RATIONALE

As noted in Activity One, researchers have found that low self-esteem is a strong influential factor in the decision to experiment with tobacco or nicotine. This activity will give students the opportunity to consider and reflect upon their own self-esteem.

GETTING STARTED

Share the digital activity link below with your students. Then, explain to them that self-esteem is a term that describes how we see ourselves, and how we either do or don’t accept ourselves as we are.

LAUNCH ACTIVITY

The statements in the chart come in three clusters:

1 through 4 are related to self-image
5 through 10 are related to how the student wants to be perceived by others and what role peer pressure might play in his or her life
11 through 14 target broad issues of self-acceptance

Ask students to give careful thought to each statement, and then move the statement to the category that best applies(“Agree” or “Disagree”).

Explain to students that the responses they give might be different today than they were six months ago or might be different six months from now. You might help them out by offering some concrete examples. For instance, for number 7, set up a scenario in which a young person has moved to a new town in the middle of the school year. How hard will it be for that person to make new friends? Ask students why some students will find it difficult, and others will not.

TALKING ABOUT IT

After students have completed the survey, give them time to reflect on their responses and then open up the class for discussion. Acknowledge how difficult it can be to discuss these sorts of issues openly and reinforce honesty and forthrightness as they open up about these sensitive issues. Ask your students to consider the following:

Did you have trouble deciding on any of the statements?
Can you come up with specific examples from your own life that relate to some of the statements?
Can you share examples of how you have changed certain behaviors or self-perceptions to feel good about yourself?

Next, have students look at their completed activities to see if they selected “Disagree” for any statement in 1 through 4,or 10 through 14. Likewise, did they “Agree” with any statement in 5 through 9?If so, open the discussion to talk about things they might be able to do to “switch categories.” For example, if it’s hard for them to meet new people, what could they do to become more comfortable with it? They could hang around with a friend who is more outgoing than they are so that they meet new people with the friend.
Emphasize to students that lots of people have something about themselves that they would like to change. Maybe they wish they were less shy, better at sports, better singers, etc.

Ask your students if they think some people believe using tobacco (smoking) or nicotine (vaping) will make them feel better about themselves. Explain that some young people who experiment with tobacco and nicotine do so because they have a low self-image, or they don’t feel good about themselves.¹ Explain that this is not a healthy choice to make to feel better about yourself. Discuss alternative, positive choices people their age could make to feel better about themselves.

WRAPPING UP

When you want to bring the conversation to a close, emphasize how all people have things about themselves they feel good about and things they want to change. Stress the fact that the students may have more power to make positive changes than they realize.

SOURCES

¹ CDC. Smoking & Tobacco Use. Fact Sheet—Youth and Tobacco Use: Estimates of Current Tobacco Use Among Youth. Referenced 2024. www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/

RATIONALE

As children mature, their image becomes more important to them. They become more concerned with how they appear to others, and what they like in others. This is an exercise in helping students assess their own views about themselves.

GETTING STARTED

When you introduce this exercise, you may want to choose a well-known celebrity and ask students to come up with adjectives to describe that celebrity. Remind students that although all adjectives are descriptive, they don’t all carry judgments. For instance, a celebrity could be labelled “cool” or “handsome,” but could also be described as “blue-eyed,” “brown-haired,” or “left-handed.

LAUNCH ACTIVITY

This activity contains 30 adjectives. Some are fairly neutral (short-haired, right-handed) and others are value-laden(athletic, stubborn). Share the digital activity link in the “Materials” section with your students. Ask them to select adjectives that best describe them and drag them into the “You!” category. You can also let them add other adjectives to the page.

Then, students should select adjectives they think friends would use to describe them and drag them to the “How You Think Your Friends Would Describe You” category. They may also add adjectives to the category. Explain to the students that these may or may not already be on the list of 30, and they may or may not be adjectives that they have used to describe themselves. What you want them to do is come up with the 10 most important characteristics their friends would choose to describe them.

