clothes hangers, suspend the “pull” factors from one side of the hanger, and the “push” factors on the other side. Explain that many different factors enter into the decision to smoke, some favoring smoking and others discouraging smoking. But if they analyze the issues carefully, there are always many more reasons against smoking than there are for smoking.
12.
Explain to students that despite all of the factors that should discourage tobacco use, many young people still take up the practice of smoking cigarettes or chewing tobacco. Once they’ve started, however, they begin to experience a powerful new feeling that keeps them smoking—sometimes after just a few days. Many young people, more than 7 out of every 10 who have started to smoke, want to stop. But when they try to quit they run into a characteristic problem— addiction. Ask your students what they think is meant by the term addiction. List their responses on the board or a piece of paper to be retained for the next class session when the addictive nature of tobacco use is discussed.
Homework: Distribute the Smokeless Tobacco Worksheet. Ask students to review the pamphlet Smokeless Tobacco: Spit It Out!, and complete the worksheet.
Journal: Several years ago, smokeless (“chewing”) tobacco was used by many baseball players. In 1993, players, coaches, and managers were banned from using smokeless tobacco during games. Why do you think smokeless tobacco was banned? Do you think it was a good decision? Why? Why not? What are the benefits of a ballplayer complying with this rule? to the ballplayer? to spectators? to the team and others?
Page 8.6.8
Lesson 8-6 Worksheet: Smokeless Tobacco
Name __________________________________
Smokeless Tobacco 1.
How is smokeless tobacco used? ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________
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2.
Source: www.trinketsandtrash.org
What are the different names for smokeless tobacco? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
3.
What is the drug that is in smokeless tobacco? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
4.
Is smokeless tobacco addictive? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
5.
Name five ways that smokeless tobacco harms your body. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Lesson 8-6 Worksheet: Smokeless Tobacco
Smokeless Tobacco 6.
Why do companies want you to get hooked on smokeless tobacco? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
7.
What can you do if someone pressures you to use smokeless tobacco? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Lesson 8-7
Tobacco: You Decide! Introduction: You can present this lesson or invite a guest speaker to take part. IF you wish a guest speaker to participate, make arrangements in advance with the local Health Department or voluntary agency. Review with the speaker the sections of the lesson (e.g., the addiction cycle, etc.) for which he or she will be responsible.
Lesson Objectives: By the end of Lesson 8-7, students should be able to: W
Distinguish between the stages of tobacco use (experimentation, initiation, regular use)
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Recognize the key characteristics of “addiction�
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Understand the addiction cycle as it relates to tobacco use
Materials: W
D.A.R.E. Decision-Making Process Handout
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Mechanical Smoker
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Graphic: the Addiction Cycle
Key Terms: nicotine: The active ingredient in tobacco products that is the chief cause of physical addiction through its effects on brain chemistry. addiction: Extreme physiological and psychological dependence on a substance such as tobacco, alcohol or other drug, that has progressed beyond voluntary control. People who are addicted often feel sick when they stop using this substance.
addiction cycle: The sequence of steps that spiral into addiction, involving the gradual development of physical dependence, along with the growing importance of withdrawal symptoms, in encouraging and reinforcing continued tobacco use.
Page 8.7.1
Lesson 8-7: Tobacco:
You Decide!
Procedures: 1.
Show the transparency of the D.A.R.E. Decision Making process steps. Review the components of the process with your students. Emphasize the importance of clarifying decisions and identifying consequences; be sure students have considered the varying consequences involved in a decision to smoke, including both health and social consequences.
2.
Discuss tobacco use as an example of a behavioral choice that has multiple consequences. Ask your students to suggest possible outcomes
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of a decision to use tobacco. For example: W
disappointing or offending friends and other peers
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disappointing or angering parents and other adults
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breaking school rules or the law
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adding to tobacco companies' revenues
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influencing others to try and use tobacco products
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preventing the purchase of other products because of the cost of tobacco products.
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3.
health consequences
Go back to the list of reasons for why young people use tobacco products that the class developed in Lesson 8-5. For example: W
“It makes me feel cool”
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“To be accepted”
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“It is something to do”
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“It makes me look older”
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“I need the energy boost it gives me”
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“It helps me relieve stress”
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“It is an easy way to have fun with my friends.
