11th Grade Lessons:
Needed Materials and Preparations Lesson 11-1
* Worksheet: Road to Improvement (transparency and handouts) Blank index cards
Lesson 11-2
* Worksheet: D.A.R.E. Decision-Making Process (transparency and handouts) * Decision cards
Lesson 11-3
* The ABCs of Smoking booklet and transparencies * Mechanical Smoker * Anti-tobacco warnings for tobacco packaging Balloon for each student * Coffee stirrers (small, hollow straws) for an emphysema demonstration A wristwatch or clock with a second hand Contact your local chapter of the American Cancer Society or the American Lung Association if you need a guest speaker who is a smoker or former smoker.
Lesson 11-4
* Graphic: The Addiction Cycle * Matching Game Cards
Lesson 11-5
* Prevention posters or advertisements related to smoking, alcohol and other drugs, drunk driving, and other health behaviors * Tobacco advertisements * Anti-tobacco materials and advertisements
Lesson 11-6
* Worksheet: The Costs of Smoking * Worksheet: Tobacco Sales * Map of State Cigarette Tax Rates Handout * Tobacco Taxation Fact Sheet Handout * Journeyworks, Inc. pamphlet: Tobacco and Money: What Does Smoking Really Cost?
Lesson 11-7
* Tobacco Advertisements * Postcards from the American Cancer Society
* 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.
11th Grade Lessons Materials List
Lesson 11-1
Developing a Self-Improvement Plan Introduction: This lesson examines the value of making a plan when trying to change a behavior. It explores the importance of taking into account barriers that emerge and need to be addressed and triggers that result in going back to old behaviors.
Lesson Objectives: By the end of Lesson 11-1, students should be able to: W
Define concepts of self-esteem and self-image
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Identify an area of self-improvement they would like to undertake
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Make an action plan for this self-improvement
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Identify situations and other triggers that may impede their progress
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Strategize ways to deal with these triggers
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Identify people who will help or hinder their progress, and explain why
Materials: W
Road to Improvement Worksheet (transparency and handouts)
W
Blank index cards
Key Terms: action plan: a detailed sequence of steps one plans to take to achieve a desired outcome. barrier: something that keeps people from acting on their plans in the ways that they would like. self-esteem: one’s sense of confidence and satisfaction in oneself; self-respect.
self-improvement: taking action to make ourselves better. social support: help from one’s friends or family members that can be crucial for changing health behavior such as quitting smoking. trigger: something that can cause people to go back to an old behavior they are trying to change.
Page 11.1.1
Lesson 11-1:
Developing a Self-Improvement Plan
Procedures: 1.
Ask students to identify one aspect of themselves that they would like to improve upon. This might include a change such as, for example, doing better in school, losing weight, becoming more outgoing, getting into better physical shape, or stopping smoking.
2.
Ask students to visualize what things will look like or feel like if they make this change. How would life be different? Would there be an impact on relationships? school performance? financial status? appearance?
3.
Teacher’s Note: Key starting points in the curriculum for each grade level are the concepts of self-esteem and self-image. We start with these ideas because they are critical to how people act and behave, to how others respond and react, and to how these reactions and responses are perceived. Your students may have covered these concepts in earlier grades. If not, you may want to draw on the materials in lessons 7-1, 8-1, 9-1 or 10-1 as appropriate, in discussing these issues with your class.
Distribute the Road to Improvement worksheet. Explain to students that any time there is something to be done, it is good to have an action plan. An action plan describes the steps that need to be taken to achieve a goal. It can help a person anticipate the steps they will need to take, and identify any difficulties they may encounter in pursuing their goal. Have your students consider what some of these difficulties might be. These might include situations people find themselves in. The behavior of friends, peers and other people can often make it difficult to keep to a plan. W
If you are trying to lose weight, friends who ask you to go with them to buy french fries and a milkshake every day after school may make it hard for you to stick with a weight loss plan.
W
If you are a smoker trying to quit, friends who continue to offer you cigarettes, or who smoke in front of you, may make it hard for you to avoid
L111_HardtoResist01
smoking yourself. How you feel about yourself can also influence your actions and behaviors. W
If you are trying to improve your study habits, feelings of stress, tiredness, boredom, hunger, sadness, or loneliness may lead you to put your books down, or keep you from doing your work. L111_Friendsmoke
W
If you are trying to lose weight, but one day feel particularly depressed because of a hard day at school, you might decide to treat yourself to a large bowl of ice cream to help yourself feel better.
Page 11.1.2
Lesson 11-1: Developing
a Self-Improvement Plan
Procedures: (continued) People, situations or self-concepts can be barriers that keep people from acting on their plans in the ways they would like. They can also be triggers that cause people to go back to the old behaviors they are trying to change. If a person learns to identify their barriers and triggers, they can plan for how they will react to them to keep from straying from their plans.
4.
Describe the following to your class: John is a school mate who wants to get better grades. What steps can you identify that would help John achieve this goal? What people might help him? What situations might hinder him? How might John’s self-concept create difficulties for him? How can John deal with these barriers and triggers? Work with your class to complete an action plan using the Road to Improvement Worksheet transparency. This should include listing steps that will help John achieve his goal and the barriers and triggers that he might encounter.
5.
Give students class time to identify an area of improvement and to complete the Road to Improvement worksheet for a change they would like to make in their own life. Invite your students to share their action plan with the class. Ask the class to provide
Teacher’s Note: Sharing the plans should be voluntary, and students should be advised of this.
additional ideas to enhance each student's action plans. List on the board the Barriers and Triggers that students
Teacher’s Note:
mention.
6.
Distribute blank index cards. Ask your students to write down the goal they identified. Ask them to then list several of the triggers that they might encounter on the card along with strategies for resisting these triggers. Explain to your students that these strategies become part of their action plan. Your students can tape the card to the mirror in their room or carry it in their pocket.
Discuss with your class that social support for achieving the goals of an action plan can be very helpful. However, friends, peers and others who care about a person do not always provide this help and support. Sometimes, they can create barriers and provide unwelcome triggers. “Smoking buddies,” “ice cream buddies,” “buddies who share play time but not work time activities,” and others can feel unhappy and betrayed when changes are made in behaviors they have been a part of. They can sometimes try to sabotage these changes, which can create problems.
Journal: If you were a smoker, why do you think your “smoking buddies” might not want you to stop smoking?
Teacher’s Note: Completion of the cards could also be a homework assignment.
Page 11.1.3
Lesson 11-1 Worksheet: Road to Improvement
Name __________________________________
The Road to Improvement! My Goal:
More steps to help me reach my goal: Possible barriers to these steps:
Possible barriers to these steps:
More steps to help me reach my goal:
Steps to help me reach my goal:
Lesson 11-2
It’s Your Decision: You Decide! Introduction: This lesson discusses factors that influence the decisions people make. It also examines the decision making process. Students will review and practice the D.A.R.E. decision making process.
Lesson Objectives: By the end of Lesson 11-2, students should be able to: W
Discuss factors that help them make important decisions such as whether or not to smoke
W
Identify which factors have the greatest influence on the decisions they make and why
Materials: W
D.A.R.E. Decision-Making Process Worksheet (transparency and handouts)
W
Decision cards
Key Terms: D.A.R.E. Decision-Making Process: 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?
decision factors: things that can influence decision-making, such as opinions of peers, friends, or family members. family values: beliefs and standards held by family members. short and long-term goals: things one strives to achieve.
(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 11.2.1
Lesson 11-2:
It’s Your Decision: You Decide!
Procedures: 1.
