Alameda County Tobacco Use Prevention Education (TUPE) 2017-2018 Peer Educator Handbook
Training Tobacco/E-Cig/VAPING Peer Educators
Goals for today’s training: 1. We want you to leave today with some new information on tobacco and e-cigarettes/vaping. 2. We want to demonstrate some activities that you can use or adapt when conducting tobacco/e-cig peer education. 3. We want to show that learning about tobacco can be fun!
When you walk into the classroom, you should always have a few goals: 1. To teach some new information on tobacco/e-cigarettes! 2. For those non tobacco users, we would like to keep them tobacco free. 3. For those current tobacco users, we’d like to encourage them to consider cutting back or even quitting. (leave resources/contacts) 4. Have fun! 5. Collect evaluations.
*We give thanks to Contra Costa Office of Education for their help on this manual.*
2017-18 Monthly Themes* More fact facts, resources, and suggested activities available soon at the ACOE TUPE web site.
SEPTEMBER Stop Calling it Vapor! E-cigarettes, also referred to as vapes, vape pens, e-hookahs, and Tinyurl.com/ mods, heat e-liquid that generally contains nicotine, flavorings, septemberkahoot additives, and propylene glycol. The e-liquid becomes an aerosol, not just water vapor!
OCTOBER Tobacco is a drug too! Nicotine is a highly addictive neurotoxin and exposure to nicotine, Tinyurl.com/ Red Ribbon Week either in cigarettes or e-cigarettes, can harm brain development. octoberkahoot 10/23-10/31
NOVEMBER Break the Cycle! Did you know? Most smokers try many times before quitting for Tinyurl.com/ Great American good. Every day, week, or month without smoking is a success, not a novemberkahoot Smokeout 11/17 failure. The more people try, the more they learn about how to quit and the closer they get to their goal.
DECEMBER The True Cost of Most adult smokers started as children. In the U.S., 90 percent of all Tinyurl.com/ Tobacco adult smokers started while in their teens or earlier. Every day, decemberkahoot another 700 children become regular smokers. One-third of them will die prematurely from a smoking-caused disease. JANUARY Make a Healthy Keep your lungs healthy by taking good care of yourself every day. Tinyurl.com/ Resolution! Don’t smoke, avoid exposure to pollutants, prevent infection, get januarykahoot Happy New Year! 1/1 regular health care, and exercise.
FEBRUARY Black History Month Big Tobacco has been targeting African Americans for decades: Tinyurl.com/ Through With Chew offering free samples of cigarettes in the inner-city, placing more bhmtupekahoot Week 2/19-2/23 ads in black neighborhoods than in others, and using culturally Valentine’s Day 2/14 targeted ads for menthol flavored products. MARCH Kick Butts! Tobacco’s terrible toll is no accident. It’s a direct result of the Tinyurl.com/ #NotaReplacement tobacco industry’s actions, including marketing that targets children marchkahoot Kick Butts! Day 3/21 and deceives people about the harmful effects of their products.
APRIL Tobacco Hurts the Cigarette butts are NOT biodegradable and cigarette butts leach Tinyurl.com/ Earth! toxic chemicals into the environment including lead, arsenic, and aprilkahoot Earth Day, Apr. 22 nicotine – the same toxic chemicals found in secondhand smoke.
MAY International Impact Tobacco use is the world’s leading cause of preventable death. Tinyurl.com/ of Tobacco Increasingly, the burden of tobacco use is greatest in low- and maykahoot World No Tobacco middle-income countries that have been targeted by the tobacco Day 5/31 industry with its deadly products and deceptive marketing practices. JUNE Reflection/Celebration Share your success story! For example, “This year, our # Peer #FinishIt Educators reached ### of their peers through classroom presentations and school-wide events!”
Table of Contents
The Basics ...... 1 Tip Sheet: Preparation for Classroom Presentaions ...... 2 Basic Structure of a Presentation ...... 3 Peer Educator Classroom Presentation Template ...... 4 Activities and Sample Classroom Agendas ...... 5 Tip Sheet: Preparing for School-wide Events ...... 6 Kahoot! Game Instructions ...... 7 Peer to Peer ...... 8 Vapor vs. Aerosol Demonstration ...... 9 Tar Jar...... 10 Find Someone Who ...... 11 Fine Someone Who Instructions ...... 12 Find Someone Who Answers ...... 13 Facts Matching Activity ...... 14 Tobaacco Facts Matching Activity Answer Key (Core Pack) ...... 15 Facts Matching Activity Answer Key (E-Cigarette Expansion Pack) ...... 16 The Tiral - Who is Responsible ...... 17 Gasping for Air (Straws) Activity ...... 22 Short and Long Term Effects Activty ...... 23 The Cost of Tobacco$$ ...... 25 The Cost of Tobacco Answer Key ...... 26 The BB Activty ...... 27 School-wide Events ...... 28 Breathe Easy Track Meet ...... 29 Cups in a Fence ...... 30 Not a Replacement...... 31 Fatal Figures ...... 32 Tombstones ...... 33 Pledge Campaign ...... 34 #BeTheFirstPledge ...... 35 Airing out Big Tobacco's "Dirty Laundry" ...... 36 Facts, Statistics & Resources ...... 37 Deaths a Year Comparision ...... 38 Youth Tobacco Facts ...... 39 E-Cig/Vaping Facts...... 40 Marijuana Facts ...... 41 How to Help a Friend Quit Smoking ...... 42 How to Help a Family Member ...... 43 Ending the Sale of Flavored Tobacco: Standing Up for Youth Health and Social Justice ...... 44 Health Effects of Electronic Cigaretes, Vapes, and Hookah ...... 46 Tobacco Cessation/Quit Resources ...... 48
The Basics
1 Tip Sheet: Preparing for Classroom Presentations
Prepare Decide what topic(s) you want to address Find out who your audience will be and how much time you have to present Select activities to go with the topic being covered Create an outline for the presentation Assign roles for each portion of the presentation (learn your part as well as be familiar with everyone else’s in case there are any absences) Assemble your resources (statistics, informational material, handouts, etc.) Practice the presentation with your co-presenters
Implement Set the ground rules before you begin your presentation. Be comfortable with what you will be presenting (know the information) Give directions to an activity BEFORE you break the students into groups or give them a handout. Try to include everyone in the activities but do not force students to participate. Avoid calling on the same students when asking for answers.
Reflect Leave time at the end of your presentation to distribute student surveys Debrief with team at next peer educator meeting o What did/didn’t work? o What to change for next time?
2 Basic Structure of a Presentation
• Intro (Who we are), Goals/Topic, Norms and Ground rules
• Ice Breakers (Optional/time)
• What does your audience think/know about the topic - Find Someone Who - Small Group Discussion - Large Group Discussion - Kahoot (https://getkahoot.com/) - Diad/Triads questions - Play a game - Quick Surveys
• Sharing Info (in the most interactive, fun way possible) - Role Plays - Power Points - Interactive activities - Kahoot (https://getkahoot.com/) - Family Feud - Jeopardy
• What did the class just learn, reinforce information/skills Games - Small Groups Come up with a Skit/Poster …etc - Role Play - Present Back - Practice/Reinforce Skills
• Wrap up - Review Goals/Topic - What did we learn - What can you do to share your new knowledge/skills - Presentation Survey
• Extra Time? (closing activities) - "I liked, I learned." - "Head, Heart, Feet."
3 Peer Educator Classroom Presentation Template
Date: ______Total Time: ______
Location: ______Amount of Participants: ______ESTIMATED ACTIVITY PLAN FACILITATOR/S TIME Activity: Materials Needed: Notes:
Activity: Materials Needed: Notes:
Activity: Materials Needed: Notes:
Activity: Materials Needed: Notes:
Activity: Materials Needed: Notes:
4
5 Tip Sheet: Preparing for School-wide Events
Prepare Decide where and when you will have your event Assemble your resources (statistics, informational material, handouts, etc.) Assign roles for each portion of the event or station Familiarize yourself with the information you will be showcasing Practice how to deliver the information
Implement Set up tables, displays, presentation materials, etc. as early as possible Engage as many students as possible Have fun!
Reflection Collect feedback through student surveys Debrief with team o What did/didn’t work? o What to change for next time?