Finally, in the “Write About It!” section, students should write a few sentences about a decision that made them feel good about themselves and why. For example, maybe they chose to join a team, help a friend with homework, or study for a big test.

TALKING ABOUT IT

Students may be sensitive to sharing the adjectives that they used to describe themselves. However, ask for volunteers to share some of the words on their list and highlight the positive words. Next, to conclude the lesson, have volunteers discuss the decisions that made them feel good about themselves. Encourage students to see how everyone is different and that we can be proud of different things.

WRAPPING UP

Ask students what types of decisions they think they’ll be making in the next few months that will make them proud. End by telling them that you will be proud to see them make the decision to be tobacco and nicotine free.

UNIT QUIZ

This should be used after students complete the activities and lessons. It is designed to help you assess their understanding of the content. Students will work in small groups to determine answers to True/False, Choices & Consequences, and Fill-in-the-Blanks questions.

RATIONALE

The quiz will help you assess your students’ understanding of the content of the “Right Decisions, Right Now: Be Nicotine Free” program.

GETTING STARTED

When you are done with the lessons and your students have completed the activities, have your class break into small groups and face the interactive whiteboard. You may also opt to project this onto a screen from your computer.

Display the main page of the quiz on the interactive whiteboard or projector screen.

In this quiz, there are three categories: “True/False“, “Choices & Consequences“, and “Fill in the Blanks.” In each category, there are five questions. There is also one “Daily Double” question(worth twice the points) and a “Final” question.

Decide which group of students will begin the game. Then, let them select a category and a number value. For example, they may select “True/False” for 200, or “Fill in the Blanks” for 400. They need not go in order.

When students select a category and number value, click on it from your computer or at the interactive whiteboard to display the question. When you click a second time, the answer will be displayed. Do not display the answer until the correct answer has been given bya team or all groups have taken a turn. Review the answers first (in the “Answers” section) and consider printing them out for easy reference. To go back to the main quiz screen after each question is answered correctly, click on the back arrow at the bottom of the screen.

Pose each question to the entire class and determine who will get to answer first based on speed of response. Alternately or in addition, you may wish to ask teams to write down their complete answers before raising their hand to respond. If you do so, you may opt to award points to all teams that get the correct answer, regardless of response time. In this case, have teams take turns selecting categories and point values, as well as answering.

If you choose to determine who gets to answer first and earn points based on speed of response, follow these guidelines: if someone in a group raises their hand first, with the correct answer to the question in the category, they will then win the points and get to choose the next category and number value. If they raise their hand first but get the answer wrong, you would then allow the other teams to answer, based on how quickly they responded. The team with the correct answer, or the team that had the last correct answer, will choose the next category and point value. This will continue throughout the game.

Request that a student volunteer keep track of points for each team on the chalkboard or on a piece of paper. When a team gets a correct answer, they earn the category value. When they get an incorrect answer, the point value of the question is deducted. Alternately, you may opt to only add and not deduct points.

For the Final Question round, show the groups the category: “Health Consequences.” Based on the category, each group should write down a point value they are willing to risk. The scorekeeper should share the team scores prior to this point so groups can make an informed decision.

Teams with the correct answer will have the point value they risked added to their score. Teams with an incorrect answer will have it deducted from their score, or simply not added.

LAUNCH ACTIVITY

TALKING ABOUT IT

Emphasize that the point of the Unit Quiz is for students to have an opportunity to share what they’ve learned about being tobacco and nicotine free.

Note the questions students struggle with most and consider discussing them with students after the quiz.