Divide the class into pairs of students. Give each pair of students an envelope containing a Decision Card, and a Decision Making worksheet. On each card, one of the following decisions to be made will be written: W
Should I try out for the swim team?
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Should I smoke?
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Should I shave my head if I go to Gallaudet University as other freshman do?
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Should I have sexual intercourse?
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Should I gossip about my classmate?
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Should I borrow my friend’s GameBoy without asking?
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Should I go to college?
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Should I go to a college with many Deaf students? With mainly hearing students?
2.
Teacher’s Note: Explain the elements of the D.A.R.E. Decision Making Process Model using the transparency. Explain that rather than only making a final decision, the model calls for identifying and listing the factors to be taken into account when making decisions. This includes assessing consequences for each choice that could be made. Discuss with your students what they are thinking about when they have to make a decision.
If your class has never covered the D.A.R.E. decision-making 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, and is based on 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 very likely 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.
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What do I want?
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Will the decision affect my health or safety?
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What would my friends say?
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Do I have any similar past experiences?
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What might my parents say or do?
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What do I know about the effects that this decision might have?
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How would it affect other areas of my life?
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Will this decision affect my short or long term goals?
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What else might you consider in making this decision?
Page 11.2.2
Lesson 11-2: It’s
Your Decision: You Decide!
Procedures: (continued) Discuss with your class how family values, friend's values, older kids, future goals, past experience, or product advertisements can influence decisions.
3.
As a class exercise, use the following example to review the D.A.R.E. Decision Making Process: I want to use my mom's car. She is not home, and although I do not have permission to use the car, I have the car keys. Should I use my mom's car without asking for permission?
4.
Ask students to use the same process to address the decisions on their Decision Cards. Ask them to list on their worksheet the factors that would influence their decisions and to assess the consequences of the choices they made.
5.
When each pair has completed their worksheets, ask the class to discuss the factors identified by their classmates and other possible influences that could be taken into account. Ask your students to think about the factors that seemed to influence them more than
Teacher’s Note: Review lesson 9-2 for a discussion of peers, friends and the influence process.
others. For example, did they always worry about what their friends think? Do they ever consider their future goals? Ask your students why they think some decisions are easier to make than others. Discuss with them the difference between peers and friends. In what kinds of decisions do these people play a part? How do peer influence and peer pressure occur?
6.
Explain to students that it is important to be aware of why they make the choices they do.
7.
Is the decision to use tobacco products different from or the same as the decision to use other substances such as hard drugs or alcohol? In what ways? Things to consider are the legality of the drug for minors and adults, the impact of the drug when used, the health effects, the addiction, product marketing, and the roles of peers and friends.
Teacher’s Note: You may also want to consider other frequently mentioned reasons for starting to use tobacco products (See Lesson 8-5). These include stress relief, getting an energy boost or having fun. To what extent do these reasons apply to using tobacco, hard drugs and alcohol?
Journal: Who is the person who most influences me in my decision-making and why?
Page 11.2.3
Lesson 11-2 Decision Cards
Decision Cards Should I try out for the swim team?
Should I smoke?
Should I shave my head if I go to Gallaudet University as other freshman do?
Should I have sexual intercourse?
Should I gossip about my classmate?
Should I borrow my friend’s GameBoy without asking?
Should I go to college?
Should I tell a teacher about my friend smoking marijuana behind the gym after school?
Lesson 11-2 Worksheet: 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 decide how you would act if you were in the following situation. Once you’ve completed the worksheet, think about important decisions you’ve had to make, and how you would think about them now. “I want to use my mom's car. She is not home, and although I do not have permission to use the car, I have the car keys. Should I use my mom's car without asking for permission?”
What would you do? Complete the D.A.R.E. Decision-Making worksheet to explain your decision.
Fill out the D.A.R.E. steps on the following page.
Lesson 11-3
Health Impacts of Smoking Introduction: This lesson reviews and demonstrates the health impacts of smoking and gives students the opportunity to consider the effects of tobacco use at all ages. If a guest speaker is invited, students can experience a personal story of these health effects. Cigarette warning labels are discussed and students can evaluate to what extent they are adequate.
Lesson Objectives: By the end of Lesson 11-3, students should be able to: W
Explain that smoking can cause various illnesses including emphysema, heart disease and lung cancer
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Interview a person who has emphysema or heart disease or a respiratory therapist to discuss illnesses related to smoking
W
Evaluate warning labels and how they have changed over time
Materials: W
The ABC’s of Smoking Booklets and Transparencies
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Mechanical Smoker
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Balloon for each student
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Coffee Stirrers (hollow straw type)
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A wristwatch or clock with a second hand
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Tobacco package warning labels (provided on CD)
Plan Ahead! Contact the American Lung Association, the American Cancer Society, or your local Health Department or hospital to arrange for a guest speaker to talk about the health effects of tobacco use. Ask for a signing speaker. If one is not available, ask the school principal to arrange for an interpreter. Prior to the arrival of the guest speaker, find out if they are willing to be videotaped so their presentation can be used in the future.
Key Terms: cancer: a term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body. chemotherapy: treatment that involves administering medicines that kill cancer cells, sometimes with severe side effects such as nausea, hair loss, and weakening. coronary heart disease: a condition in which the arteries that supply the heart with blood (and oxygen) narrow from an accumulation of plaque (atherosclerosis), causing a decrease in blood flow to the heart.
emphysema: a chronic disease in which the lungs lose their ability to absorb oxygen. A primary cause is smoking, while air pollution, environmental or occupational hazards, and genetic factors may also play a role in this disease. heart attack: also called myocardial infarction; damage to the heart muscle due to insufficient blood supply and lack of oxygen. lung capacity: the amount of air one can hold in one’s lungs. radiation: the use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation therapy affects cancer cells in a targeted area.
Page 11.3.1
Lesson 11-3:
Procedures: 1.
Tell your students that tobacco use, especially smoking, increases morbidity (sickness) and mortality (death). In fact, tobacco use is the #1 preventable cause of death and disease in
Teacher’s Note: Some of the most important health effects of tobacco use have been described in prior lessons (see 8-6, 94, 10-4 and the introduction to the curriculum). If your students have already had these prior lessons, you may be able to move quickly through the material presented in this lesson. If not, a careful and detailed discussion of the material presented here is appropriate.
the United States.
2.
What is smoking, and how does it affect your health?
Valuable Resource: Additional sources of excellent information about the health effects of tobacco use can be found online at: http://www.cdc.gov/tobacco/sgr/ sgr4kids/sgrmenu.htm
Use the Mechanical Smoker machine to show the mechanics of smoking, and to
http://tobaccofreekids.org/research/ factsheets/index.php
demonstrate the build-up of smoking residue on the lungs. Point out the residue on the
Check This Out!:
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
A wonderful interactive animated presentation of the effects of tobacco on different organ systems in the body can be found at:
health effects AND addiction.
3.
Health Impacts of Smoking
Pass out balloons to all students. Each student
http://www.cdc.gov/tobacco/sgr/ sgr_2004/sgranimation/flash/ index.html
should take as deep a breath as possible, blow as much air as possible into the balloon (one breath only) and then tie them. Explain to the class that their lungs held this air before the balloon did. Every person's lungs have a different lung capacity. Notice the different size of the balloons in the room. There is a good chance that students who are athletes will have bigger balloons (i.e., were able to expel more air into the balloon) than non-athletes, and that non-smokers will have bigger balloons than smokers. Explain to students that certain things can increase or decrease lung capacity. Ask students to discuss what they
L113_Lungs
think these may be. If students do not mention smoking, explain that smoking decreases lung capacity. It also significantly increases a person's risk for lung-damaging diseases such as emphysema and lung cancer.