Suggested School-wide Events Cups In a Fence Not a Replacement Number Representation Pledge Campaign Breathe Easy Track Meet
6 Kahoot! Game Instructions
Step 1: Go to https://getkahoot.com/ and log-in to your account. Don’t have an account? Click on the “Sign up for free!” button at the top of the page, and follow the instructions. Step 2: Create a quiz or access one through a public quiz link.* Even with public quizzes, you will need to be signed-in to your account. Step 3: Ask students to get their devices ready. They can use any device with a web browser -- phone, tablet or laptop. Students don’t need an account to join. Step 4: Project your screen. At this point you should have your device (laptop or tablet) connected to the projector or screen for your students to see. Step 5: Press the “Classic” (individual players) or “Team Mode” button. Your screen will display the instructions for how to join (kahoot.it) and Game PIN. Step 6: Students join game at kahoot.it. They will be prompted to enter the Game PIN, followed by a nickname. Their nickname will appear on the screen at the front as they join the game. Step 7: Once everyone has joined the game, click the ‘Start’ button on the right. The game will then load with an “Are you ready?” message. The first question will then be projected. Step 8: Click the ‘Next’ button to move through the game. Only the question will be projected at first, then the answer options will appear and the timer counts down. On the student’s devices, they will see answer buttons that correspond to the answers displayed on the projected screen. Each option is differentiated by a color/shape. The question finishes when everyone has answered or the time has run out. Then the correct answer and results are automatically displayed. The faster students answer correctly, the more points they get. The top 5 players are displayed on the projected screen in between each question. Once you get to the final question, press the ‘End’ button to display the winner!
Kahoot! Tips • Nicknames: If a student joins with an inappropriate nickname, you can remove them from the game by simply clicking on the name from the “Waiting for Players” screen. • Discussion: While playing Kahoot, you’re students may be louder than normal. This is a good thing - they’ll be talking about the content you’re teaching! Because you click ‘Next’ to move through the game, you can pause at any time to discuss a question and answer in more detail. • Devices and Access: If your students temporarily drop out of a game due to a slow network, Kahoot! will automatically try to get them back in on the next question. Kahoot! now has a team option, and this may be good if each student does not have access to a device. • Sound: Turn the volume up for questions - it adds to the excitement!
7 Peer to Peer
8 Vapor vs. Aerosol Demonstration
Materials Needed: Spray bottle filled with water, aerosol hairspray can
Instructions/Script:
[Hold the spray water bottle up.]
Say: “This spray bottle is filled with regular water. If I spray this on my hair, what will happen?” (Answer: your hair will get wet) [Spray water bottle on your hair.] “When this water dries, what will be left behind on my hair?” (Answer: nothing)
Say: “Do you think it is safe to spray this into my mouth and swallow? [Point spray bottle towards your mouth.] Is it safe to drink and digest? (Answers will likely be yes.) [Spray water into your mouth.] Yes it is safe. It’s only water and water vapor.”
[Hold the aerosol hair spray can up]
Say: “What will happen if I spray this hairspray onto my hair? Is this only water vapor?” [Read some of the chemicals in the product]
Say: “What will happen when I spray my hair with this hair product?” (Answer: It will shape and hold your hair.) When the hairspray dries, what will be left in my hair? (Answer: hair spray, chemicals, etc.) Yes, you’re right, some of the chemicals will still be left in my hair.”
Say: “The difference between the hairspray and the water is that the hairspray is an aerosol, not vapor. They may look similar, except an aerosol consists of small chemical particles suspended in a gas.”
Say: “Now let me ask, is this aerosol safe for me to spray into my mouth and breathe in or swallow? [Hold the can near your open mouth.] Why or why not?” [Wait for responses.]
Say: “Vapor is one of the main words the e-cigarette companies want you to associate with their products. Water vapor sounds nice and safe, right? The thing is, e-cigarettes, vape pens, etc. produce aerosol, not water vapor. The aerosol contains harmful chemicals that enter the user’s lungs and leave chemical residue behind. Also, many e- cigarettes contain nicotine, which is known to have harmful effects on the cardiovascular system.”
Reflection Questions: • Why do you think e-cigarette companies want their customers to think that e- cigarettes only produce water vapor? • Why is it important for people to know that e-cigarettes produce aerosol, not water vapor? 9 Tar Jar
Materials Needed: Tar Jar
Instruction/Script:
Say: “Another harmful chemical inside of cigarettes is tar. Has anyone even seen tar before?” [Wait for answers] “Does anyone know what tar is used for? “ [Wait for answers]
Say: “You may be familiar with the tar that is used on roofs and streets. It is thick, black, sticky, and smelly. After a while it then hardens, imagine this hardening in your arteries and blocking your blood flow. Cigarette tar refers to the residue left behind by the toxic chemicals in a burning cigarette. Tar includes the majority of the cancer – causing chemicals found in tobacco.” [Hold up Jar]
Say: “This Jar of Tar represents how much tar will build up in a smoker’s lungs each year from smoking a half a pack of cigarettes each day. A pack contains 20 cigarettes so a half a pack would equal smoking 10 cigarettes a day. Ask: “Does anyone know someone who smokes 10 cigarettes a day? This (waving the jar around) is the amount of tar that a person will take in every year. Does anyone know anybody who smokes a pack a cigarettes a day? Then (waving the Jar around) double this amount is what they would put into their body every year.”
Say: “Tar damages a smoker’s lungs over time, by damaging the cilia. Cilia are tiny hair- like structures that line our trachea and help to prevent toxic particles from entering our lungs. Tar also stains teeth and damages the gums and taste buds. The tar in cigarettes is similar to that found in marijuana.
Say: “One of the problems with Tar is how sticky it is.” Ask: “Has anyone ever by accident or on purpose ever dipped their fingers or toes in Tar? Ever stepped in some on a beach? Was it easy to get off? NO, it’s very hard to remove and clean off.”
10 Your Name______
Find Someone Who
Has a Twitter, Instagram, and Snapchat account ______
Can name two cancers associated with smoking ______
Likes to binge watch Netflix ______
Knows exactly what the “cloud” from a vape pen is ______
Can name two chemicals found in cigarette smoke ______
Will tell you a joke ______
Can name the most popular cigarette brand ______
Can name two brands of e-cigarettes ______
Can name the only flavor of cigarettes that is legal ______
Can name someone famous and very smart who supposedly quit 8 years ago but has been struggling for years to quit ______
Bonus questions:
What is one reason smoking was banned in bars and restaurants?
How many people die every year in the world due to tobacco? A. 1,000 B. 1,000,000 C. 2,000,000 D. 5,000,000
How many cigarettes are smoked EVERY MINUTE in the world? A. 1,000 B. 10,000 C. 100,000 D. 1,000,000
11 Find Someone Who Instructions
Time: 15 minutes
Instructions
1. Hand out worksheets. 2. Read instructions Everyone will be participating in a group activity. The goal is to be the first person to get all the correct answers. With your worksheet, you will walk around the room looking for people who can answer the questions on your paper. Once you find a person who fulfills the prompt, write their name on the line next to it. For all tobacco- and cigarette-related questions, you must write the correct answer to the question along with writing the person’s name on the line. When you have all answers filled in, bring your paper to me to check your answers. (If you are providing prizes, say there are prizes for the first people who have all the correct answers.) Here are the rules: a. You are not allowed to answer questions on your own paper. b. You may not receive two answers from one person. c. Adults can answer one question per person too!
Review all tobacco/cigarette related questions with the whole class after a few correct papers have been identified. Read the question, have participants answer.
12 Find Someone Who Answer Key
• Can name two cancers associated with smoking: o cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, uterus, pharynx, and rectum, as well as acute myeloid leukemia • Knows exactly what the “cloud” from a vape pen is : o Aerosol • Can name two chemicals found in cigarette smoke: Arsenic Cadmium Methanol Acetic Acid Carbon Monoxide Nicotine Ammonia Formaldehyde Tar Arsenic Hexamine Toluene Benzene Lead (thousands more) Butane Naphthalene • Can name the most popular cigarette brand: o Marlboro • Can name two brands of e-cigarettes: o Blu, Vuse, Mark Ten, NJoy, V2, Green Smoke • Can name the only flavor of cigarettes that is legal: o Menthol • Can name someone famous and very smart who supposedly quit 8 years ago but has been struggling for years to quit: o President Barack Obama
Bonus Questions: What is one reason smoking was banned in bars and restaurants? The people that worked there were getting sick from the smoking that was happening in those establishments.
How many people die every year in the world due to tobacco? Trick Question! 6 million
How many cigarettes are smoked EVERY MINUTE in the world? Trick Question! 10 million
13 Facts Matching Activity
Time: 15 minutes
Materials Needed: Fact and Answer Cards, Answer Key
Preparation: • Before you begin, count out the number of people participating in the activity. • Select the number of matching Facts and Answers Cards corresponding to the number of people. (Ex. If there are 20 people, you’ll need 10 Facts [green] and the 10 answer [orange] that match the facts). • Have the Answer Key ready to check participants’ matches.
Instruction/Script: 1. Hand out the Facts and Answers, one per person. Make sure to mix them up so the matches won’t be standing next to each other. 2. Once everyone has a Fact or Answer, Say: “You will now roam the room looking for the person that has the match to your Fact or Answer. When you and another person feel like you have your match, check with me to see if you are correct.” [Make sure to have the answer key ready] “If you and your partner are correct, you will stand together off to the side until all of the remaining students have found their match. If you are incorrect, you must return to the pool of students to look for another possible match.” 3. After all students have been correctly paired together, pick a few pairs to share their Fact and Answer as a group. If time allows, it is recommended to ask a few follow up questions. Sample questions are provided.