ANSWERS

Points	Question	Answer
Questions/Prompts in “True/False” Category
(100)	Most middle schoolers are not current cigarette smokers.	What is “True”?
(200)	Young people who smoke cannot become addicted to nicotine.	What is “False”?
(300)	Many young people say they’re going to quit smoking in the future, and then can’t.	What is “True”?
(400)	Smokeless tobacco is harmful to your health.	What is “True”?
(500)	Smoking cannot cause heart disease.	What is “False”?
Questions/Prompts and Answers in “Choices & Consequences” Category
(100)	Young people who smoke cigarettes_______. a) are likely to be less physically fit and to have more breathing problems than kids who don’t smoke b) report that they cough and wheeze more than their peers who don’t smoke c) neither A nor B d) both A and B	d
(200)	Smoking cigarettes can damage________. a) only your mouth and gums b) only your lungs and heart c) only your lungs d) nearly every organ in your body	d
(300)	What best describes what you should think about when making a decision? a) your friends b) what other people will think c) your goals, choices, and consequences d) your friends, choices, and consequences	c
(400)	What are three health consequences of tobacco use?	What are: any three of the following would be correct: strokes, cataracts (which can cause blindness), emphysema, gum disease, pneumonia, bronchitis, chronic coughing, wheezing, heart disease, phlegm production, bleeding gums, mouth sores, shortness of breath, hardening of the arteries, increased risk of infection, damaged immune system, cancer, being less physically fit, impaired lung growth
(500)	What are three consequences of tobacco use that are not related to health?	What are: any three of the following would be correct: stained teeth, wrinkles, smelly clothes, stinky hair, punishment from parents, punishment from school, legal consequences, avoidance/ostracism from non-smokers
Questions/Prompts and Answers in “Fill in the Blanks” Category
(100)	The chemical in tobacco that affects the brain is_______________.	What is nicotine?
(200)	(Double Your Points—Worth 400 Points!) Three reasons why most middle schoolers do not use tobacco are ______________, ____________________, and ____________________.	What are: any three of the following would be correct: They want to be tobacco free. They know about the health consequences. They are concerned about the non-health consequences (e.g., getting in trouble). Their friends don’t use tobacco.
(300)	“My friends who smoke teased me about trying it. So, after school I smoked a cigarette with them even though I didn’t want to.” This statement is an example of ______________.	What is peer pressure?
(400)	Three reasons why some young people try tobacco are:	What are: any three of the following would be correct: They don’t know how to say “no” to their friends. They don’t feel good about themselves (low self-esteem). They aren’t doing well in school. They don’t understand the health consequences. They think everyone is doing it (overestimating the number of people who smoke). They don’t realize they can become addicted (underestimating the addictive nature of nicotine). They think it will make them look cool or grown-up. They think it will help them fit in.
(500)	You want to be tobacco free. What are three ways you could say “no” to a friend who offers you a cigarette or smokeless tobacco?	What are: any three of the following would be correct: Say “no” and suggest something else. Say “no” and talk about the consequences. Say “no” and give a reason or explain why you said “no.” Say “no” and reverse the pressure. Say “no” and change the subject. Say “no” and add some humor. Say “no” and walk away.
Prompt and Answers for the Final Question
TBD by Students	Category: Health Consequences List three types of cancer caused by smoking.	What are: any three of the following would be correct: pharynx (mouth and throat), larynx (voice box), esophagus, lungs, stomach, pancreas, kidney, bladder

WRAPPING UP

Teachers, please note that students may come up with other health impacts they believe are caused by smoking, vaping and use of other nicotine products. Direct students to some of the online resources included in the program footnotes to have them check to see if they are correct.

When the Unit Quiz is completed, congratulate students on what they’ve learned about being tobacco free!

INTERACTIVE WHITEBOARD POWERPOINT

For your convenience, we have created this same activity in two formats. The optimized interactive whiteboard PowerPoint includes additional audio and visual effects to engage your students. Click here to download the PowerPoint. You’ll also find it in the “Materials” section below.

RATIONALE

Before starting this activity, discuss the concepts of peer pressure and peer influence with your students. (See the Overview Booklet for information you can share with your students.) Emphasize how we often want to “fit in” and “be liked” by others, and how sometimes the easiest way to accomplish this is by behaving like everyone else. At times, that might mean behaving in a way we would rather not behave.