4.
Ask the class if anyone knows what emphysema is. Explain that emphysema is a disease that destroys the lungs' ability to absorb oxygen. What does this mean? Explain to your students that emphysema is a disease process
Teacher’s Note: An effective demonstration of what it feels like to have emphysema is presented on the next page. If your students have not tried this exercise in a previous grade, you can use it to great effect here.
in which smoking can play a major role. The smoke irritates the
Page 11.3.2
Lesson 11-3: Health
Impacts of Smoking
Procedures: (continued) tissues of the lung, and over time leads to a breakdown in the lungs' alveoli sacs, where oxygen from the air in the lungs is taken into the bloodstream. When the alveoli sacs are destroyed, the body cannot extract the oxygen from the air in the lungs. Emphysema makes it very difficult to breathe. There is no cure for emphysema. It is a progressive disease that just gets worse, and is usually fatal.
5.
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.
Emphysema is only one of the diseases that can result from smoking. Smoking can also cause cancer. Tobacco smoke contains many different chemicals, some of which can cause damage to the genetic information contained in the body's cells. In the lung, this damage can lead to lung cancer. Lung cancer is the uncontrolled growth of abnormal cells in one or both of the lungs. While normal lung tissue cells reproduce and
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.
develop into healthy lung tissue, these abnormal cells reproduce rapidly and never grow into normal lung tissue. Cancer cells (tumors) then form and disrupt the lung, making it difficult for the
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.
lungs to function properly.
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.
L113_HealthyLung
Lung cancer is the most common cause of cancer death in both men and women. One of the reasons is that by the time it is discovered, the cancer has spread to different organs and tissues in the body. Smoking is the number one cause of lung cancer.
L113_LungCancer
Page 11.3.3
Lesson 11-3: Health
Impacts of Smoking
Procedures: (continued) What does emphysema look like? Compare the healthy lung on the previous page with the lung from a person with emphysema at left. Chemicals from tobacco eventually end up in the urine, which then collects in the bladder. The bladder is then bathed in these cancercausing chemicals, which can cause bladder cancer. L113_emphysema L113_BladderCancer
Oral cancers include those of the tongue, mouth, cheek and lips. One of the most important causes of oral cancer is tobacco, both smoked and chewed. Here, a sore on the tongue is cancer which, if not removed, may spread to other tissues. L113_OralCancer
s
L113_LiverCancer
Because the liver filters the body’s blood, it is a common site for cancer to spread.
Smoking is the cause of laryngeal cancer, or cancer of the voicebox which is located in your throat. Smoking can lead to high blood pressure, which in turn can cause a stroke, or bleeding in the brain. The damage that strokes can do is clear in this specimen at right.
L113_Stroke L113_Larynx
Page 11.3.4
Lesson 11-3: Health
Impacts of Smoking
Procedures: (continued) The same chemicals that damage lung cells can also cause damaging cellular changes in other organs of the body, leading to other cancers in organs and tissues such as the mouth and nasal passages, esophagus, cervix, pancreas, bladder, and others. Cancer can often be treated. However, cancer treatment—chemotherapy, radiation therapy, and other treatments—can have severe side effects, including nausea, hair loss, diarrhea, weakening, and extreme weight loss. Moreover, chemotherapy is not always successful.
6.
Smoking can also contribute to heart disease. The chemical called tar in tobacco narrows the arteries that carry oxygenated blood to the body, meaning that the heart must pump harder and faster to do its job. Over many years, this can damage the heart. The heart itself also suffers from the body's reduced ability to oxygenate its blood. This damage can lead to heart failure, or a heart attack. Because smoking narrows the arteries supplying blood, it increases the chance that a person will experience a stroke, or a blockage of blood to the brain. When a stroke happens, portions of the brain are deprived of oxygen and suffer damage. (See the illustration on the previous page.) This damage can be mild or severe, and can result in paralysis and even death. Ask students if anyone they know has ever suffered from any of these conditions.
7.
Have your students consider the warning messages that smokers receive when it comes to these consequences of smoking. W
Point out that the United States was the first country in the world to introduce health warning. The first warning label on cigarettes came about in 1965. The message said
Teacher’s Note:
L113_WarningLabel01
No additional warning labels were allowed. W
In 1969, the message was changed to read
L113_WarningLabel02
All of these labels used on cigarettes in the United States represented a compromise between the government and the tobacco industry. Other countries such as Canada, Australia, Brazil and countries in the European Union have implemented stronger labels with bold print, large font and hard hitting pictures and package inserts. See the following examples and use them with your students for a discussion on how warning labels might be designed to be more effective.
No additional warning labels were allowed.
Page 11.3.5
Lesson 11-3: Health
Impacts of Smoking
Procedures: (continued) W
In 1984, the messages were changed again. Now, 4 rotating messages were included :
L113_SGLabels
No additional warning labels were allowed on cigarettes. W
In 1986, a law was passed to put three rotating warning labels on smokeless tobacco.
L113_Smokeless03
L113_Smokeless01
L113_Smokeless02
Ask what your students think about these changes. Do they think that the labels that are now on cigarettes are strong enough to discourage people—especially young people—from smoking? Why do they think the laws prevented other messages? Have your students consider how the United States might make messages stronger. Have them review some of the warning labels from other countries. Remind your students as they consider this question that “a picture is worth a thousand words.”
Homework: Ask your students to go on an internet “Tobacco Facts Scavenger Hunt” to collect information on the consequences of tobacco use. They can collect specific facts and statistics about the impact of tobacco use in the United States and elsewhere. These could include facts on short- and long-term health consequences, and the social and economic costs of tobacco use to individuals and the society. Students can work in teams. Every student should come up with at least 20 facts. This exercise could be a team competition.
Page 11.3.6
Lesson 11-3: Health
Impacts of Smoking
Procedures: (continued)
L113_Brazil01
L113_Brazil02
L113_Brazil03
Cigarette warning labels required on tobacco products sold in Brazil
L113_Canada01
L113_Canada02
L113_Canada08
L113_Canada13
Cigarette warning labels required on tobacco products sold in Canada
Journal: What will you remember about the guest speaker and why? OR In addition to health effects of smoking, what are some social effects of smoking?
Page 11.3.7
Lesson 11-4
The Addiction Cycle Introduction: This lesson explains in detail the phases of the addiction cycle. It also discusses different ways to quit smoking.
Lesson Objectives: By the end of Lesson 11-4, students should be able to: W
Define the terms addiction, withdrawal, addiction cycle and cessation
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Discuss reasons people quit smoking
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Define relapse
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Identify reasons people might relapse
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List cessation strategies
Materials: W
Graphic: The Addiction Cycle
W
Matching Game Cards
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. 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.
craving: An intense and prolonged desire; for those addicted to nicotine, it is usually manifested as an intense desire for cigarettes or other tobacco product. relapse: In terms of tobacco, starting to smoke or chew tobacco again after an attempt at quitting has been made; to take up tobacco use again after a period of abstinence. withdrawal: The range of unpleasant physiological and emotional reactions of the body in response to withholding a drug that the body has become addicted to.
cessation: In terms of tobacco use, the process of stopping all tobacco use, particularly after one has already become addicted.
Page 11.4.1
Lesson 11-4:
Procedures: 1.
Ask your students if anyone can define the term addiction. For example, one teenager has described it as “Addiction is needing to smoke first thing in the morning, not just when you are bored or hanging out with your friends.” Explain to students that people often use the word “addiction” in a very general way. They’ll say, “I’m addicted to pizza,” or “I’m addicted to that television show,” referring to any behavior someone might find pleasurable and doing excessively. However, when it comes to behaviors such as tobacco use or drug use, “addiction” means something very different. With true addiction, the following things happen: W
The substance produces a pleasant feeling.