14 Tobacco Facts Matching Activity Answer Key
Secondhand Smoke 49,000 The number of people who die each year from second hand smoke in the United States. 88,000,000 The number of people who are exposed to second hand smoke in the United States. Tobacco-Related Health Problems & Deaths 10 The number of years the average smoker will shave off their life. 1,200 The number of people who die each day from tobacco related causes in the United States. 443,000 The number of people who die each year from tobacco related causes in the United States. 6,000,000 The number of people who die each year from tobacco related causes worldwide. 4,000+ The number of chemicals found in tobacco. Smoking tobacco from a hookah (or water pipe) during a 1-hour smoking session is the same as inhaling the smoke from this 100 many cigarettes. Financial Costs 1,825 The dollars that someone will spend in a year if they smoke a pack of cigarettes a day. 96,000,000,000 The amount of money spent on health care in the United States each year because of tobacco use. Rates of Use 90 Percentage (%) of cigarette smokers who began before they were 18. Percentage (%) of Alameda County high school students who said that they used smokeless tobacco (chew, dip, etc.) in 5 the last 30 days. 1 Percentage (%) of Alameda County 7th graders who said that they smoked cigarettes in the last 30 days. 4 Percentage (%) of Alameda County high school students who said that they smoked cigarettes in the last 30 days. 28 10 years ago, the percentage (%) of high school students who said that they smoked cigarettes. Percentage (%) of Alameda County continuation/alternative high school students who said that they smoked cigarettes in 16 the last 30 days. 3 Percentage (%) of Alameda County high school students who have attempted to quit or stop using cigarettes. 36 Percentage (%) of lesbian, gay, and bisexual high school students who smoked cigarettes in the last 30 days. 51 Percentage (%) of high school smokers who currently want to quit. Tobacco Industry & Advertising 3,000 The number of new replacement smokers the tobacco companies need every day. 12,500,000,000 The dollars spent on Tobacco Advertising and Promotion each year. 30 Percentage (%) of 3 year olds who could identify Joe Camel 20 years ago. 90 Percentage (%) of 6 year olds who could identify Joe Camel 20 years ago. Environmental Impact 4,500,000,000,000 The number of cigarette butts that end up as toxic trash each year. 31 Percentage (%) of garbage collected that is cigarette butts. 11,000,000 The amount of money San Francisco spends on cleaning up cigarette butts.
15 E-Cigarette Expansion Pack Answer Key Usage 3,000,000 The number of middle and high school students who used e-cigarettes in the past month. (United States) 60 Percentage (%) of high school cigarette smokers in 2015 that also used e-cigarettes. (United States) 38 Percentage (%) of high school students who have ever used e-cigarettes in 2015. (United States) 14 Percentage (%) of middle school students who have ever used e-cigarettes in 2015. (United States) 900 Percentage (%) of increased usage among high school students from 2011-2015. (United States) Flavors 7,700+ The number of e-cigarette flavors on the market. 85 Percentage (%) of middle and high school students who said they had seen e-cigarette advertising in 2014. Toxicity 215 The number of poison center calls per month in 2014 involving e-cigarettes. Alameda County 25 Percentage (%) of Alameda County 11th grade students who report that they have ever used electronic smoking device. 17 Percentage (%) of Alameda County 9th grade students who report that they have ever used electronic smoking device. 6 Percentage (%) of Alameda County 7th grade students who report that they have ever used electronic smoking device. Percentage (%) of Alameda County Non-traditional grade students who report that they have ever used electronic 47 smoking device. Percentage (%) of Alameda County 11th grade students who report that they have used an electronic or other vaping 7 device in the past 30 days. Percentage (%) of Alameda County 9th grade students who report that they have used an electronic or other vaping 5 device in the past 30 days. Percentage (%) of Alameda County 7th grade students who report that they have used an electronic or other vaping 3 device in the past 30 days. Percentage (%) of Alameda County Non-traditional grade students who report that they have used an electronic or other 18 vaping device in the past 30 days.
16 The Trial- Who’s Responsible Time: 30 minutes
Ready
Summary In this lesson, students simulate a trial in order to explore people’s responsibilities when someone close to them uses tobacco.
Objectives Students will demonstrate the ability to: describe the responsibility of people who care about those who use tobacco Norms Promoted • It’s a bad idea for children to smoke. • People can’t predict when they’ll become addicted to nicotine. • It’s good for people to support their friends to stop using tobacco or not to use it in the first place. • Perceiving messages critically helps people make good decisions • It’s okay to turn down an offer to use tobacco.
Risk Factors Addressed • Friends who use tobacco • Favorable attitudes toward the use of tobacco • Early use of tobacco
Set Roles “Who’s Responsible? The Older Brother (defendant)” “Who’s Responsible? The Mother (defendant)" “Who’s Responsible? The Mr. SleezeTar(defendant)" “Who’s Responsible? The Girlfriend (witness)” “Who’s Responsible? The Judge Preparation 1. Make a copy of each of the work sheets 2. Before class, choose five students who can effectively read the roles of the Older Brother, the Mother, the Girlfriend, and give the appropriate work sheet to each student. Explain to students what will happen in the lesson, i.e., they will “testify,” be asked questions, and then be “judged” by the rest of the class. 3. Place a chair in the front of the room.
Go Review 1. Remind students that in the previous lesson they came to recognize two important fact about influence and using tobacco: people have the ability to influence them to use or not to use tobacco, they have the ability to influence others to use or not to use tobacco Objective 2. Tell students that today they’re going to explore the issue of influence a little more deeply, and that they’re going to try to answer the question, “Whose responsibility is it when a young person begins to smoke?”
17 The Victim 3. Explain to students that now you want to talk about a victim. Give them the following description: • “The victim’s name was Daniel. He died at age 44 of an advanced form of lung cancer. From Daniel’s standpoint, it came on pretty suddenly. The cancer was diagnosed at his annual check-up, two weeks before his 44th birthday. He died seven months later.” • “At the time of his diagnosis, Daniel was smoking from two to three packs of cigarettes a day. He’d begun smoking at age 13, and, except for a period of eight months when he was 21, smoked constantly.” • “Daniel had seriously tried to quit smoking three times, each time on his own. The first time, when he was 17, lasted three months: He’d started going out with a girl who didn’t like him to smoke. When they broke up, he began to smoke again.” • “The second time Daniel tried to quit was the most successful: He didn’t smoke for eight months when he was 21. He’d had a serious, hacking cough for about two months, and his doctor told him that he should give up smoking if he wanted to get rid of his cough. Eight months later, however, he relapsed, thinking that he was somehow cured.” • “The third time Daniel tried to quit was when he was 22. He got a job working in a place that didn’t allow smoking, and, again, he started going out with a woman who didn’t approve of smoking. Within a month, however, he was smoking before and after work, during breaks, and after weekends. As a result, his relationship with the woman ended. He kept his job for five years. Eventually, he got another job where he could work outside and keep smoking.” • “That was the last time Daniel seriously tried to quit. Even during the last year of his life, when he was sick and in a lot of pain, Daniel smoked two to three packs a day. He died with a pack by the side of his bed.” • Daniel never married, but he left behind survivors-his mother, his older brother, and several friends.” The Accused 4. Explain to students that three people are accused of contributing to Daniel’s death-his mother, his older brother, and Mr. SleezeTar. Say that their job is to apportion responsibility-among Daniel and the three people. Say that Daniel, being dead, is unavailable to testify, but the other three people are, as are three other witnesses.
The Testimony 5. Give students the following instructions: • “Here’s how this will work: I’m going to be the judge in this trial. I’m going to call up each defendant and let them testify on their own behalf. I’ll then call up the three witnesses.” • “After each testimony, I’ll ask a follow-up question or two. Your job is to take notes on everything that happens, because you’ll have to make some decisions.” • “After the final witness testifies, I’ll leave the judgement in your hands: You’re the jury. You can talk among yourselves, and you can also write down up to three questions that you want to ask a defendant or a witness-three questions in all, not three questions for each person.” • “After that, I want a verdict, and here’s how that goes: Take 100% guilt and divide it among Daniel himself and the three defendants. Daniel 18 and any of the defendants can receive anything from 0% to 100% guilt. Any questions?” The Trial 6. Begin the trial by calling the first defendant, the Older Brother. Have each witness sit in a chair at the front of the room, testify, and then respond to your follow-up questions. Consider asking any of the following questions of each person who testifies, or make up some of your own: -the Older Brother • “What were some of the affects you yourself experienced from smoking?” • “And you were okay with your brother experiencing those same effects?” • “What do you think would have happened if you’d refused to give Danny any cigarettes?” -the Mother • “Did you ever smell smoke on Daniel or in his room, or discover cigarettes around the house?” • “What do you think a parent’s responsibilities are to protect her child?” • “Did you ever ask Daniel if he was smoking?” -the Girlfriend • “Did Danny want to break up with you?” • “Do you think that Danny knew you’d stay with him if he quit smoking?” • “Which strategies did you use to try to get Danny to quit?” 7. After the students have testified, separate them from the rest of the class, and give the “jury” time to deliberate and to write down their questions. Ask them to appoint a foreman or forewoman, who will hand you the questions as well as the verdict. Give that person the work sheet, the Verdict. 8. When the foreman or forewoman hands you the questions, call up the appropriate defendants or witnesses to respond to the questions.