GETTING STARTED

To reinforce the concept, read this example to your students: A new student comes into the class midway through the year. She notices that she is the only girl wearing a dress in the whole class. Although she likes to wear dresses, she shows up the next day, and every day, wearing pants.

Ask your students:

Was the girl pressured? (No—there wasn’t any overt pressure. This is an example of peer influence.)
Why did she choose to wear pants? (She wanted to be accepted. She put pressure on herself to fit in—she was influenced by her peers.)
Do you think her decision bothered her? (Answers will vary but encourage students to see that the girl is probably disappointed because she may have enjoyed wearing dresses.)
Do you think the other students care about what she wears? Do you think it is important to them that she dresses the same way they do? (Probably not.)

Share the digital activity link below with your students. Explain to them that they are going to fill out a checklist they will use to measure how peer pressure and influence might affect them. Ask them to complete Part One independently. Students will complete Part One and then wait until you tell them it’s time to move on to Part Two. Begin the discussion below after they have completed Part One.

LAUNCH ACTIVITY

TALKING ABOUT IT

Part One
When the students have finished Part One, gather as a class or in small groups and encourage discussion. Ask students to think about these questions:

Did you find any surprises in your answers?
Did the students in your group answer any of the questions the same way?
Which issues did you find most important?

See if patterns emerge that indicate students’ sensitivity to peer pressure and peer influence. In particular, do the students see a strong tendency to want to be with other students who hold similar interests, values, etc., as themselves? Open the discussion and ask each group to report on some of the things they learned. In a wrap-up of Part One, acknowledge that the desire to be with those who are most like us is quite common. But also mention that there will always be some ideas and behaviors that students don’t hold in common, even with their best friends, and that this is what makes us individuals. Before students move on to Part Two, explain to them that our friends play certain roles in our lives. They can be people we do things with, people we enjoy talking to, people we confide secrets in, people we like to joke with, etc. Explain to the students that this part of the exercise will help them examine the role friends play in their lives.

Part Two
Ask students to complete Part Two. When they have finished, ask them to talk generally about how important friends are to them. Ask your students:

Are there times when you prefer to spend your free time by yourself, or with family members, rather than with friends? Why or why not?
Do you have certain friends with whom you are close enough to keep secrets? (For those who answer “yes,” ask them to speak more generally about the role those friends play in their lives.)
One of the questions asked if you would lie to protect a friend. Can you offer a possible example in which you would lie to protect a friend? (For example: “My friend slept over at my house the other night. She took one of my sister’s CDs and told me not to tell. When my sister asked me about it, I said…”)
Can you think of a scenario in which you might consider breaking a promise to a friend? (For example: “I told my friend I would come over on Saturday to help him study for the history exam, but then my dad came home with tickets to the ball game. So I decided…”)
Think about this situation: There’s a really cool group of students at school. You and your best friends have always wanted to hang out with them. Some of the cool people ask you if you want to go to the mall with them, but they don’t invite your friend. How do you handle this?
Would you compromise your values and choice to be tobacco and nicotine free if a friend asked you to use a tobacco and nicotine product?

To finish this section, acknowledge how important our friends can be to us, and how difficult it can be when we feel that we have to choose between doing something we don’t necessarily want to do in order to solidify a friendship, and not doing it. Talk about how truly strong friendships can handle differences of interests, values, etc.  

Part Three
Explain to students that while our interests and behaviors influence us in our choice of friends, sometimes our friends influence us in our choice of behavior. Ask students to complete Part Three. Then, assemble them in small groups and ask them to discuss their answers and address these questions:

Why would someone go to a movie she did not want to see?
Why would someone want to smoke or vape or use smokeless tobacco if he or she didn’t want to?
If you answered “no” to a particular question, why do you think someone might say “yes” to the same question? What might cause someone to say “yes”?

WRAPPING UP

Have students work in their groups to complete the “You Decide!” section of the activity. After about ten minutes, reconvene and ask your students:

Was there a consensus in your group about how the situation should be managed?
What sort of conflicting feelings might a person experiencing this situation be feeling?
Were there any easy solutions? Do any solutions have a negative consequence attached to them?