Ask your students to brainstorm alternative activities or choices through which to address these issues without resorting to tobacco use.
Page 8.7.2
Lesson 8-7: Tobacco:
You Decide!
Procedures (continued) 4.
Ask your students to consider an additional reason why tobacco users continue to use these products—even after they have made the decision to stop. Add the words “I’m addicted—I can’t quit” to the list of reasons (above) on the board. Students may be able to pose alternatives to the reasons given in Activity 3 above. However, what is the logical alternative to “I’m addicted—I can’t quit.”? Don't start.
Teacher’s Note: Make sure students understand that, while people offer several reasons for why they began smoking, very quickly "addiction" takes over as a primary reason for continuing to smoke. Even though they may come to decide that smoking in fact does not make them look cool, or feel more accepted, or give them an energy boost, physical addiction to tobacco makes it very difficult for them to stop smoking.
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Page 8.7.3
Lesson 8-7: Tobacco:
You Decide!
Procedures (continued) 5.
Ask your students if, when smokers make the decision to quit, can they do so? Can this be easily done? Why? Why not? Discuss with students why it is often difficult to stop. Several factors contribute to smoking when a person is starting to smoke, including peer pressure, stress reduction, boredom, the desire to rebel, and others. However, as one begins to smoke more regularly, the main reason for smoking quickly emerges: the person feels unpleasant or bad if he is NOT smoking, and to feel better, he needs to smoke another cigarette. This is addiction. Review the characteristics of addiction that your students listed in 8-6. Most students will likely refer to the cravings associated with addiction; some may be aware of the notion of withdrawal. Add to the discussion using the following information about nicotine and the addiction cycle.
6.
Ask the class what happens when someone smokes. Use the Mechanical Smoker to demonstrate the residue that is left behind in the lungs from smoking a cigarette. Explain that when a person uses tobacco, either by burning it and inhaling the resulting smoke, or by placing it in the mouth and sucking on it, chemicals in the tobacco smoke (or juice in the case of smokeless tobacco) are absorbed by the body. In fact, cigarette smoke contains over 4,000 chemicals, including ammonia (used as a floor/toilet cleaner), arsenic (used in making rat poison), formaldehyde (used to preserve dead body tissues), and hydrogen cyanide (one of the components of gas chamber poison). More than 50 of these chemicals are known human carcinogens—that is, they have been proven to cause cancer—and dozens more are thought by scientists to be possible human carcinogens. One of the most important chemicals in tobacco smoke is nicotine. Nicotine by itself does not cause cancer. It is, however, highly addictive. It is nicotine that produces the mild pleasant sensations when a person smokes, but that also compels smokers and chewers to continue using tobacco even when they want to quit.
7.
Show your students the addiction cycle graphic. Review the key elements of the addiction cycle with your students. When tobacco is used, nicotine is rapidly absorbed into the bloodstream, either through the lungs (smoking) or through the mucous membranes in the mouth (chew). It is quickly transported in the blood to the brain.
Page 8.7.4
Lesson 8-7: Tobacco:
You Decide!
Procedures (continued)
6 So you smoke another cigarette. And the cycle starts over again.
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Within seconds of inhaling, nicotine speeds its way to your brain.
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Over time, your brain becomes accustomed to nicotine stimulation. Once this happens, you experience unpleasant withdrawal symptoms if your nicotine craving is not satisfied.
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Your brain starts to crave another “hit” of nicotine— telling you to smoke another cigarette.
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In your brain, nicotine causes the release of a chemical called dopamine which stimulates feelings of pleasure and relaxes you.
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But as soon as you stop smoking, this stimulation wears off as the nicotine level in your body falls.
In the brain, the nicotine excites the pleasure/excitement/relaxation centers, creating a pleasurable sensation.
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However, this stimulation rapidly dissipates, prompting the desire - the craving - for another “hit” of nicotine. Without this “hit” most tobacco users begin to experience unpleasant symptoms, known as “withdrawal symptoms.” These can be: i
Feeling irritable, moody or tense
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Headache or dizziness
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Feeling restless or nervous
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Insomnia
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Upset stomach or constipation
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Coughing
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Drowsiness or fatigue
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Difficulty concentrating
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Increased appetite
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Dry mouth, sore throat, gums and tongue
Page 8.7.5
Lesson 8-7: Tobacco:
You Decide!