The Verdict 9. When the jury is finished, ask the defendants to stand up and the foreman or forewoman o read the verdict. Thank everyone for their roles in the simulation. Discussion 10. Focus discussion, with the entire class, on the following questions: • “Was it difficult to come to a verdict? Why?” • “What implications does this simulation have for your life, particularly your relationships with people who use tobacco?” Closure 11. Ask students, “What level of responsibility should we accept for our friends’ health and safety?” Point out that although people need to take primary responsibility for their own behavior, they also need the support of their friends. Add that sometime they may have to put the health and safety of their friends over the friendship itself. Extension 12. Ask students to think about anyone they care about who uses tobacco. Have them ask themselves the following questions and then follow through with their responses: • “Have I given this person all the information about using tobacco that I have access to?” 19 • “Have I tried to persuade this person to stop using tobacco?” • “Have I offered my support in helping this person stop using tobacco?”
Next 13. Tell students that next they’ll be thinking about setting limits on a variety of behaviors.
Script
Deputy: (bangs gavel) All rise, the U.S. District Court of California is now in session, the Honorable ______presiding. Judge: Will the Deputy please swear in the jury? Deputy: Will the jury please stand and raise your right hand? [Wait for everyone to stand.] Do each of you swear that you will fairly try the case before this court, and that you will return a true verdict according to the evidence and the instructions of the court? Please say “I do”. [Wait for jurors to say, “I do.”] You may be seated. Deputy/Facilitator-back story and additional pages The Mother “I never knew Daniel smoked. Maybe I wasn’t the best mother, but I ever (defendant) knew he smoked. Well, I knew later, of course, when he got sick. And I guess I knew even before that, when I would see him, you know, as an adult. But as a teenager? No. How was I to know? He’d come home from school and go right to his room. And on weekends he was with his friends. Teenage boys aren’t that close to their mothers, you know? All these people who say, well, she should have known this, she should have known that. How could I? I didn’t want to smother him. He wouldn’t have listened to me, anyway. Maybe if his father would have been around, things would have been different. But I did my best. And I think I did okay, too. It’s not my fault he started smoking. He could have started when he was 20 and out of the house, too. Would it still be my fault? Well, would it?” The Older Brother “Look, I admit it. I gave Danny his first cigarette. In fact, I probably bought (defendant) him his first 10 cartons of cigarettes. You know, he was underage, and I bought them. I admit all that. But am I guilty? Hey, you know what I didn’t do? I didn’t tie him up and force the cigarettes down his throat. And I didn’t sneak into his room while he was asleep and blow smoke up his nose, either. I didn’t hook Danny on cigarettes. Danny hooked Danny on cigarettes. Man, I was doing him a favor! I smoked, he wanted to smoke, I gave him the opportunity to smoke. He was my little brother, okay? And I’m really sorry he got lung cancer and died, but Danny enjoyed smoking. He was the one who made the decision to smoke, not me. He knew that.” The Girlfriend “I don’t like talking about this. I went out with Danny when we were 22. I (witness) really liked him-except for the smoking. I mean, he always smelled of smoke. His hair, his clothes, his breath-it didn’t matter if he used mouthwash or if he had just brushed his teeth. He still smelled like stale smoke. And maybe that was shallow of me, because he was a really nice guy. But I just figured, you know, I’ll meet another really nice guy, one who doesn’t smoke. The thing is, we had a lot going for us, and sometimes I wonder if I should have stuck it out, helped him more or something. But I guess he had to want to quit, and I’m not sure he wanted to enough. I guess he thought that smoking was
20 more important than our relationship. Well, maybe he didn’t, I mean, he was addicted and all. But that was the bottom line, anyway.”
Mr. Sleaze Tar [Takes his/ her time to walk up to the witness stand. Sleaze Tar is a confident large business owner who only cares about making money, and after all, it is a legal product. They feel they have zero responsibility, and it’s really the families fault.] I am sorry to hear about Daniels death, unfortunately, Daniel died because of his family’s inability to be good role models. We at Ziggy cigarettes send our condolences to the family and we wish them the best. Now, regarding my company having anything to do with Daniels death, (small chuckle) we are innocent. We at Ziggy take pride in providing our customers with a clean pleasurable smoke without the unpleasant aftertaste. Our e-cigarettes are currently our most popular product and we have a wonderful selection of fruity flavors that will delight our most selective customers. I would also like to note that we at Ziggy supports local schools, gives back to the community and supports local environmental protection laws. We want to be your friends, and a part of your family and a member of your community for years to come. With that said, in honor of Daniels unfortunate death, we at Ziggy are going to give everyone a 50 percent discount on all our products, today only! And don't forget to check out our patent pending new chocolate-strawberry e cig. (smile)
Wrap up Questions Now you’ve heard the testimonies, and he have a few questions for you! • If you had a 100% guild, and you could give some of that away to those on trial, with a show of hands, who would you give it to? • Daniels mother? • His big brother? • The tobacco company? • Daniel? • Well, the sad truth is, that there is plenty of guilt to go around. Each person on trial except for the girl friend, had a hand in Daniels death, including Daniel!
Why do you think that just about everyone on trial had a hand in Daniels death?
21 Gasping for Air (Straws) Activity
Time: 5 minutes
1. Explain they are going to participate in an activity that demonstrates how difficult it might be to breathe in certain situations. Explain that if someone has asthma that they need to be careful during this activity. If anyone feels light headed or faint, they should stop and take a good, deep breath.
2. Provide each participant with a coffee straw.
3. Ask participants to pinch their nostrils closed and place the straw in their mouth.
4. Have participants breathe through the straw for one minute while someone else times them.
5. Ask students what it was like to breathe through the straw.
6. Explain that the long term effects of smoking cigarettes are very serious. Breathing through the coffee straw demonstrates what it is like to breathe when you have chronic obstructive lung disease (like emphysema for example).
With emphysema, there is limited airflow in and out of the lungs because the smallest air passages to the lungs are destroyed by cigarette smoke.
It becomes difficult for the lungs to bring in oxygen and remove carbon dioxide. The heart must work hard to get oxygen to the cells.
Emphysema is non-reversible. Someone who is diagnosed with emphysema may live 5, 10, 15 years with the disease. What kind of quality of life do they have?
22
Short and Long Term Effects Activity Derived from: Center for Human Development
Time: 10 minutes
1. Post the easel sheet with the ‘gingerbread man’ outline on it.
2. Tell students you are going to do a brainstorming activity and ask them to think of all of the consequences that tobacco use has on a person. This would include the impact on someone’s health and appearance along with social or financial consequences. Call on students one at a time to get their responses.
3. Record students’ responses on the ‘gingerbread man’ outline. For example, write “lung cancer” on the hand. Write “exposing others to 2nd hand smoke” off to the side, etc.
4. Add the following to the picture if they are not mentioned by the class: *Addiction *Smelly hair and clothes *Spends lots of money! *Yellow teeth and fingers *Premature aging and wrinkles *Loss of sense of taste and smell *Emphysema (lung disease) *Heart disease *Blocked arteries *Cancer (lungs, pancreas, etc.) *Cataracts (cause of blindness) *Expose friends and family to 2nd hand smoke *Shortness of breath and decreased stamina
5. Thank the students for their responses.
23
24 The Cost of Tobacco$$
Time: 10 minutes
Ms. Taylor died at the age of 54 of emphysema. Before Ms. Taylor died she was on high blood pressure medication for eleven years, which cost her $225/month. She was in the hospital 40 days before her death at $1,800/day. She was also on oxygen for 5 years at $600/month. Ms. Taylor began smoking at the age of 13, and smoked 2 packs of cigarettes a day. Ms. Taylor paid an average of $6.00 per pack, and she smoked till the day she died.