W
Over time, you need to use more and more of the
The Addiction Cycle
Teacher’s Note: Review findings from the scavenger hunt homework from the prior lesson. That is, use these facts to emphasize the consequences of tobacco use. Although many people, including many smokers, know these facts, they still cannot quit. Use this review to introduce the concept of addiction.
Teacher’s Note: The addiction cycle has been described in detail in grade 9-5 and 10-5. If students have been exposed to this information in prior grade levels, the information presented here can be reviewed briefly.
substance to obtain this pleasant feeling. W
If you stop using the substance, you will feel unpleasant feelings called withdrawal symptoms. You will feel better only if you can use more of the substance.
W
You will continue to use this substance to pursue this pleasant feeling and avoid feeling bad, even if you know the substance is harming your body.
2.
Use the graphic of the Addiction Cycle to guide the following discussion: W
Nicotine is an addictive substance that is found in all tobacco products: cigarettes, cigars, pipe tobacco and chewing tobacco. Research shows that nicotine is as addictive as heroin and cocaine. If a person is addicted to nicotine, their body craves it.
W
Most people start using tobacco when they are young. The addiction process starts with experimentation. When a person first uses tobacco, he or she may feel dizzy and nauseous, and the smoking can sometimes cause the smoker to feel sick.
W
If the person continues to “try” smoking, these initial physical reactions may subside as the body becomes accustomed to inhaling smoke. At this time, the smoker may begin to have feelings of mild pleasure and relaxation with the act of smoking. This is due to the nicotine that is in tobacco. Nicotine reaches the brain within 10-20 seconds from the start of a puff. It releases chemicals in the brain that affect mood and performance.
Page 11.4.2
Lesson 11-4:
The Addiction Cycle
Procedures: (continued)
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.
4
Your brain starts to crave another “hit” of nicotine— telling you to smoke another cigarette.
In your brain, nicotine causes the release of a chemical called dopamine which stimulates feelings of pleasure and relaxes you.
3
But as soon as you stop smoking, this stimulation wears off as the nicotine level in your body falls.
L114_AddictionCycle
Because nicotine affects the pleasure center of the brain, it can suppress appetite, improve performance and memory and reduce anxiety and tension. W
These physical responses of pleasure and relaxation may lead a person to more regular use. However, the brain and body also become less sensitive to the pleasurable effects of nicotine. This means that the smoker needs to smoke more, and more often, in order to receive the same pleasurable sensations.
W
These are the first steps to addiction/dependency. This is the process by which your body and brain cells become dependent on the nicotine in tobacco. While providing nicotine may cause pleasurable sensations in the body, withholding nicotine starts to cause a number of unpleasant sensations
W
These physical symptoms are known as withdrawal. Withdrawal can be a very uncomfortable feeling, and is the reason why most people find it so difficult to quit smoking after becoming addicted to nicotine. Most withdrawal symptoms are very strong 24-48 hours after cessation of tobacco. For most people, they gradually start going away over several weeks. Some
Page 11.4.3
Lesson 11-4: The
Addiction Cycle
Procedures: (continued) symptoms, such as eating more than usual, weight gain, and craving cigarettes (particularly in stressful situations) may go on longer. W
When a person is dependent on nicotine, they feel that they don't have a choice about using tobacco anymore. They feel they must use tobacco. They must plan where they go and what they do so that they will be able to use the drug nicotine. It is like carrying a ball and chain. Addiction creates a feeling of need—a craving—in your body and your brain. If the body becomes dependent on a drug, the person experiences a range of discomforts if deprived of the drug.
W
Most people who experiment with, and begin to casually use, tobacco, plan to quit when they get older. But most people are unable to quit once they've become addicted.
L114_cartoon
Page 11.4.4
Lesson 11-4:
The Addiction Cycle
Procedures: (continued) 3.
Ask students to describe the symptoms of withdrawal. As they mention symptoms, write them on the board. Ask students how a person experiencing these symptoms might deal with them. Use the following list for guidance: W
Feeling irritable, moody, or tense—try to relax, take a walk
W
Headaches or dizziness—sit or lie down and close your eyes
W
Feeling restless—walk, exercise or do a hobby
W
Insomnia—avoid caffeine, do relaxation exercises
W
Upset stomach or constipation—drink lots of water, eat more fruits and whole grains
Teacher’s Note: The key concept here is to have students understand the difficulties of stopping smoking and therefore the value of never starting in the first place.
W
Coughing—drink water, juice, warm tea (decaf)
W
Drowsiness or fatigue—get fresh air, take a nap
W
Difficulty concentrating—take a break, get some exercise
W
Increased appetite—drink water, eat healthy snacks, exercise
W
Dry mouth or sore throat, gums and tongue—drink water, suck on ice
Point out to students that when a person stops smoking, he has to cope with the physical changes associated with nicotine withdrawal, AND he also has to learn new ways to cope with stressful situations, that do not include smoking a cigarette.
4.
People stop smoking either all at once (cold turkey) or more gradually (tapering or cutting down until you stop entirely). There are different strategies that people use to quit: W
Support Group: Join other people who also want to quit using the drug. Group members can support and encourage each other, understand each other's feelings, and provide assistance with withdrawal symptoms.
W
Counseling: A professional counselor can help a person who wants to quit by helping them talk about their feelings, stress, or how to cope with withdrawal symptoms and other aspects of the quitting process. Counselors may also use other methods to help people quit smoking such as biofeedback, relaxation exercises and hypnosis. Physicians and other health providers can also offer counseling face-to-face or by telephone (hotline).
W
Nicotine Replacement Therapy (NRT): Some people use The Patch, Nicotine Gum, Nicotine Nasal Spray, or Nicotine Inhalers to help them stop smoking. NRT is a way for people to still get small doses of nicotine without smoking or using smokeless tobacco. Each day they use less and less until
Page 11.4.5
Lesson 11-4:
The Addiction Cycle
Procedures: (continued) their body does not feel cravings or withdrawal anymore. Some of these NRT products are available over the counter for people who are 18 or older. Physicians can prescribe NRT for minors. W
Medication: Some people get a medication from the doctor called an antidepressant. The anti-depressant drug helps the brain get used to living without nicotine again. These drugs require a prescription.
Ask your students if they think that NRT or anti-depressants are appropriate for younger smokers who want to quit. Do the benefits outweigh any possible risks?
5.
Explain to your students some of the changes that occur in the body when someone quits smoking: W
within 20 minutes of quitting: k Blood pressure drops to normal. k Pulse rate drops to normal.
W
within 8 hours of quitting: k Carbon monoxide level in the blood drops to normal.
W
24 hours after quitting: k Chance of heart attack decreases.
W
48 hours after quitting: k Improved sense of smell and taste.
W
72 hours after quitting: k Lung capacity increases. k Breathing becomes easier.
W
Two weeks to three months after quitting: k Lung function increases. k Circulation improves.
W
One to nine months after quitting: k Body's overall energy level increases. k Coughing, sinus congestion, fatigue, and shortness of breath all decrease. k Cilia regain normal function in lungs, increasing ability to handle mucus, clean the lungs, and reduce infection.
W
Ten years after quitting: k Lung cancer death rate is half that of a continuing smoker.
Page 11.4.6
Lesson 11-4:
The Addiction Cycle
Procedures: (continued) k The chance of developing cancer in other parts of the body, including the mouth, throat, esophagus, bladder, kidney and pancreas, also decreases.