Procedures (continued) W
To relieve these feelings most tobacco users will again use the tobacco product. This restarts the addiction cycle.
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For many tobacco users, over time the body builds up a gradual tolerance to nicotine. This means that the tobacco user needs even more doses to create that same sense of well-being.
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Many people who try to stop using tobacco products experience “withdrawal symptoms.” While this is not likely to last for a very long time, these symptoms can be unpleasant and many people who try to quit therefore relapse to tobacco use to relieve these feelings.
8.
Remind your students that most young people who smoke have many incorrect beliefs about tobacco use. W
They think that smoking won't affect their health until they are older. Even though many of the most dramatic health effects of smoking, such as lung cancer, emphysema, heart disease or stroke usually occur later in adulthood, emphasize that the damage starts as soon as one starts smoking. Review the immediate health consequences of smoking that were outlined in Lesson 8-6.
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They don't realize how quickly tobacco users become addicted. They say, “I only smoke a little. That won't hurt me.” Or “I'm only going to smoke for a few years, then I'll quit.” Again, point out that there is no “safe” amount of smoking. Tobacco smoke--even just a little bit--can harm the body. And while people may say they'll smoke “just a little,” most people cannot do that for long. Tobacco is powerfully addicting, and if your body has “just a little” tobacco, it will quickly L87_Boasting
develop the need for greater and greater amounts just to feel normal. And no one can assume that “just smoking a little” doesn't do any damage to the body. Smoking for just a short time can cause permanent damage to the lungs, heart, eyes, throat, urinary tract, digestive organs, bones and joints, and skin.
Page 8.7.6
Lesson 8-7: Tobacco:
You Decide!
Procedures (continued) W
They think they can stop whenever they want to. i
“I'll never get addicted”
i “This is something I just like to do. It doesn't mean that I HAVE to do it.” i
“I'm young. I have plenty of time to quit when I want to.”
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“I can quit whenever I want.”
Instead, what they find is that once they try to quit smoking, they find that they cannot. They experience withdrawal symptoms just like adult smokers; they find that they are addicted. Remind your students that all tobacco products are addictive—including chewing tobacco—not just cigarettes.
9.
Discuss with your students the relationship between the two characteristics of tobacco products: (1) that they are addictive (because of nicotine, one component of tobacco), and (2) that they have serious health consequences (because of the tar and other chemicals in tobacco products). Explain that because young people get “hooked” on cigarettes, despite what they expect, these health and other consequences can result.
10.
Discuss the cycle of tobacco use with your students. Remind your students that most experimentation and initiation begins in childhood or adolescence but rapidly becomes regular use for most tobacco users. Many people—including many young people—try to quit but find they relapse (i.e., go back to smoking), and regular use continues. This is why quitting is so difficult. And this is why the best way to avoid addiction is not to start using tobacco—at all—in the first place.
Journal: Some people who smoke cigarettes cough, are short of breath, and know they increase the chance of having a heart attack or getting diseases such as cancer. Why do you think these people keep smoking cigarettes? What would you tell them if you could chat with them?
Page 8.7.7
Lesson 8-7: The D.A.R.E. Decision-Making Process
Name __________________________________
Decisions, Decisions! The D.A.R.E. Decision-Making Process
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Define the decision to be made.
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Assess the options. What are the options? What are the consequences of each option?
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Respond by choosing the option that will have the most desirable impact.
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Evaluate the final choice. How good was the decision that was made?
Lesson 8-7 Graphic: The Addiction Cycle
The Addiction Cycle
6 So you smoke another
cigarette. And the cycle starts over again.
1
Within seconds of inhaling, nicotine speeds its way to your brain.
5
2
Over time, your brain becomes accustomed to nicotine stimulation. Once this happens, you experience unpleasant withdrawal symptoms if your nicotine craving is not satisfied.
In your brain, nicotine causes the release of a chemical called dopamine which stimulates feelings of pleasure and relaxes you.
3
4 Your brain starts to crave
But as soon as you stop smoking, this stimulation wears off as the nicotine level in your body falls.
another “hit” of nicotine— telling you to smoke another cigarette. L87_AddictionCycle