1. How much money did Ms. Taylor spend on cigarettes?
2. How much money did Ms. Taylor spend on high blood pressure medication?
3. How much money did Ms. Taylor spend on hospital care?
4. How much money did Ms. Taylor spend on oxygen?
5. How much money did Ms. Taylor spend in her lifetime because of smoking?
6. What else may have Ms. Taylor had to spend money on due to her smoking?
7. If Ms. Taylor never smoked, what else could she have possibly bought?
25 The Cost of Tobacco Answer Key
1. How much money did Ms. Taylor spend on cigarettes? • 2 packs/day = $16.00 a day • 365 days/year = $5,840 a year • Age 13-54 = 41 years • 41 years X $5,480 = $239,440
2. How much money did Ms. Taylor spend on high blood pressure medication? • $225/month = $2,700 a year • 11 years X $2,700 = $29,700
3. How much money did Ms. Taylor spend on hospital care? • $1,800 X 40 = $72,000
4. How much money did Ms. Taylor spend on oxygen? • $600/month = $7,200 a year • $7,200 X 5 = $36,000
5. How much money did Ms. Taylor spend in her lifetime because of smoking? • $239, 440 + $29,700 + $7,200 + $36,000 = $377,100
6. What else may have Ms. Taylor had to spend money on due to her smoking? • (answers will vary)
7. If Ms. Taylor never smoked, what else could she have possibly bought? • (answers will vary)
26 The BB Activity Adapted from Tune out Tobacco, County of Orange (California) Health Care Agency, Tobacco Use Prevention Program
Time: 5 Minutes
Materials Needed: • Plastic container • Four small containers with BB’s
Preparation: Have your BBs ready in small jars that are labeled: Start up- 2BB, heroin- 22 BBs, alcohol- 241BBs, tobacco- 1315BBs. When packing up the BBs for the next demonstration, simply count out the smaller quantities (2, 22, and 241) from the large bowl or kettle, and pour BBs into their separate containers.
Script: “You may want to close your eyes for this demonstration. We all know that tobacco is harmful to our health, but few of us really understand just how harmful it is. To give you a new perspective on the problem of tobacco, I’m going to ask you to think about death. I have a metal BB here. Now listen to the sound it makes when I throw it into this jar.” [Toss BB into jar]
“Let the sound of the one BB-toss represent one death. Think about someone you know who died.” [Toss in another]
“First, let’s think for a moment about a hard drug –heroin. You think that’s bad? It is. It kills…Here’s how many people will die from a drug overdose every day in this country. [Toss 22 BBs] That represents 22 people who will die every day from this drug – about 8,200 people every year.”
“Now what about alcohol? Do you think alcohol is bad for you? It is. It can kill you. Usually not right away, but slowly over time. Here’s how many people will die from alcohol every day. [Pour BBs slowly] That’s 241 people every day, 88,000 every year.”
“Now tobacco– listen to how many people tobacco will kill today and every day in America. [Pour slowly, pause] That’s 1,315 people who die every day and are dying right now…over 480,000 people every year. Three out of four people who are dying from tobacco every day started to smoke before they were 18 years old. About half started before they were 13 years old. Tobacco kills. It won’t kill you today or tomorrow like hard drugs can. We must begin to see tobacco for what it is: A legal, dangerous, addictive drug. So don’t be a BB, and don’t let your family or friends be BBs either. “
***Please reference “Deaths a Year Comparison” on page 38
27 School-wide Events
28 Breathe Easy Track Meet
Purpose/Summary: Increase tobacco prevention awareness by organizing a track meet to show how cigarettes can affect peoples’ ability to perform well as athletes.
Materials Needed: • Track meet supplies • Straws • Poster board and markers
Preparation/Instructions: You can either organize a special track meet to educate students about the harmful effects or hazards of tobacco, or you can add the theme to one of your school’s scheduled events. • Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
EVENTS • Activity: Breathing through Straw! Give everyone a straw and have them hop on one foot or run in place for 30 seconds while breathing through the straw. This is meant to simulate how it feels for a smoker to breathe while participating in physical activities. Remind everyone to keep this in mind while they are running their races. • Relay: Get rid of that cigarette as fast as you can! You can have a variety of relays so everyone can participate. The first thing to do is decorate your baton (a track baton or an empty paper towel roll) with paper or paint to look like a cigarette. Then cover the cigarette baton with hazard and warning labels. For example, use the Surgeon General’s warning, or be creative and make your own! For the relay, tell everyone they need to get rid of the “cigarette” as fast as they can by passing it off to their teammates. • Individual Events: Breathe Easy! Get ready to race. Hold individual events from the 50 meter dash to the two-mile run, making everyone aware of the simple fact that if they were to smoke, they would not perform as well, nor be able to breathe as easily while running. • Shot Put Event: Crush Big Tobacco! The “Crush Big Tobacco” shot put event is just like a normal shot put event— everyone is trying to throw the shot put as far as possible. For the distance marker lines you have a variety of options: You can decorate posts to look like cigarettes for each distance line. Make a line of tobacco advertisements for the kids to “crush” as they throw the shot put. Come up with your own idea! If you don’t have a real shot put, don’t worry about it—any ball will do! • Long Jump: How far will you go to stay tobacco-free and stop Big Tobacco? If you have a long jump pit at your track, all you have to do is let students take turns jumping. If not, you can perform this event on a field instead. All you need is a line to start running from, a line to jump from, and a tape measure to keep track of how far people jump.
29 Cups in a Fence
Purpose/Summary: Spell it out! Create a powerful visual display through placing cups in a chain-link fence on your campus to make a statement AGAINST Big Tobacco and FOR prevention!
Materials Needed: • Colored plastic cups • Chain-link fence in a high traffic location • Graph paper
Preparation/Instruction:
Before the event: • Find a fence that many people pass by every day. Consider tying your activity to a popular community event – is there a 5K race happening? A community field day? • Get permission from the owner of the property or the event organizer to decorate the fence, and agree to clean it up after your event. • Decide what message you would like to display. The message can be a few simple words such as “Tobacco Lies,” or a phrase of your choice. • Map out your message on graph paper ahead of time – make sure you have enough cups!
During the event: • Put plastic cups through the holes of your fence to spell it out! • If you plan to have a table, set up your table and have representatives on hand to answer questions and share information about fighting Big Tobacco. • Take photos and post them to social media! Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
After the event: • IMPORTANT: Make sure to take down the cups when finished, leaving them up can invite other students/passerby’s to get creative with the cups and change the original message.
30 Not a Replacement
Purpose/Summary: Are you just a replacement for the 1,300 American customers Big Tobacco loses daily to tobacco-related illnesses? Or are you something more than a replacement? Tell Big Tobacco with this creative “selfie-statement” campaign. The tobacco industry understands the long-term effect of this daily loss of customers and, to keep replenishing its customer base, has marketed its products aggressively, particularly to youth. In fact, one tobacco industry document actually describes youth as “replacement smokers.” Why? Because Big Tobacco needs to replace their customers who become addicted and die from their products.
Materials Needed: • Not a Replacement “Selfie Statement” • Not a Replacement Rally Card • Copies of RJ Reynolds “Replacement Smoker” memo • Markers, camera, cell phone/smart phone with camera • Access to a social media account (Instagram, Twitter, Facebook) to post photos
Preparation/Instructions:
Before the Activity: • Plan a time to have you’re Not A Replacement activation table set where youth will see it. • Print plenty of copies of the Not A Replacement Selfie Statements to have at the table.
During the Activity: • Educate youth who visit your table on basic tobacco industry history of marketing to youth using your key messages. • Have youth personalize a Not A Replacement Selfie Statement with descriptions of who they are and what they represent. For example, “I am Not A Replacement, I AM a high school sophomore with a passion for art.” • Have youth take pictures of themselves holding their Selfie Statements. These should be taken using their own cameras. • Take photos and post them to social media! Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness,too!
31 Fatal Figures
Purpose/Summary: Create a powerful visual display to show the “fatal figures” for your state, or community in order to help people understand the deadly consequences of tobacco use.
Materials Needed: • Any items that can creatively symbolize numbers (shoes, lunch boxes, chairs, anything you can get enough of to represent your numbers..*this can be connected with the tombstones activity) • Signage with your statistic regarding tobacco and/or tobacco-related deaths
Preparation/Instructions:
Before the Event: • Choose your “Fatal Figure” – make sure the number is feasible; it’s very difficult to find 400,000 lunchboxes! To get started, check out the Toll of Tobacco page on kickbuttsday.org. • Identify what items would work best for your display – is it shoes? Lunch boxes? Tombstones? Body bags? • Identify a high traffic location and get permission for your display, if necessary. • Collect the items you will use to represent your statistic. Work with friends or your club, and explore collaborating with other organizations that support your mission. Make sure you give yourself enough time to collect all the items you need! • Create posters and other visuals to explain the number. Be sure that your messaging is consistent throughout the event (pick one number, and stick to it!) • If necessary, have a plan for the items you have collected once your event is over (example: donating shoes to a local charity). • Spread the word! Inform the rest of the school about your activity!
During the Event: • Create your visual display in an area where many people will see it. • Have representatives from your group on hand to talk about the statistic, and what you’re doing in your school or community to lower the rate of tobacco use. Set up a table or booth if you’re able to with materials and a call to action! • Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
32 Tombstones
Purpose/Summary: Create a powerful visual display that can help people at your school realize the deadly consequences of tobacco use, in order to support and spark conversations on ways we can all reduce tobacco use.
