Collectively, the two-part survey will provide insight into your students’ perceptions about tobacco and nicotine use and their prior knowledge of the facts, which can help you more effectively implement the unit and address their questions and concerns. Once students complete the survey, use the facts listed in the answer key to help dispel misperceptions they may have about tobacco and nicotine use and to reinforce the message that most young people are tobacco and nicotine free. Since the survey asks students about their personal experience with tobacco and nicotine, it should be done independently and anonymously. Tell students to input your e mail when asked. The anonymous results will be sent directly to you. The topics presented in the survey will be addressed throughout the program materials. For example, students will be provided with facts related to the health consequences of tobacco and nicotine use. In addition, they will be given information about why some adolescents use tobacco and nicotine, and why most choose to remain substance free. They will also be provided with refusal skill techniques that they can use if they are ever pressured to use tobacco or nicotine products.

Before starting the activity, explain to your class that they are going to take a survey that asks them questions about tobacco and nicotine to help you understand what they know or think about it. To begin, ask students:
 
Do you think it is legal for young people to purchase tobacco and nicotine products? (Explain that it is illegal to sell tobacco and nicotine products to minors in every state.)
 
Do you think there are health consequences related to using tobacco and nicotine? (Explain that students will learn more about health issues in this unit.)
 
Direct students to the online survey by clicking the thumbnail below. We recommend emailing the link to your students, posting it on a class webpage, projecting it on an interactive whiteboard, and/or writing it on a chalkboard. Tell students the survey will be entirely anonymous. Explain that no personally identifying information will be included in emails sent to you. Encourage students to answer the questions as honestly as they can.

Once they are done, let students know that you are going to share some information with them. They can listen and should feel free to volunteer answers if they feel comfortable. Once you have completed all activities, please delete or dispose of all student surveys.

Answers, part one
1–4. Answers will vary. Review the answers students provided for these questions. This will give you a sense of your students’ experience with tobacco and nicotine but should not be shared with the students.

5. Explain to students that some young people try tobacco or nicotine products because of a “lack of self-efficacy in the ability to refuse offers to use tobacco or nicotine,”³ or they don’t know how to tell their friends they don’t want to try it. Explain to students that people their age are sometimes pressured to use tobacco and nicotine products like vapes, and that pressure can be difficult to handle. Let them know that in this unit, they are going to learn some ways to say “no” and cope with peer pressure.

6. Explain to students that according to the Surgeon General, symptoms such as coughing, shortness of breath, nausea, and phlegm production can start to develop in young people who smoke.³ Youth and young adults are also uniquely at risk for long-term, long-lasting effects of exposing their developing brains to nicotine. These risks include nicotine addiction, mood disorders, and permanent lowering of impulse control. Nicotine also changes the way synapses are formed, which can harm the parts of the brain that control attention and learning.⁷ Moreover, students may have heard that quitting tobacco and nicotine is difficult, but they may not know why. Read to your students the following passage from the Surgeon General’s Report “Preventing Tobacco Use Among Young People”:

Most young people who smoke regularly are already addicted to nicotine, and they experience this addiction in a manner and severity similar to what adult smokers experience. Most adolescent smokers report that they would like to quit smoking and that they have made numerous, usually unsuccessful attempts to quit. Many adolescents say that they intend to quit in the future and yet prove unable to do so. Those who try to quit smoking report withdrawal symptoms similar to those reported by adults.³

Answers, part two
Answers will vary, but share the following with your students.

1. Only about 1 of every 100 middle school students (1.0%) reported that they had smoked cigarettes in the past 30 days. However, about 1 out of every 30 middle school students (3.3%) reported that they had used electronic cigarettes (vapes) in the past 30 days.¹

2. Ask students to volunteer answers about why they think young people use tobacco and nicotine products. Explain to your students that some of the reasons young people try these products are:^{3, 4}

They don’t feel good about themselves (low self-esteem and self-image).
They aren’t doing well in school (low achievement in school).
They don’t know about the health consequences of tobacco or nicotine.
They think lots of people smoke and use e-cigarettes or smokeless tobacco (overestimating the number of people who smoke and use nicotine products).
They don’t realize that they can become addicted (underestimating addictive potential of nicotine).

Ask students: Why do you think most young people do not use tobacco or nicotine? Explain that most people choose to be tobacco and nicotine free. Some reasons include:^{3, 4, 5}

Their friends don’t use tobacco or nicotine products.
They know about the health consequences.
They want to be tobacco and nicotine free.

3. If students volunteer stories, remind them not to use names. Listen to their concerns and explain to students that feeling pressure from friends happens, but that they will learn some ways to deal with the pressure.

4. Again, answers will vary. Write students’ answers on the board, and explain to them that they are going to learn more about health consequences in Activity Two.

5. See answer 6 in Part One. Additional information on addiction is included in the Support Lessons. You can also see the booklet for grade 7.

6. Answers will vary. However, explain to your students that according to a poll, most kids strongly dislike being around smokers.

To assist you with evaluating your students’ anonymous responses to this survey, we have created a data collection spreadsheet that will allow you to input and view quantitative and qualitative measures. Click here to access the downloadable survey-response spreadsheet. You’ll also find it in the “Materials” section below.

Let students know that you don’t expect them to know the answer to this question and they should just take a guess. Afterward, ask volunteers to share their answers. Reinforce the stat: Only about 1 of every 100 middle school students (1.0%) reported that they had smoked cigarettes in the past 30 days. However, about 1 out of every 30 middle school students (3.3%) reported that they had used electronic cigarettes(vapes) in the past 30 days.¹

To end the lesson, display the “Tobacco: Myth or Reality?” poster and review the content with your students. The poster will reinforce the message that most young people are tobacco free.

¹ CDC. Smoking & Tobacco Use. Fact Sheet Youth and Tobacco Use: Current Estimates of Youth Tobacco Use. Referenced 2023. www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

² CDC. Smoking & Tobacco Use. Fact Sheet Youth and Tobacco Use: Estimates of Current Tobacco Use Among Youth. Referenced2017. www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/

³ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C., 2012. Referenced 2023. www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf

⁴ CDC. Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. MMWR 1994; Vol. 43, No. RR-2; 1-18. Referenced 2017. www.cdc.gov/mmwr/PDF/RR/RR4302.pdf

⁵ Milton, M.H., Maule, C. O., Yee, S. L., Backinger, C., Malarcher, A. M., & Husten, C. G. Youth Tobacco Cessation: A Guide for Making Informed Decisions. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2004.Referenced 2017. https://stacks.cdc.gov/view/cdc/11319

⁷ https://e-cigarettes.surgeongeneral.gov/knowtherisks.html#:~:text=Youth%20and%20young%20adults%20are,permanent%20lowering%20of%20impulse%20control.