6.
Review with students the meanings of new terms by having the class match the term to its definition on the Matching Game Cards.
7.
Discuss with your students the advantages and disadvantages of cessation. Be sure to include health, social and economic considerations. Review with your students the difference between prevention and cessation.
Journal: Do you know anyone who has ever quit smoking? What methods did they use to try to stop smoking? Which methods worked for them? What do you think is the most effective way to quit and why?
Page 11.4.7
Lesson 11-4 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.
4 Your brain starts to crave
another “hit” of nicotine— telling you to smoke another cigarette.
In your brain, nicotine causes the release of a chemical called dopamine which stimulates feelings of pleasure and relaxes you.
3
But as soon as you stop smoking, this stimulation wears off as the nicotine level in your body falls.
L114_AddictionCycle
Lesson 11-4 Matching Game
Matching Game Cards Nicotine
An addictive substance (nicotine)
Addiction Cycle
1) Experimentation 2) Regular Use 3) Dependency/Addiction (The Addiction Cycle)
Craving
The feeling of needing something very badly (craving)
Withdrawal
Unpleasant physical and psychological feelings that occur when you stop using a drug to which you’ve become addicted. (withdrawal)
Smoking Cessation
Relapse
Quit smoking (smoking cessation)
Go back to using a drug such as tobacco after you’ve already tried to quit. (relapse)
Tapering Use
Quitting by using less and less of a drug each day. (tapering use)
Cold Turkey
To quit using a drug or substance abruptly, without ever touching it again. (cold turkey)
Nicotine Replacements
The patch, nicotine gum, nicotine inhalers (nicotine replacements)
Counseling
Helping someone to quit smoking by talking, biofeedback, relaxation, hypnosis. (counseling)
Anti-Depressant
Medicine prescribed by a doctor to help a person quit smoking. (anti-depressant)
Nicotine withdrawal symptoms
Moodiness, anxiety, increased appetite, stomach aches, nausea, insomnia, inability to focus (nicotine withdrawal symptoms)
Reasons to Quit Smoking
Health, pregnancy, money, family, friends (reasons to quit smoking)
Lesson 11-5
Promoting Healthy Decisions Introduction: This lesson introduces students to the concept of marketing. It examines how products such as tobacco are promoted. It also talks about campaigns to promote healthy decisions such as, for example, tobacco counter-advertising campaigns. The goal of this lesson is to have students think about the many ways in which the tobacco industry seeks to manipulate young people to start smoking, and what those concerned about this problem have tried to do to limit the industry's influence.
Lesson Objectives: By the end of Lesson 11-5, students should be able to: W
Recognize tobacco marketing strategies
W
Identify strategies used in campaigns to promote healthy decisions, such as the decision not to smoke.
W
Use marketing techniques to create an anti-tobacco advertising campaign for teens
Materials: W
Prevention posters or advertisements related to smoking, alcohol and other drugs, drunk driving, and other health behaviors
W
Tobacco advertising samples (provided on CD)
W
Anti-tobacco materials and advertising samples (provided on CD)
Key Terms: advertising campaign: when a business or group tries to sell an idea or product to a group of people. Advertising campaigns use different strategies to sell depending on the group they want to convince or target.
marketing: the steps a business or group takes to convince others to buy a product or believe an idea. This usually involves emphasizing positive things about the product or idea, for example, that smoking is fun, relaxing and cool.
counter-advertising: when a group or organization tries to lessen the impact of an advertising campaign by presenting other information. For example, governemnt health agencies try to show the negative health and social impacts of smoking to counter the tobacco industry’s ads that portray smoking as glamorous and fun.
Page 11.5.1
Lesson 11-5: Promoting
Healthy Decisions
Procedures: 1.
Display the health promotion posters supplied with the lesson materials. Ask students to identify what message each poster is trying to convey. The class should make a single statement of the message of the poster and tape it below the poster. For example, for an ad about drunk drivers, the message might read: "Don't drink and drive because it can kill you or others."
2.
Ask your students to identify any other campaigns that they have seen that target health or other social issues. Examples might include: W
Partnership for a Drug Free America (Alcohol and other drugs)
W
The More You Know Series (parenting, literacy, prejudice, child abuse and other topics) (www.nbc.com/footer/tmyk/)
W
Take a Bite Out of Crime (McGruff the Crime Dog) (www.mcgruff.org)
W
The Truth Campaign (www.thetruth.com)
What do these campaigns involve beside the kind of print ads the class has been examining? These might include for example TV ads, newspaper stories and billboards.
3.
Now ask your students specifically to think about the marketing campaigns of the tobacco industry. Ask students to identify in what ways tobacco companies spend money to promote their product. Use the images on the following pages to prompt discussions. Possible answers include: W
magazine ads
W
point-of-purchase displays (advertising placed right where you would normally buy a product; for example, tobacco ads near the cash register where you would buy cigarettes.)
W
sports event sponsorships
W
entertainment and cultural sponsorships
W
product placements in movies
Ask your students what appeals to them, if anything, in these ads. Is it the message? Is it the use of movie stars? Are the messages clear? Do they think the ads can be successful in getting people to think about their behaviors? Change their behaviors?
L115_MarlboroAd
s Everyone has probably seen traditional advertising by tobacco companies, such as this Marlboro Cigarettes magazine advertisement. Why do you think the makers of Marlboros chose this particular image? Who would it appeal to?
Page 11.5.2
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued) Tobacco advertising dollars are also used for in-store displays. How many of you have seen displays like these at corner grocery and liquor stores?
L115_InStoreAd
A great deal is also spent on special promotions, such as these mailed dollar-off coupons, giveaways, and purchase points that can be redeemed for other merchandise... L115_CamelCoupons
L115_CamelBracelet
L115_MarlboroCoupon
L115_KoolRadio2
...as well as on special promotional packaging for their products.
L102_NewportCoupon
Look closely at the Kool display and packaging for their “Soundtrack of the Streets� promotion. Who is the target of this appeal? What about the Stars packaging, with their flavored cigarettes?
L115_CamelGolf
L115_Kool3DMailer
L115_StarsCollage
L115_SalemSlideBox
Page 11.5.3
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued) Tobacco dollars are also used to hire celebrities to promote products. Why do tobacco companies want to use movie stars and models in portraying their products?
L115_LindaEvangelista
L115_AlecBaldwin L115_DemiMoore
The tobacco companies have also used “stealth� marketing techniques, sponsoring sporting events and producing lifestyle magazines and using them as advertising vehicles. Who do you think a women’s tennis match would appeal to? What about lifestyle magazines?
L115_PenelopeCruz L115_Navratilova
L115_koolradio
Free gifts with the purchase of cigarettes were an important marketing tool for tobacco companies. This practice has since been voluntarily restricted by the tobacco companies under the terms of the Master Settlement Agreement, although they still offer sales-linked coupons that are redeemable for a range of clothing, gadgets and other goods.
L115_MarlboroPackage
L115_Giveaway
Page 11.5.4
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued) 4.
Explain to your students that the 1998 Master Settlement Agreement was designed to limit tobacco marketing to young people. Have your students consider the following facts: W
The major cigarette companies now spend more than $11.22 billion per year (or more than $30.7 million every day) to promote their products.
W
Cigarette company spending to market their products increased by more than 67% from 1998 to 2001.
W
Magazine ads for each of the three most popular youth brands (Marlboro, Newport, and Camel) reached more than 80% of young people in the United States an average of 17 times in 2000.