Materials Needed: • Cardboard, poster board or cloth • Gray paint or spray paint • Black paint or markers • Metal frames (for rent through TUPE, contact your Youth Development Specialist)
Preparation/Instructions:
Before the Event: • Identify a high traffic location to set up your display. Get the proper permission in advance! • Cut out cardboard in a tombstone shape. Consider how you are going to display your tombstones. They can be taped to a wall or free-standing. If they are free- standing, contact your Youth Development Specialist regarding metal stakes you can rent and use for your event. • Paint each of the tombstones gray. • Brainstorm messages to display. The messages can include tobacco-related causes of death (lung cancer, emphysema, learn more ways tobacco effects your health), names of those whose lives have been lost from tobacco use, or quotes from the tobacco industry related to death and disease. • Spread the word! Inform the rest of the school about your school-wide activity, possibly as an announcement over the PA system.
During the Event: • Display your finished tombstones in a populated area. • If you plan to have a table, set up your table and have representatives on hand to answer questions and share information about fighting Big Tobacco. • Take photos and post them to social media! Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
33 Pledge Campaign
Purpose/Summary: Everyone has a reason they’re tobacco free, and even former smokers have reasons they quit. Set up a booth and have passerby’s take pictures with a sign like:
“I am tobacco-free because…”
Materials Needed: • Camera/cell phone • Fill in the blank signs (get creative, make them look like a timeline photo on Facebook or Instagram) • Markers
Preparation/Instructions:
• Pick a message for your pledge campaign. It can be anything from “I am smoke- free because…” to “I support ___ tobacco-use prevention education program because…”. Choose a message that will help to advance your group’s goals and make a splash (if your group has a specific name, use it in the campaign). • Make copies of a well-designed sign and pass them out to your group’s members, or friends at school. Ask them to take a picture with the sign, and their filled in answer. • Collect all of the photos, and create a giant pledge wall, display them in a public area (cafeteria, quad), • Take photos and post them to social media! Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
34 #BeTheFirst Pledge Wall
Purpose/Summary: Let’s make history together, and make the pledge to be the first tobacco- free generation! Gather pledges/signatures to #BeTheFirst tobacco-free generation!
Materials Needed: • A long roll of paper or printed banner for the signatures • Markers • A high traffic location to hang the banner
Preparation/Instructions:
Before the Event: • Location, location, location: Identify a high-traffic location or event in your school or community where you will set up your #BeTheFirst pledge station. Will you gather pledges in the cafeteria during lunch periods or a club expo? Consider collecting pledges in the school cafeteria, in the quad, amphitheater, a sporting event, during lunch, leave it up throughout the day for people to sign while they walk to class or at an existing tobacco prevention event you’re already planning! • Create your banner: Download the banner template (you can find this banner online at kickbuttsday.org) or get creative and make your own! Please note: Our banner template is a 14 MB file that will print up to 34x72 inches. Make sure you plan ahead and leave enough time to have this professionally printed. • Identify materials: Gather any materials you may need, including your banner, markers, a large table or surface for participants to sign the banner on, and additional pamphlets or factsheets supporting your local tobacco prevention work. • Spread the word: Once you’ve identified your location, it’s time to promote your event! Inform your peers over your school’s PA system that they have the opportunity to sign the pledge and become a part of history as the first tobacco-free generation! Give them details of when and where they can sign the banner, and get them excited to be a part of something big!
During the Event: • Set up Once you’ve identified an approved location, it’s time to set up. Set up your banner in an easily accessible location where attendees can easily sign their name in support of a tobacco-free generation. • Educate During the event, be sure to engage with your audience and share your message with them in a clear, concise and compelling way. Let them know why they should care, and how they can help! Explain directions clearly. • Document Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
35 Airing Out Big Tobacco’s “Dirty Laundry”
Purpose/Summary: Expose Big Tobacco’s lies and tricks, creatively, through airing out their dirty laundry!
Materials Needed: • Laundry items (old shirts, socks, sheets, pants…*you can use paper to draw and cut out “laundry”) • Markers • A clothes line, and something to string it from • Clothes pins (*you can use tape if using paper, and tape them to a wall) • Tobacco company quotes on marketing to kids (you can find quotes at tobaccofreekids.org/research/factsheets/pdf/0114.pdf)
Preparation/Instructions:
Before the Activity • Begin collecting donations of light-colored secondhand clothing for your display. Engage other clubs and organizations in your Kick Butts Day project by having them help collect articles of clothing! Having trouble collecting enough clothing? Cut t-shirts and pant shapes out of colored paper and hang those up. • Identify a high traffic location to set up your display, like the cafeteria or the quad. Get the proper permission in advance! • Spread the word! Inform the rest of the school about your school-wide activity, possibly as an announcement over the PA system.
During the Activity • Make a sign that says “We’re Airing Out Big Tobacco’s ‘Dirty Laundry.’” • Write quotes from the tobacco industry on the articles of clothing to expose what the industry has said historically about marketing tobacco products to young adults. • Create your display by hanging up the decorated clothing on a clothesline. • Set up a table or booth manned by your group members to share additional information on fighting Big Tobacco on hand. • Upload photos/videos to social media using #ACOEWellness and #iKickButts. Don’t forget to tag @ACOEWellness, too!
36 Facts, Statistics, & Resources
37 Deaths a Year Comparison
*Yearly, tobacco kills more than alcohol, AIDS, suicide, car crashes, and other drugs…COMBINED.
38 Youth Tobacco Facts
40.6% Kids (3-11) exposed to secondhand smoke.1
3200 People under 18 smoke their first cigarette each day, and approximately 2,100 youth and young adults become daily smokers.2
5.6 million Children alive today will ultimately die early from smoking without reduction in current smoking rates. That’s equal to 1 child out of every 13 alive in the U.S. today or 2 of the 27 in the average 3rd grade classroom.3
25 of every 100 United States high school students (24.6%) and nearly 8 of every 100 middle school students (7.7%) used some type of tobacco product in 2014.4
47.2% Percent of 8th graders say cigarettes are easy for them to get.5
4.6 million Youth, including 3.7 million high school and 900,000 middle school students, who reported current use (use on one or more days in the past 30 days) of any tobacco product in 2014.6
9X The rate of current illicit drug use among youths aged 12 to 17 who smoked cigarettes in the past month compared to those who didn’t (53.9 vs. 6.1 percent).7
1 Centers for Disease Control and Prevention (CDC), “Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke – United States, 1999-2012,” Morbidity and Mortality Weekly Report, February 3, 2015 2 http://betobaccofree.hhs.gov/about-tobacco/facts-figures/index.html 3 http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_youth_508.pdf 4 Centers for Disease Control Tobacco amongst Middle School and High School students-United States 2011-12014 Morbidity and Mortality Weekend report 2015 2015;64(14):381–5 [accessed 2015 Jul 24]. 5 2014 Monitoring the Future Survey, http://www.monitoringthefuture.org/data/14data/14tobtbl2.pdf 6 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a3.htm?s_cid=mm6414a3_e 7 http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf 39 E-cig/Vaping Facts
215 Number of calls a month made to poison control center involving e-liquid in 2014. That’s 213 more than 2010! 8
20.3% Percent of middle school students who used e-cigarettes who had never smoked traditional cigarettes; thus, they served as their introduction to nicotine.9
3X more Middle and high school students used an electronic smoking device in 2014 compared to 2013 (approximately 660,000 to 2 million students).10
7000+ Catalogued flavors of e-juice available such as watermelon, girl scout cookies, key lime pie, and gummi bear.11
59.3 million Dollars spent on e-cigarette advertising in 2013. That’s 3X the amount spent in 2012 (18.3 mil) and 9x in 2011 (6.4 mil)!12
2 billion Dollars in sales for e-cigarettes (1 billion in the U.S. alone) in 2013, 100X what was made 5 years prior!13
8 New CDC study finds dramatic increase in e-cigarette-related calls to poison centers, Centers for Disease Control and Prevention, April 3 2014, accessed Aug. 2015 http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html 9 Centers for Disease Control and Prevention. “Notes from the field: electronic cigarette use among middle and high school students— United States, 2011–2012”. Morb Mortal Wkly Rep. 2013;62:729–730. Available here: http://www.ncbi.nlm.nih.gov/ pubmed/24005229?dopt=Abstract 10 Center for Disease Control and Prevention, E-cigarette use triples among middle and high school students in just one year, CDC Newsroom release, April 16 2015, accessed Aug. 2015, http://www.cdc.gov/media/releases/2015/p0416-e-cigarette- use.html 11 National Cancer Institute, Debate, Research on E-cigarettes continue, Dec. 11 2014, access Aug. 2015, http://www.cancer.gov/news-events/cancer-currents-blog/2014/e-cigarettes 5National Institute of Drug Abuse, “E-cigarettes, the facts”, July 2015, accessed Aug. 2015, http://www.drugabuse.gov/related-topics/trends-statistics/infographics/e-cigarettes-facts 6 National Institute of Drug Abuse, “E-cigarettes, the facts”, July 2015, accessed Aug. 2015, http://www.drugabuse.gov/related-topics/trends-statistics/infographics/e-cigarettes-facts
40 Marijuana Facts
6% The increase in amount of THC in marijuana over the past few decades— from an average of about 4 percent in the early 1990’s to almost 10 percent in 2013.1
8 Point drop in IQ from ages 13 to 38 who used marijuana a lot in their teens, even if they quit in adulthood.2
4 The number of states who have legalized marijuana for recreational use (Colorado, Oregon, Alaska, and Washington).3
1 in 6 People who start using as a teen become addicted to marijuana.4
81% United States 12th graders who say it is easy to obtain marijuana in 2014.5
27.3% United States 10th graders who reported using marijuana in the past year.6
1 ElSohly MA. Potency Monitoring Program quarterly report number 124. Reporting period: 12/16/2013 -03/15/2014. Bethesda, MD: National Institute on Drug Abuse; 2014. 2 Zalesky A, Solowij N, Yücel M, et al. Effect of long-term cannabis use on axonal fibre connectivity. Brain 2012;135:2245-55 3 http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html 4 https://teens.drugabuse.gov/drug-facts/marijuana#3 5 University of Michigan, Monitoring our Future Study 2014, printed February 2015 http://monitoringthefuture.org/pubs/monographs/mtf-overview2014.pdf 6 University of Michigan, Monitoring our Future Study 2014, printed February 2015 http://monitoringthefuture.org/pubs/monographs/mtf-overview2014.pdf
41 How to Help a Friend Quit Smoking
Your friend has decided it's time to quit smoking. This is great news! You're excited, and you want to help, but you don't want your buddy to feel that you're nagging. Here are a few steps to help you encourage your friend to stay quit.