This exercise and the follow-up activity can offer you an opportunity to talk with your students about how unhappy people can feel when they give up their own desires and values to go along with those of a group. Talk about how difficult it can be to take a position that is unpopular with one’s peers, but how good it can feel when the student exercises his or her independence. Most times, young people are actually quite tolerant of differences among friends as long as the differences don’t outweigh the similarities.

FOLLOW-UP ACTIVITY

After completing the digital activity, your students will be presented with the following two scenarios and space to type in their responses. Have them work in small groups to decide how to respond.

1) Pretend your friends are going to get a certain haircut, but you’ve been forbidden by your parents, and your friends tease you about it. What will you do? Why?

2) Imagine you’re thinking about joining the school chorus, but other students think it’s uncool. What will you do? Why?

Then, ask your students:

Was there a consensus in your group about how the situation should be managed?
What sort of conflicting feelings might a person experiencing this situation be feeling?
Were there any easy solutions? Do any solutions have a negative consequence attached to them?

LAUNCH ACTIVITY

RATIONALE

This exercise, and the scenarios it includes, are designed to get students to reflect on the effects of peer influence. Explain that peer influence means being influenced by what we observe in other people, rather than by any overt pressure we are made to feel. We are merely reacting to our own thoughts rather than anything someone says or does to us.

GETTING STARTED

Share the digital activity link below with your students. You may wish to present the activity on an interactive whiteboard and follow along with students as they complete it individually, or model possible choices students might make.

LAUNCH ACTIVITY

Ask students to read the activity introduction. Then, read this aloud:

Scenario 1: The Sneaker Dilemma – You hang around with a particular group of friends. When a new style of sneaker hits the market, a lot of your friends go out and buy them. But, you don’t have the money for them, and besides, you don’t particularly like the way they look. How do you feel when you realize you are the only one in the group who has not purchased the sneakers? What are the different ways you can manage this situation?

TALKING ABOUT IT

In the digital activity, students will see the scenario above. Then, they will see a“Choices and Consequences” branching activity that will ask them to makedecisions based on the scenario. Talk with them about the decisions they makeand ask them these questions:

What is the dilemma?
What sorts of things may go through your mind in this situation?
Has anyone ever been in a similar situation?
What are the options? (Write the options on the board.)
What consequences might ensue from each option? (Write the consequences on the board.)
What do you think you would do in this situation and why?

Students will be presented with three additional scenarios. For each, they will be asked to make decisions based on the scenario. Read each scenario to the students. Then, talk with them about the decisions they make and ask them the questions above. In discussing these scenarios:

Acknowledge the difficulty students face with decisions that may be hard for them.
Reinforce the notion that a student who disagrees with one or two aspects of group behavior can still find a place in the group. Remind students that they chose to be friends before the issue came up, so there are other qualities that they like about each other.
Explain that if they disagree with friends on important issues like using tobacco or nicotine, like vaping, they can refocus their friendship on the issues they do agree on.
Uphold the idea that the ability to think and act independently is by no means easy, but it is to be admired.

Scenario 2: After School – You go with a group after school to a friend’s house. There is no adult supervision, and some of your friends there are vaping. They want you to join them, but you are really opposed to it. What sort of position does this put you in with your friends? Can it jeopardize your friendships? What sort of feelings and thoughts would go through your head? What should you do?

Scenario 3: The New Friend – You meet a new kid in your neighborhood, and you hit it off well, but when he shows up at school, none of your friends like him. Some make fun of him behind his back, while others just refuse to warm up to him. You want to remain friends with the new kid, but how do you feel about hanging out with someone your other friends don’t like? What do you think your friends expect you to do in this situation?