W
Cigarette advertising in magazines with high youth readership actually increased by 33% after the Master Settlement Agreement, in which the tobacco companies agreed not to market to kids.
W
After tobacco billboards were banned by the Master Settlement Agreement the cigarette companies increased their advertising and promotions in and around retail outlets, such as convenience stores.
Ask students why tobacco companies make such an effort and spend so much money to promote their products. Possible answers include: W
to sell more product
W
to replenish the pool of smokers by replacing those who quit or die.
Who are these "replacement smokers?" Point out to your students that almost 90% of all regular smokers begin smoking at or before age 18, and once they start it is very hard to quit. This makes young people, such as your students, an important target for the tobacco industry. Do your students agree with this? Ask your students if they think that tobacco marketing really influences young people. Have your students consider the following research findings: W
Kids are more than twice as likely as adults to recall tobacco advertising.
W
Teens are more likely to be influenced to smoke by cigarette advertising than they are by peer pressure.
W
Adolescents who own a tobacco promotional item and who can name a cigarette brand whose advertising attracted their attention are twice as likely to become established smokers than those who do neither.
Page 11.5.5
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued) Ask your students how they feel about being manipulated by these big tobacco companies!
5.
Explain to students that while tobacco companies spend a great amount of money on advertising to sell cigarettes,
Teacher’s Note: You and your students can find more facts about tobacco marketing at: www.tobaccofreekids.org/factsheets
the government and various other organizations also make a tremendous effort to prevent people from smoking. These agencies support research and anti-tobacco programs, and the government has passed laws as part of anti-tobacco campaigns. Ask students what type of anti-tobacco marketing and strategies they have seen. Possible answers include: W
ads on television
W
the Truth Campaign posters
W
“No smoking� signs
W
school-based educational efforts
W
billboards
W
magazine ads
W
laws that prohibit smoking in the workplace, in public buildings, in public spaces, restaurants, bars
W
internet sites
Ask students why the government and other organizations are so concerned about preventing smoking. Possible answers include: W
the costs of treating smoking-related diseases
W
the social and economic costs of illness (missed days from work or school)
W
the social burdens of addiction and illness
W
the costs to society in terms of higher insurance rates
W
fire-related economic costs L115_ButtsGross
Anti-tobacco ads have sometimes used humor to attack smoking, as in these ads here.
L115_JoeChemo
Page 11.5.6
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued)
L115_BugSpray
“Many bug sprays contain nicotine. All cigarettes do.”
L115_Frog
“The same formaldehyde that preserves dead frogs is found in cigarettes.”
L115_RatPoison
“Cyanide is the deadly ingredient in rat poison. And just one of the many in cigarettes.”
L115_MindIfISmoke
s Look how these billboards are using the “glamour of smoking” as portrayed in tobacco advertisements, and L115_Scent turning the message around to point out why smoking is a bad idea... ...while carrying the “masculinity” of the Marlboro Man to its natural conclusion if one takes up smoking.
L115_Emphysema
L115_IMissMyLung
Page 11.5.7
Lesson 11-5:
Promoting Healthy Decisions
Procedures: (continued)
L115_TableforOne L115_BlewAway
s
L115_FirstWarningSign
Some anti-tobacco advertising portrays directly the deadly consequences of tobacco use.
L115_ToldYou
Others borrow the technique of celebrity appeal to promote both tobacco use prevention and cessation.
L115_BoyzIIMen
L115_Smoking Is Ugly
L115_tonyhawks
Page 11.5.8
Lesson 11-5:
Procedures: (continued) 6.
Divide the class into groups of four students. Have the groups design an anti-tobacco campaign. Have each group consider the type of strategies they would choose to influence young people not to smoke. Review the appeal strategies used by marketers that were introduced in Lesson 9-3: W
Fun and Pleasure
W
Health
W
Adventure and Excitement
W
Money/Fame/Power
W
Beauty
W
Acceptance/Popularity
W
Romance
W
Brains/Intelligence/Wisdom
W
Free Stuff!
Ask each group to choose the appeal strategy(ies) they will use. Ask each group to come up with an ad slogan or idea that would be suitable for a television advertisement or a poster. Have them consider, in particular, how to appeal to other deaf youth like themselves. Have these ideas ready by the next class.
Promoting Healthy Decisions
Teacher’s Note: This is a good point at which to introduce the fact that the government has had ambiguous policies towards the tobacco industry. On the one hand, the government has sought to control tobacco in many ways. For example:
W Supports research to better understand the health consequences of tobacco use, how to prevent such use, and how to help people stop smoking
W Provides education about the dangers of tobacco use
W Requires the placement of labels on cigarettes and other tobacco products
W Passes laws establishing "smoke free" public places On the other hand, there are many ways the government has failed to do all it could to control tobacco. For example, the government:
W Provides subsidies to tobacco farmers to keep them in business
W Has failed to place even stricter labeling and advertising requirements on the tobacco industry
W Has for many decades failed to identify tobacco
and nicotine as drugs, and therefore subject them to regulation as drugs
W Has failed to vigorously enforce laws about tobacco sales to minors
W Has failed to support international efforts to control tobacco advertising and sales, especially by American tobacco companies.
Consider why federal, state, and local government has not always taken stronger actions. Note the economic and political power of the tobacco industry.
Teacher’s Note: This activity can be expanded over several lessons. Students can design a more detailed plan—such as developing a script for a commercial. Students can also implement a campaign in school if time allows and if a video camera or other equipment is available. This might include introducing the concepts in the first session; allowing students to discuss and refine their ideas with their classmates in the second session; and then allowing perhaps a week or more to actually develop a finished product.
Journal: Which of the appeal strategies you talked about in class are most important for you and your friends? Why do you think that is so?
Page 11.5.9
Lesson 11-6
Controlling Access to Tobacco by Minors Introduction: This lesson explores some of the laws and policies that have been implemented to discourage young people from smoking. Your students should be able to recognize the relationship between these types of laws and individual behavior.
Lesson Objectives: By the end of Lesson 11-6, students should be able to: W
Understand the restrictions on the sale of tobacco to minors
W
Research the penalties for vendors who sell tobacco to minors
W
Calculate the economic costs of smoking to individuals
W
Understand public policy issues such as taxation as they relate to tobacco use
Materials: W
Internet access
W
Costs of Smoking Worksheet
W
Tobacco Sales Worksheet
W
Map of State Cigarette Tax Rates Handout
W
Tobacco Taxation Fact Sheet Handout (See L12_WebPages Folder)
W
Tobacco and Money: What Does Smoking Really Cost? Journeyworks pamphlet
Key Terms: minor: legal term for a young person, usually under 18 years of age. penalties: punishment. sting operation: In law enforcement a sting operation is an operation designed to catch a person committing a crime, by means of deception. For example, a teenager working with law enforcement might try to purchase tobacco from a store to identify store keepers that are not complying with laws limiting sales to minors. vendors: someone who exchanges goods or services for money.
Page 11.6.1
Lesson 11-6: Controlling
Access to Tobacco by Minors
Procedures: 1.
Pass out the Tobacco Sales Worksheet, and write the following questions on the board:
2.
W
Is it legal to sell tobacco to a minor?
W
Is there a penalty for selling tobacco to a minor? What is the penalty?
W
Are the rules and penalties the same in all states?
W
What do cigarettes cost per pack?
W
What does chewing tobacco cost?
W
What taxes are charged per pack of cigarettes?