Step 1: Ask if you can help. Before offering help, ask if it's okay to help, and then ask what you can do. Suggest getting support, and find out if it's okay to ask how he or she is doing.
Step 2: Why do they want to quit? Help your friend list his reasons for why he enjoys smoking, as well as the benefits of quitting. This can help him clarify his motivations and help him decide to quit.
Step 3: Baby steps can be a good thing. Suggest she begin by reducing the amount she smokes if she’s not ready to stop completely.
Step 4: Encourage them to try again. Most smokers don't succeed the first time they try to quit. If the person begins smoking again, don't be disappointed, or make the person feel guilty. Instead, help him or her think about trying to quit again.
Step 5: Seek Help. Encourage your friend to join a support group, or call 1800- NO-BUTTS for support.
Step 6: Change old habits. Help your friend change the habits that may trigger her desire to smoke again. Distractions can go a long way in battling cravings, as well as hanging with friends who don’t smoke.
Step 7: Replace old habits with new ones. Suggest a different activity that will replace the negative habit of smoking when the desire for a cigarette arises. • Prepare healthy snacks, such as nuts, gum, or fresh fruits and veggies. • Drink water. • Exercises, like pushups or jumping jacks
42 How to Help a Family Member Quit Smoking
It's difficult to watch someone you care about smoke cigarettes. However, smokers need to make the decision to quit, not because someone else wants them to. They might stop smoking for you, but they won't stay stopped, unless they're doing it for themselves. This doesn't mean you can't help. You can influence a smoker's behavior and can assist him or her in making the decision to quit. You can provide support and encouragement once he or she has stopped smoking. Below are a few tips that can help you support a loved one when they are finally ready to stop smoking.
DO’s Do Be Honest: Let your family member know how important it is that they quit smoking. Do Understand Withdrawal Symptoms: Many smokers have withdrawal symptoms during the first few weeks after they quit. Symptoms may include: trouble sleeping, lack of concentration, and feeling anxious or restless. Over time however, these symptoms will get better. Do Listen: Smokers often want to talk about their feelings when they are going through nicotine withdrawal. Don’t worry about fixing the situation. Sometimes lending a listening ear can help someone trying to stop smoking. It’s okay to ask questions, and just listen to their side of the story. Do Give a Helping Hand: Stress can often trigger a person to continue to smoke. Lending a helping hand occasionally, can alleviate some stress and show your loved one that you care. A few great opportunities to help include cleaning up around the house, running errands, or cooking meals. Do Celebrate Milestones: Help your family member celebrate small steps that lead to a tobacco free lifestyle. Give lots of praise and offer rewards for getting through a day, a week, or a month without smoking. Rewards can be simple – a movie, something to eat, a walk. Even when she makes a mistake, make sure to tell her that you’re proud of her for continuing to work toward her goal. Do Ask: One of the best ways to help a loved one is to ask how you can help. When you ask, you show her or him that you care. Sometimes, that is all the help he or she really needs.
DON'T Don't Be a Nag: No nagging, scolding, or preaching. While you may think, nagging will help, it may have the opposite effect and discourage them from quitting or even thinking about attempting to quit. Try to see it from your family members side. He may still not be sure he wants to quit. Let him know you understand his doubts. Don’t Forget to Be Sympathetic: Smoking is an addiction, and it can be difficult to overcome. Some people will quit cold turkey, while others will take months to stay quit. Regardless of how long the process takes, be sympathetic and encourage her or him to continue working towards better health. Don’t Get Frustrated: It’s natural to get upset when the person you care about slips up. Just remember that lecturing will only add more stress, which might discourage her from trying to stay quit. Tell your family member that she can make it this time even if she has tried to quit before and failed. In fact, most smokers "practice" quitting a few times before they quit for good.
43 ENDING THE SALE OF FLAVORED TOBACCO: STANDING UP FOR YOUTH HEALTH AND SOCIAL JUSTICE
The tobacco It may seem astonishing, but 80% of teen smokers started with a flavored tobacco 1 industry targets product -- this is something that tobacco companies would rather the public not know. The tobacco industry has sought every way possible to get youth to start smoking, children refining its methods for decades.
Flavors are a Tobacco companies target youth by flavoring tobacco like candy, packaging it like candy, 2 key part of the and pricing it similar to candy. Flavored tobacco is sold throughout San Francisco, especially targeting low-income children and youth of color. targeting
Social justice Flavored tobacco products have been especially targeted at youth of color. The youth requires ending smokers who most use menthol cigarettes (the largest category of flavored tobacco) are 3-4 flavors disproportionately African American, Asian American, and LGBT. Flavored tobacco is especially killing individuals in these communities.
MORE DETAILS ABOUT ENDING FLAVORED TOBACCO
What is Flavored Tobacco? • Minty menthol cigarettes, strawberry “Swisher Sweets” little cigars, chocolate flavored hookah, and fruit and candy flavored cigars/chew: in general, any tobacco product with a key characterizing flavor. • Flavored tobacco has the same deadly health effects as regular tobacco, but is flavored to taste like candy, mint, and fruit to attract children and teens. • E-cigarette flavors hook youth, especially targeting youth of color, with flavors like gummy bear, cotton candy, piña colada, chicken and waffles, horchata, and boba.
Policy Impact of Ending the Sale of Flavored Tobacco in San Francisco • Fewer youth will start smoking. Flavored tobacco is a key way that tobacco companies get youth to start smoking. 80% of teen smokers started out with some flavored tobacco product.1 • The tobacco industry will be less able to entice youth with its deadly products. Tobacco leads to a lifetime of addiction and increased risk for many diseases, and 90% of adult smokers start before age 18.2 • Fewer people will die from tobacco. Tobacco is still the #1 preventable cause of death in the United States, killing an estimated 540,000 Americans every year.3
Youth Health: Flavors are Targeted to Children and Teens • Tobacco companies are flavoring tobacco to taste like candy and other flavors that kids enjoy, such as popcorn, cotton candy, gummy bear, and cola. • The tobacco industry packages these products like candy to further target youth. Chocolate cigars are packaged in long foil wrappers to look like chocolate candy bars, and mint-flavored chewing tobacco is packaged in circular green cans just like wintergreen mints. • Tobacco companies price flavored tobacco at the price point for teens. Double packs of little flavored cigars are sold for just 50 cents throughout San Francisco (“2 for 99 cents”).