Scenario 4: Old Friends, New Changes – You have had the same set of friends for several years now, and you are all very close, which you like. Lately, however, you notice that some of your friends are changing. Some of them have started stealing, and the others seem to approve. They’ve lost interest in the things you used to do together, like school sports, and you still want to be on some of the teams. What sort of changes are going on here, and what effects could they have on you? Can friendships change and still be friendships? What roles might these friends have played in your life in the past, and what roles might they play in the future?

WRAPPING UP

After reading the scenarios and making decisions, students will be asked to answer this question:

What do you think will really happen if you don’t go along with your friends?

Use the supplemental “Skater Boy” video to complement this section.

RATIONALE

In this activity, students will examine two illustrations demonstrating peer pressure and peer influence to use tobacco or nicotine. They will answer questions about what a character might be thinking and ultimately will do in each situation.

GETTING STARTED

Share the digital activity link below with your students. They can complete this activity independently or in groups.

LAUNCH ACTIVITY

TALKING ABOUT IT

Once everyone has finished, meet as a class to discuss the pictures and students’ answers. Point out the good feelings that might be had by the student who refused the temptation/pressure to participate and just walked away instead. Reinforce the feeling of inner strength and self-control this student would have for refusing. Ask students to think about how they would handle themselves in each case.

WRAPPING UP

Ask students to share the advice they would give to the boy about not smoking or vaping. Write these answers on chart paper so that you can keep it on display as a reminder to your students about why they should stay tobacco and nicotine free.

In addition to trying to determine what characters might think and do, students will be asked to determine which illustration is an example of peer pressure (#1) and which peer influence (#2). Encourage students to talk about the differences between the two illustrations so they are able to ascertain that some pressures are self-generated. They would also do well to explore why they feel these pressures.

RATIONALE

In this activity, students will review the health information that they learned in Activity Two and reinforce their understanding of the facts.

GETTING STARTED

Before sharing the link to the activity, read the following scenario to your students:

Janelle’s parents are not home. Her friends call and ask her to go to the movies with them. Janelle knows her parents would not let her go, but her friends beg her to go with them. They tell her she could be back before her parents get home and they would never know.

Ask your students:

·      What choices does Janelle have? (Write their answers on the board.)
·      What are the possible risks and consequences for each of these choices?
·      Are there any negative consequences associated with Janelle’s options?
·      Can you think of any situations in which there are possible health consequences to consider when making a decision? (e.g., use of tobacco, nicotine, other drugs or alcohol)

Next, explain to your students that this example was used to get them to think about evaluating choices and consequences before making decisions. There are health risks to consider with some decisions (e.g., using tobacco and nicotine products), which you will discuss in this activity. Share the digital activity link below with your students. You can have students go directly to the activity on their computers. Have them work ingroups to assess the risks and health consequences for the scenario.

Note that they may navigate back and forth between the activity screens by clicking the “Page” tabs at the bottom of the activity.

LAUNCH ACTIVITY

TALKING ABOUT IT

Facts about the health consequences associated with using tobacco and nicotine use are important for students to understand. Before moving on to the “Take a Look” section, display the “Look what tobacco will do” poster with the images displaying health consequences associated with tobacco use (e.g., diseased gums and lung) and read it with your group. Students will see it on their individual computer screens and may click to enlarge it ina separate window. Ask them to keep the separate window open so they can refer back to the poster. The diseased images are included to bring the message home—using tobacco products can seriously impair a person’s health. Students will need to refer to the poster images to complete this part of the activity. Next, have students work in groups to complete the question in the “You Decide!” section. Have a class discussion to review student’s answers.