L116_ItsTheLaw
Divide the class into teams. Have your students find the answers to these questions for their community and state by: L116_SeeID
W
Calling or visiting a store that sells cigarettes
Teacher’s Note:
(make sure the students ask to see a store manager and explain that they are doing a class exercise) W
Researching online
W
Going to the library
Warn your students that their answers may vary, depending on where they find the information. For
The internet can be useful to your students in completing the worksheet. Much of the information can be found through a Google search (for example, searching for “tobacco tax rates new jersey”), or by visiting some of the web sites listed below. The Tobacco Free Kids site is particularly good. It has a series of “factsheets” which cover a number of the issues listed above in Procedure #1. Sites:
example, the price of a pack of cigarettes will vary considerably by brand, store, or whether they are
http://tobaccofreekids.org/research/factsheets
purchased online.
www.ash.org
3.
www.whyquit.com
Assign an additional State to each team. Is the legal age to buy cigarettes the same in every state?
www.cdc.gov/tobacco www.cdc.gov/tobacco/tips4youth.htm www.cdc.gov/HealthyYouth/tobacco/ index.htm
Is the cost of a pack of cigarettes the same in every state? Have your students compare their notes to see if the rules are consistent across all states. Ask students why states and communities might differ in their policies towards taxation and L116_Misty
regulation of sales to minors.
Page 11.6.2
Lesson 11-6: Controlling
Access to Tobacco by Minors
Procedures: (continued) 4.
Explain to your students that in some communities, young people and police officers have conducted sting operations to identify vendors who sell tobacco products to minors, or people who are too young to legally purchase those products. Do you think this is a good idea? Will it prevent people from selling to minors? Do
Teacher’s Note: Under no circumstances should students attempt sting operations on their own. These must be conducted in conjunction with the local police.
you think it will prevent minors from smoking?
5.
Distribute the Cost of Smoking Worksheet. Ask your students about the tax amounts they uncovered in their search in their own community and other states. If necessary use the handout Map of State Cigarette Tax Rates if students have not been able to locate materials on their own. Explain how the taxes can raise the price of cigarettes. What does this mean for young people
L116_InStoreAd
trying to buy cigarettes? (Answer: it makes them more expensive, and therefore more difficult to buy.) What else determines the price of a cigarette? Ask your students to report what they found out about the cost of cigarettes and chewing tobacco in local stores. Explain
Teacher’s Note: Students should consider that people who are addicted to tobacco will often give up other things to pay for cigarettes.
to students that smokers who are addicted to smoking often find they must smoke from half a pack (10 cigarettes) to more than two packs (40 cigarettes) per day. Ask your students to calculate, using the worksheet, how much a smoker would spend on cigarettes every year if they smoked half a pack; one pack; or two packs per day. How much will they have spent after five years? Ask your students to list some of the things they could buy with these amounts of money.
Teacher’s Note: Your students may want to explore the price of cigarettes in different countries on the internet. For example try http://ash.org or try a google search using keywords such as “cigarette prices international.”
Ask your students if they think this cost has an impact on whether or not people-especially young people-smoke. Why? Why not?
6.
Ask your students to compare the cost of cigarettes in local stores and those sold on the internet. How difficult do your students think it would be to purchase cigarettes online? What are the difficulties in controlling internet sales to underage teens? Do people pay taxes when they buy cigarettes on the internet?
7.
Ask how governments use these taxes as instruments of public policy. How do tobacco taxes and the cost of cigarettes in the United States compare to those in other countries? Use the Tobacco Taxation Fact Sheet Handout.
Page 11.6.3
Lesson 11-6:
Controlling Access to Tobacco by Minors
Procedures: (continued) Journal: What do you think is the best way to prevent stores from selling cigarettes and chewing tobacco to minors? Give reasons for your answer.
Page 11.6.4
Lesson 11-6 Worksheet: Tobacco Sales
Name __________________________________
Tobacco Sales Instructions: Complete the following chart regarding tobacco sales and young people, and the cost of cigarettes. You can find answers by conducting Google searches on the internet, visiting some of the web sites mentioned in class, or by visiting stores and finding out how much packages of cigarettes cost. Caution: If you ask store owners about policies regarding selling tobacco or cigarettes to minors, please be sure to inform them that you are conducting this as part of a class exercise.
Question
Answer
Is it legal to sell tobacco to a minor?
Is there a penalty for selling tobacco to a minor? What is the penalty?
Are the rules and penalties the same in all states?
Cost per pack: What do cigarettes cost per pack?
What does chewing tobacco cost?
What taxes are charged per pack of cigarettes?
Cost per carton of 10 packs:
Source of Your Answer (If a website, list the URL)
Lesson 11-6: Tobacco Tax Map
Tax Rates by State The numbers below show the amount of tax each state adds to a package of cigarettes. Which states are highest? Which are lowest?
L116_TaxMap
National Center For Chronic Disease Prevention and Health Promotion
TIPS Home | What's New | Mission | Fact Sheets | Site Map | Contact Us
Tobacco Taxation • Overview • Publications Catalog • Surgeon General's Reports • Research, Data, and Reports • How To Quit • Educational Materials • New Citations • Tobacco Control Program Guidelines & Data • Celebrities Against Smoking • Sports Initiatives • Campaigns & Events • Smoking and Health Database • Related Links
Fact Sheet Substantial scientific evidence shows that higher cigarette prices result in lower overall cigarette consumption. Most studies indicate that a 10% increase in price will reduce overall cigarette consumption by 3% to 5%. Youth, minorities, and low-income smokers are two to three times more likely to quit or smoke less than other smokers in response to price increases. Increases in cigarette excise taxes are an effective policy tool in deterring smoking initiation among youth, prompting smoking cessation among adults, and reducing the average cigarette consumption among continuing smokers. Despite the proven effects of increasing both the price of cigarettes and tobacco excise taxes, the average price and excise tax on cigarettes in the United States is well below those of most other industrialized nations. Higher cigarette prices will not simply reduce average cigarette consumption but also will reduce overall smoking prevalence. Higher prices will result in more smokers deciding to quit and fewer young people opting to begin smoking. Studies of smokeless tobacco products suggest that increasing their prices would reduce the prevalence of smokeless tobacco use as well.
Global Cigarette Prices and Taxes in U.S.Dollars,1999 Country
Tax as % Tax Price Tax Price
UK
86% 5.64
6.56
Denmark
82% 4.47
5.47
Portugal
80% 1.88
2.37
Finland
76% 3.82
5.02
France
76% 3.03
4.01
Canada
75% 3.35
4.48
Belgium
75% 2.65
3.55
Italy
75% 1.94
2.60
Austria
74% 2.33
3.15
Greece
73% 1.75
2.41
Spain
73% 14.19 1.63
Netherlands 72% 2.37
3.29
Germany
71% 2.58
3.65
Sweden
70% 3.70
5.27
Ireland
60% 3.26
5.44
Canada
55% 1.41
2.55
US3
41% 1.92
4.65
US4
11% 0.34
3.04
Source: Non-Smokers’ Rights Association web site. * 1:(Highest-New Foundland) 2:(Lowest-Ontario) 3:(Highest-Alaska) 4:(Lowest-Kentucky)
Taxes on smokeless tobacco products are much * Links to non-Federal organizations are provided solely lower than taxes on cigarettes, particularly at as a service to our users. Links the federal level. Research suggests that do not constitute an increases in cigarette excise taxes, while endorsement of any organization by CDC or the Federal reducing cigarette smoking, may have contributed to greater use of smokeless tobacco Government, and none should be inferred. The CDC is not products. Some public health advocates and responsible for the content of others have therefore called for the equalization the individual organization Web pages found at this link. of taxes on tobacco. Healthy People 2010 calls for state and federal
taxes to increase to an average of $2 for both cigarettes and smokeless tobacco products by the year 2010. The importance of tobacco to the U.S. economy has been overstated. Judicious policies combined with higher tobacco taxes and stronger prevention policies can help foster economic diversification in tobacco-producing areas. Privacy Policy | Accessibility TIPS Home | What's New | About Us | Site Map | Contact Us CDC Home | Search | Health Topics A-Z
This page last reviewed May 14, 2004 United States 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
Lesson 11-7
Saying “No” to Tobacco Introduction: This lesson draws together many of the themes developed in the prior lessons. It reviews aspects of communication and how to say "no" effectively to friends and peers when it comes to tobacco use. It reviews some of the ways in which the tobacco industry promotes its products, and develops the theme that young people can resist these forces.