Social Justice: Menthol Cigarettes Target Youth of Color, LGBT Communities, Girls, and Young Women • 95% of African American teen smokers (age 12-17) use menthol cigarettes,4 due in large part to aggressive targeting by the tobacco industry for decades.5 Ending the sale of menthol cigarettes would help save the lives of many African Americans. • 6 in 10 Asian American teen smokers use menthols.4 • More than half of Latino (58%) and white (51%) teen smokers use menthol cigarettes. • 7 in 10 LGBT young adult smokers use menthol cigarettes,6 and youth menthol use is usually higher than for young adults. • Teenage girls who smoke are more likely than teenage boys to use menthol cigarettes,4 and young women are twice as likely as males to use menthol cigarettes.7
44 Negative Health Effects of Specific Flavored Tobacco Products • Flavors mask the taste of tobacco, but cannot mask the negative health effects. 8 • People using menthol cigarettes have a harder time quitting, especially younger smokers and people of color. • Diacetyl is found in an estimated 75% of e-cigarette flavors on the market. Diacetyl is the “butter flavoring” in microwave butter popcorn that causes “popcorn lung” disease when inhaled over the long-term.9 • E-cigarettes are already known to have negative cardiovascular effects, including an over 40% increased chance of 10 heart attack on top of the risk of smoking any regular cigarettes. • Teens who are nonsmokers but who use e-cigarettes are over 3 times more likely to be smoking regular cigarettes 11 one year later, compared with teens who did not smoke or use e-cigarettes.
Cities around the country and Northern California have already acted on flavored tobacco • There is already precedent in California: Santa Clara County and Yolo County already acted to end the sale of flavored tobacco in the fall of 2016, affecting all their unincorporated areas. • Contra Costa County and Oakland are considering policy action. • Chicago, New York City, Minneapolis, Providence, and Berkeley have taken bold steps to restrict flavored tobacco. • In 2009, Congress prohibited the sale of almost all flavored cigarettes, but kept menthol cigarettes and other flavored tobacco products on the market. Ending the sale of flavored tobacco in San Francisco would close this loophole.
What has Breathe California been doing about flavored tobacco? • Breathe California’s Project E-NUFF has been working since 2015 on a campaign to end the sale of flavored tobacco. Our team of emerging community leaders has worked to draw attention to how the tobacco industry uses flavors in tobacco to target young people. • Our efforts have included surveying youth, conducting focus groups with adults about tobacco industry targeting of flavors to youth, key informant interviews, researching current policies, circulating petitions calling for action, and establishing partnerships with local community agencies. • Project E-NUFF is supported through the San Francisco Department of Public Health. We also work closely with other youth organizations that focus on tobacco prevention, including Youth Leadership Institute, Bay Area Community Resources, and Vietnamese Youth Development Center.
SOURCES
1. Ambrose BK, et al., "Flavored Tobacco Product Use Among US Youth Aged 7. Rath J., et al., Correlates of current menthol cigarette and flavored 12-17 Years, 2013-2014.“ JAMA 2015; 314(17): 1871-1873. other tobacco product use among U.S. young adults. Addictive Behaviors 2. US Department of Health and Human Services. 2012. Preventing 62 (2016) Tobacco Use Among Youth and Young Adults: A Report of the Surgeon 35-41. General. Atlanta: US Department of Health and Human Services, Centers for 8. Foulds J, et al. 2010. Do Smokers of Menthol Cigarettes Find It Harder to Disease Control and Prevention, National Center For Chronic Disease Quit Smoking? Nicotine Tob Res (2010) 12 (suppl_2): S102-S109. Prevention And Health Promotion, Office on Smoking and Health. 9. Allen JG. 2016. Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3- 3. Carter B, et al., “Smoking and Mortality – Beyond Established Causes”, Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, New Candy-, and Cocktail-Flavored E-Cigarettes. Environmental Health England Journal of Medicine, 2015:372:631-40. Perspectives 124(6): 4. Giovino GA, et al., "Differential trends in cigarette smoking in the USA: is 733-739. menthol slowing progress?“ Tobacco Control 2015; 24: 28-37. 10. Temesgen N, et al. 2017. A cross sectional study reveals an association 5. Gardiner PS. 2004. The African Americanization of menthol cigarette use between electronic cigarette use and myocardial infarction. School in of Medicine and Health Sciences Poster Presentations, George the United States. Nicotine and Tobacco Research 6(Suppl 1): S55-S65. Washington University. 6. National Youth Advocacy Coalition. 2010. “Coming Out About Smoking: 11. Primack BA, et al. 2015. Progression to Traditional Cigarette Smoking A After Electronic Cigarette Use Among US Adolescents and Young Adults. Report from the National LGBTQ Young Adult Tobacco Project.” JAMA Pediatrics 169(11): 1018-1023.
Breathe California 1 Sutter Street, Suite 225 | San Francisco, CA 94104 (650) 994-5868 www.ggbreathe.org/enuff
45 HEALTH EFFECTS OF ELECTRONIC CIGARETTES, VAPES, AND HOOKAH
E-cigarettes, which are sold in over 7,000 flavors, are already known to have negative cardiovascular effects, including an over 40% increased chance of heart attack on top of the risk that comes from smoking any conventional cigarettes.1
Effects of Nicotine Found in E-Cigs/Vapes2
• Nicotine in youth may have adverse health effects, such as: o causing addiction o having lasting adverse consequences for brain development and cognition • Nicotine while pregnant may have adverse health effects, such as: o crossing the placenta and effect fetal and postnatal development o causing Sudden Infant Death Syndrome (SIDS) o resulting in altered corpus callosum o creating deficit in auditory processing o leading to obesity • Nicotine in adults may have adverse cardiovascular health effects, such as: o increased heart rate o increased blood pressure (BP) o greater cardiac output, leading to an increase in myocardial oxygen demand • Other effects include: o acute toxicity and possibly death if the contents of refill cartridges or bottles containing nicotine are consumed (often lands in the hands of infants and children who mistake it for food) o production of various inflammatory responses, including, at the cellular level, inducing C-reactive protein (CRP) expression, which contributes pro-inflammatory and pro-atherosclerotic effects o aerosol produced by e-cigarettes and released into the environment during second hand smoke contains harmful and potentially harmful chemicals, including nicotine
Possible Effects of Other Chemicals Found in E-Cigs/Vapes
E-cigarettes can expose users to several chemicals. In addition to nicotine, carbonyl compounds and volatile organic compounds found in these products are known to have adverse health effects. The health effects and potentially harmful doses of heated and aerosolized constituents of e-cigarette liquids, including solvents, flavorants, and toxicants, are not completely understood.
• Aldehydes (i.e., benzaldehyde and vanillin): o categorized as primary irritants of the respiratory tract • Amino-tadalafil (structural analogue of tadalafil) and rimonabant: o FDA approval of a drug containing tasalafil has been withheld because of unresolved issues involving rimonabant therapy and increased frequencies of psychiatric adverse events, including suicide and an ill-defined constellation of neurologic symptoms and seizures • Carbonyls (i.e. formaldehyde, acetaldehyde, acrolein): o levels of carbonyls increase with device voltage o long-term exposure to carbonyl compounds increases the risk of cancer . Propylene glycol and glycerol: not thought to be dangerous on their own; may decompose when heated and be transformed into toxic compounds (for example, formaldehyde) . Acetaldehyde: an irritant and a probable carcinogen . Acrolein: may cause respiratory and ocular irritation; in cigarette smoke, it has been linked to several pulmonary diseases, including increased risk of lung cancer, asthma, www.ggbreathe.org 46
HEALTH EFFECTS OF ELECTROIC CIGARETTES, VAPES, AND HOOKAH
and COPD; a study found an association between acrolein exposure and risk of cardiovascular disease (CVD) • Diacetyl (DA) and acetyl propionyl (AP): o used in flavorings, it is associated with a decline in respiratory function in persons exposed to it through inhalation o has been implicated in the development of bronchiolitis obliterans, an irreversible respiratory disease also called “popcorn lung disease” o acute inhalation exposure to AP has been shown to cause airway epithelial damage similar to DA • Diethyl phthalate (DEP) and diethylhexyl phthalate (DEHP): o both DEP and DEHP have estrogenic and antiandrogenic activity that cause premature breast development in girls • Tobacco Specific Nitrosamines (TSNAs): o potent carcinogens identified in tobacco and tobacco smoke (NNN, NNK, NAB, and NAT) were found in e-cigs in low levels o the aerosol of some e-cigarettes contains traces of the carcinogenic nitrosamines NNN and NNK • Toxic heavy metals (i.e., lead and cadmium): o have been found in e-cig aerosols in lab tests conducted at temperatures within the range of most e-cig products
See health effects of flavored tobacco and nicotine products in our companion factsheet.
1 (Temesgen N, et al. 2017. A cross sectional study reveals an association between electronic cigarette use and myocardial infarction. School of Medicine and Health Sciences Poster Presentations, George Washington University.) 2 U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. 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, 2016. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
www.ggbreathe.org 47
Tobacco Cessation/Quit Resources
. The California Smokers' Help Line offers free services for teens and adults that include: self-help materials and one-on-one counseling over the phone. Services are available in multiple languages. www.nobutts.org • English: 1-800-NO BUTTS (1-800-662-8887) • Spanish: 1-800-45 NO FUME (1-800-456-6386) . Chewing Tobacco: 1-800-844-CHEW (1-800-844-2439) . SmokeFree.gov Smart Phone Apps: NCI QuitPal, QuitSTART, QuitGuide . Smokefree TXT Support for Teens: Text QUIT to iQuit (47848)
48