WRAPPING UP

Answers may vary. Explain to students that it is harder to breathe with diseased lungs, making it tough to walk, climb, exercise, and get around. It is important to have a healthy heart because it pumps blood throughout the body that carries oxygen we need to live. Your students need the facts about the health consequences of using tobacco to make smart decisions on saying “no” to tobacco. Seeing a picture of a diseased lung or gums might make them think twice before using tobacco. Other students might say “no” to tobacco because of the cosmetic or social reasons, which the CDC indicates successful prevention programs address in addition to the physiological consequences.⁴ Explain to your students that in addition to the health issues presented, using tobacco can also result in stained teeth, foul-smelling hair and clothes, and ostracism from non-smoking peers.⁴ Explain that 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.⁸

FOLLOW-UP ACTIVITY

As a follow-up exercise, ask students to complete the “Choices and Consequences” digital activity below. You may share the link and ask students to complete it individually. During or after the activity, ask students to talk about their choices and the possible consequences. Next, use role-playing methods in class to help students think of healthy ways to respond when faced with making decisions about these behaviors. Remind students that the way a person reacts to a given situation will vary based on the individual. Use the supplemental “Summer Boredom” video to complement this section.

LAUNCH ACTIVITY

SOURCES

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

⁸https://e-cigarettes.surgeongeneral.gov/knowtherisks.html#:~:text=Youth%20and%20young%20adults%20are,permanent%20lowering%20of%20impulse%20control.

RATIONALE

This activity outlines many of the health consequences of smoking cigarettes and using nicotine products like e-cigarettes (vapes) and smokeless tobacco. It is designed to teach students the facts because most young people who start smoking or vaping underestimate the health consequences.⁷ As a result, the CDC recommends that schools provide instruction to students about the short- and long-term negative physiologic and social consequences of tobacco use.⁷ However, the CDC also notes that “programs that only discuss tobacco’s harmful effects or attempt to instill fear do not prevent tobacco use.”⁷ Therefore, a comprehensive approach to tobacco and nicotine prevention is important to help keep students tobacco and nicotine free.

GETTING STARTED

Share the activity link below with your class. Then, review the information provided in the activity. Ask your health teacher or school nurse to join you for the activity. Have a dictionary or a health textbook on hand so students can look up unfamiliar terms and share them with the class.

LAUNCH ACTIVITY

TALKING ABOUT IT

After students complete the activity, take a class poll to see which of the health consequences students knew, and which facts were unfamiliar to them. During the discussion in Activity One about reasons young people use tobacco or nicotine, students might have said that young people think smoking makes them look “cool.” Explain to students that there is nothing “cool” about the health consequences of tobacco or nicotine use. They are real and serious—making the decision to be tobacco and nicotine free a smart one.

WRAPPING UP

End the lesson with a class discussion about decisions students make to be healthy and positive. Ask them what it means and why they think it is important to have a healthy, active lifestyle and good eating habits. Ask them how using tobacco or nicotine products such as vapes or smokeless tobacco would negatively affect a healthy lifestyle.

For a complete list of health consequences related to tobacco use, visit www.cdc.gov/tobacco. For more information about the health impact of using e-cigarettes, visit: Know the Risks of E-cigarettes for Young People | Know the Risks: E-cigarettes &Young People | U.S. Surgeon General’s Report

FOLLOW-UP ACTIVITY

After completing the digital activity, students will be asked to create digital posters presenting the facts about tobacco and nicotine. Words and images will be provided after the activity to help them create the digital posters. Alternately, ask students to create paper posters. Click the thumbnail below for the link. They can use the facts and statistics from this activity and research additional health consequences on the internet or in the school library. Ask each student to explain the words and images in his/her poster to classmates. Print the digital posters and hang them around the classroom. Invite other classes to stop by and view the posters.

LAUNCH ACTIVITY

SOURCES

⁷ CDC. Healthy Youth! Health Topics. Tobacco Use: School Health Guidelines, Summary. Referenced 2023. www.cdc.gov/HealthyYouth/tobacco/guidelines/summary.htm

This student survey is designed to help you launch your prevention unit and generate class discussion about the health impact of tobacco and nicotine. But first, be sure to read the Overview Booklet for Grades 5–9 . It provides all the information you need to know to successfully implement this material.

Survey, Parts One and Two

Part One of the activity asks students about their experiences with tobacco and nicotine. It consists of questions taken from the CDC’s National Youth Tobacco Survey (NYTS) 2023 Questionnaire — a survey that can be used to estimate current use of tobacco products and selected indicators related to tobacco use among U.S. middle school and high school students. These surveys are periodically done by the government to assess tobacco use. The complete survey and reports are available online here.