Lesson Objectives: By the end of Lesson 11-7, students should be able to: W
Use refusal skill strategies
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Recognize the many marketing strategies of the tobacco industry.
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Write a message to the tobacco industry
Materials: W
Tobacco advertising samples (provided on CD).
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Postcards from the American Cancer Society
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.
Page 11.7.1
Lesson 11-7:
Saying “No” to Tobacco
Procedures: 1.
Ask students to think about all of the "pushes" and "pulls" to behave in one way or another. Discuss with them that, ultimately, it is up to each person to be responsible for his or her own behavior, for finding ways to make good decisions and to carry them out. This is not always easy to do. Ask your students: Have any of you ever been in a situation where someone has asked you to do something that you thought might be wrong, illegal, dangerous, or disappointing to your parents or friends? What kind of situa-
Teacher’s Note:
tions do you think you might encounter where you might find yourself struggling to say no? List student responses.
2.
Be prepared to provide some examples or add to the list created by the students.
Explain to your students: One of the difficult things for anyone to do is to say "No" when they don't really want to do something. How difficult do you think it would be to say no to the following situations? W
your best friend invites you to join her after school to smoke
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a group of people you'd like to get to know invites you to someone's home because their parents are gone and everyone will be drinking beer
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your boyfriend asks you to have sex
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your friends are cutting school and want you to join them
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your parents aren't home, and your friend tells you to take the family car out for a spin without permission
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you are shopping with your friends, and one of them dares the others in the group to shoplift something
3.
Explain to students that there are different ways to respond to pressure to do something that they don't want to do. These can be classified as passive, aggressive, and assertive. 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 do. Tell your students that refusing to go along with others—
Teacher’s Note: This discussion on resistance strategies is also presented in Lessons 8-4 of the 8th grade and 9-2 of the 9th grade curriculum. If your students have already covered this material, review briefly the different types of resistance strategies students can use when confronted with pressure to do something they don't want to do.
including people whose ideas and opinions are important to us—can be difficult to do, but that it helps if they know specific ways to say “No!”—resistance strategies.
Page 11.7.2
Lesson 11-7:
Saying “No” to Tobacco
Procedures: (continued) Remind your students that ultimately they are responsible for the decisions they make, no matter how they are pressured by others. In making these decisions, it can be helpful to go through the steps of the D.A.R.E. Decision-Making Process.
4.
Discuss the different types of resistance that people use. Sometimes these are referred to as passive, aggressive and assertive resistance strategies. What do these terms mean?
Example #1: Passive Resistance W
Your friends ask you to join them behind the gym to smoke cigarettes.
L117_Passive
What are the common ways you might resist this request? (e.g., I ignore my friends’ invitation; I shrug my shoulders; I say, ‘Maybe next time.”; I giggle and then look away.) Explain that when we use these methods, we are using passive resistance. We avoid confrontation by being neither agreeing or disagreeing, walking away, or ignoring the issue.
Teacher’s Note:
Ask your students: What other types of situations can you think of where you've used passive resistance? What are some of the advantages of passive
Advantages might include avoiding conflict; disadvantages might include not resolving the problem, or not making your decision clear to others.
resistance? What are some of the disadvantages?
Example #2: Aggressive Resistance 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!” L117_Aggressive
Ask your students: What other situations can you think of where someone might use aggressive resistance? What are some of the advantages and disadvantages of
Teacher’s Note: Advantages might include being clear and forcefully direct; disadvantages might include sparking a fight or argument, or causing bad feelings.
aggressive resistance? L117_Assertive
Example #3: Assertive Resistance A third resistance strategy is sometimes called assertive resistance. Assertive resistance usually involves making your resistance known in a direct but non-
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Lesson 11-7:
Saying “No” to Tobacco
Procedures: (continued) 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:
Teacher’s Note:
What other situations can you think of where someone might use assertive resistance? What are the advantages and disadvantages of assertive resistance?
5.
Advantages might include being direct; disadvantages might include causing bad feelings.
Ask your students: What can you do if a friend or group of friends wants you 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? It can be hard to stand up to them and say “No,” even when you want to. Different situations may require different strategies. Here are some techniques you can use to say “No.” Have your students examine the following techniques. How well do they think they would work in different situations?
1. Be Direct 2. Change the Subject L117_Refusal01
L117_Refusal02
3. Think of a Clever Response
L117_Refusal03
4. Make a Joke
L117_Refusal04
Page 11.7.4
Lesson 11-7:
Saying “No� to Tobacco
Procedures: (continued) 5. Blame an Adult
6. Avoid the Situation or Walk Away
L117_Refusal05
L117_Refusal06
6.
Point out to your students that there are also pressures that come from beyond immediate friends and people we know. Students need to be aware of these forces and able to respond appropriately to them. Use the social and cultural messages conveyed by the tobacco industry to illustrate this point. Review what some of the images that are used in tobacco advertisements convey. What desires do these advertisements for cigarettes appeal to? What experiences and self-images do these advertisements want us to associate with tobacco use?
L117_CamelPool
L117_Celebrity
L117_MeritYacht
How does advertising reinforce the notions of smoking as a relaxing pleasure?
L117_Fun
L117_ParliamentHammock
Page 11.7.5
Lesson 11-7:
Saying “No” to Tobacco
Procedures: (continued) What do these advertisements say to us about smoking and our sense of femininity and masculinity?
L117_MarlboroCowboy
L117_VSlims01
L117_VSlimsAppeal
L117_Romance
L117_Ad04
s Or our sense of the exotic, romantic and fun?
L117_CamelCasbah
Before the harmful health effects of tobacco were widely publicized, tobacco companies sought to allay smokers’ health concerns with advertisements featuring medical personnel, and others describing cigarettes that were “mild” and free of “irritation.”
L117_Doctor1940
Many of these ads were produced in the 1940s and 1950s. Do you think tobacco companies could produce advertisements like these today? Why or why not? What do you think of these ads?
L117_Doctor1946
L117_CamelNoRegret
Page 11.7.6
Lesson 11-7:
Saying “No� to Tobacco
Procedures: (continued) These advertisements are also from the 1940s and 1950s. To whom do you think these ads appeal? Do you think you would see ads like thes today? Why or why not?
L117_FatherSon1945 L117_MotherChild
Note that the industry uses many other strategies to promote their products and their industry. These include, for example, funding sport, cultural, educational, and community events and activities that people value (see examples in Lesson 11-5)
7.
Pass out the postcards from the American Cancer Society. Ask students to write a message about not smoking either to a friend or to a tobacco company. Have each of the students present their message to the class.
Teacher’s Note: In instances when you feel that the message is appropriate, have students identify the mailing address and send the cards. See if anyone responds!
Journal: Think about the ways to respond to pressure from others. Which is the most effective for you and why? OR What are the ways in which the tobacco industry tries to gain acceptance in our society?
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