Part Two of the Survey includes open-ended questions that ask students what they think or know about the prevalence and health consequences of tobacco and nicotine use, quitting, and why young people use tobacco or nicotine products, including e-cigarettes or smokeless tobacco.

Once you have completed all activities, please delete or dispose of all student surveys.

RATIONALE

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.

GETTING STARTED

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.

LAUNCH ACTIVITY

TALKING ABOUT IT

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.

WRAPPING UP

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.

SURVEY DATA COLLECTOR

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.

WHAT DO YOU THINK?

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.

SOURCES

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.

Grades: grades-5-6

ACTIVITY 9: What I See In Me

ACTIVITY 9: What I See In Me

How I Am (Intrapersonal Skills)

SKILLS: Building Self-Esteem / Understanding Personal Values

Suggested Time Consideration: 25 mins

LAUNCH ACTIVITY

ACTIVITY 10: That’s Me!

ACTIVITY 10: That’s Me!

How I Am (Intrapersonal Skills)

SKILLS: Building Self-Esteem / Understanding Personal Values

Suggested Time Consideration: 30 mins

LAUNCH ACTIVITY

UNIT QUIZ: Student Assessment

UNIT QUIZ: Student Assessment

Unit Quiz

SKILLS: Comprehending / Analysing Data

Suggested Time Consideration: 25 mins

LAUNCH ACTIVITY

Activity Resources

INTERACTIVE WHITEBOARD POWERPOINT

ACTIVITY 4: Thinking About Your Friends

ACTIVITY 4: Thinking About Your Friends

How Friends Fit In (Interpersonal Skills)

SKILLS: Understanding Peer Relationships / Dealing With Peer Pressure

Suggested Time Consideration: 30 mins

LAUNCH ACTIVITY

Activity Resources

GRADE 5&6 OVERVIEW BOOKET

OVERVIEW BOOKLET

ACTIVITY 5: What Would You Do?

ACTIVITY 5: What Would You Do?

How Friends Fit In (Interpersonal Skills)

SKILLS: Understanding Peer Relationships / Dealing With Peer Pressure

Suggested Time Consideration: 30 mins

LAUNCH ACTIVITY

ACTIVITY 6: Saying “No”

ACTIVITY 6: Saying “No”

How Friends Fit In (Interpersonal Skills)

SKILLS: Refusal Skills

Suggested Time Consideration: 20 mins

LAUNCH ACTIVITY

ACTIVITY 3: Tobacco & Nicotine - Using It Is Unhealthy!

ACTIVITY 3: Tobacco & Nicotine - Using It Is Unhealthy!

Keeping Healthy

SKILLS: Assessing Risks and Consequences

Suggested Time Consideration: 25 mins

LAUNCH ACTIVITY

Activity Resources

HOW TO SAY "NO" SET OF TWO POSTERS

ACTIVITY 2: Tobacco & Nicotine Use–The Health Consequences

ACTIVITY 2: Tobacco & Nicotine Use–The Health Consequences

Keeping Healthy

SKILLS: Assessing Risks and Consequences

Suggested Time Consideration: 25 mins

LAUNCH ACTIVITY

ACTIVITY 1: Take a Tobacco & Nicotine Survey

ACTIVITY 1: Take a Tobacco & Nicotine Survey

SKILLS: Assessing Risks and Consequences

Suggested Time Consideration: 25 mins

Survey, Parts One and Two

LAUNCH ACTIVITY

Activity Resources

GRADE 5&6 OVERVIEW BOOKET

OVERVIEW BOOKLET

WALL POSTER

GRADES 5 & 6

GRADES 5 & 6

Keeping Healthy

How Friends Fit In (Interpersonal Skills)

How I Am (Intrapersonal Skills)

Unit Quiz

Activities for other Grades

GRADE 7

GRADES 8 & 9