1. S.C. Tobacco Education Program (TEP) Educating South Carolina Youth on the Dangers of Tobacco Use
Introduce yourself. Tell the group why you are facilitating the Tobacco Education Program.

2. What is TEP?
The S.C. Tobacco Education Program is designed to get you thinking about your smoking, vaping, and dipping habits.

3. Ground Rules
No Use of Tobacco Products During Breaks or Before, During or After Class
Respect Others
Be Honest
Participation Is Important!
Other Suggestions
**Ask participants to name other ground rules they feel will make their experience of the program more pleasurable. Write these on a flip chart and keep ground rules displayed during the program. Examples: Participation is expected. No cell phones or iPods.
**Explore the participants’ expectations and/or fears of the program. Acknowledge all negative feelings and do not attempt to negate the participants’ feelings or misconceptions about the program or tobacco use.
**Emphasize that there is no tobacco use on the premises, during breaks, or on the grounds.

4. Introductions Have participants introduce themselves.
Below is a list of suggested questions:
Name
School / Grade
How Do You Feel About Being Here?
Why are you here today?
What type of tobacco products do you currently use?
How Long Have You Been Using?
What Do You Expect to Learn Today?

5. Activity 1 “Icebreaker”
List of possible icebreakers:
“Pick a Quote”: Have a number of quotes scattered throughout the room. Ask the participants to choose a quote that they most relate to and take it back to their seats with them. Then have them explain why the quotes stood out to them and how they relate to them during the introductions.
“Silent Lineup”: Without talking, the entire group is to line up single file, placing themselves according to birth date (month & day), using whatever resources are available in the room. All of their actions are to be done non-verbally. Leader can identify a starting line or can make the group consider that in their planning. (Variations include having the group line up by height or the first letter of their last name or by the number(s) of their street address.)
“Name Boggle”: Each player lists his/her first name in large letters on a single piece of flip chart paper using a uniform left margin. The group then tries to make as many words as possible from the combined letters in the names. Words should be three letters or more. Letters can be reused. Give three minutes to complete the task and then request that volunteers list their words out loud as you act as secretary and list words on the paper. Explore possible themes of the words found by the different group members.
“All My Neighbors”: Using a prepared list of situations, the leader reads one situation and begins each statement by saying, “All my neighbors who…” (with neighbors being those people in the room at the time of the activity.) Example: All my neighbors who play a musical instrument, have gone to the movies in the past month, have a member of their family in the military, enjoy the thrilling rides of roller coasters, were born outside of South Carolina, know how to swim, have done at least one nice thing for a neighbor in the past seven days, prefer Coke to Pepsi, prefer McDonald’s to Burger King, have ever played for an organized sports team, who own a pet ,who in the past 24 hours played a video game, have ever sent a text to someone, etc. The leader just uses popular issues, slang terms or popular activities with teens in conducting the activity.
For additional icebreakers you can read Tom Johnson’s Activities that Teach Book.
Activity 1
“Icebreaker”

6. Get Your FACTS Straight!
Please Take Out Your “Get Your Facts Straight” Pre-Test.

7. Section 1: Myths and Facts

8. 1) Most teens in South Carolina smoke…
FALSE
Most teenagers do not smoke. Current surveys in South Carolina indicate that only about 9.6% of teenagers smoke cigarettes.
That means 90.4% DO NOT SMOKE!
7.2% of high school students have used dip or chewing tobacco in the past 30 days (2015 SC YRBS). However, this percentage can vary by county or school. What percentage of students in your homeroom class do you think use tobacco? Remember, you should think about not only the friends you hang out with, but an overall sample of teens at your school. “Most” would be defined as 50% or more. Is your perception realistic?
Nationally, the CDC (Centers for Disease Control) estimates that 10.8% of high school students are current cigarette smokers and 31.4% are current users of tobacco products (cigars, cigarettes, smokeless tobacco, vapes, etc). (YRBS 2015) You do not need to feel pressured to smoke or chew. Not “everybody” is doing it.

9. 2) Smokeless tobacco (e. g
2) Smokeless tobacco (e.g., dip, chewing tobacco) is safer than cigarettes
FALSE
Smokeless tobacco contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer.
Public health authorities including the Surgeon General and the National Cancer Institute have found that smokeless tobacco use is hazardous to health and can lead to nicotine addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated with other health problems including lesions in the mouth and tooth decay.

10. 3) Almost all high school smokers in South Carolina who decide to quit succeed…
FALSE
Approximately 50.3% of high school smokers tried to quit in If you continue smoking or chewing, it will only get harder to quit as you get older.
The time to quit is NOW!
SC Youth Tobacco Survey (YTS) 2015

11. 4) Smoking among S.C. high school students has dropped over the past 10 years…
TRUE
In 1997, almost 40% of South Carolina high school students smoked, but now only about 9.6% do. (Source: 2015 SC YRBS) What do you think has contributed to the decrease in smoking?
Possible reasons for the drop in tobacco use may include:
Awareness about the dangers of tobacco use has increased and led to the passage of smoke-free ordinances, increased compliance checks and merchant education, perception of risk, and shift in media advertising. Increase in cost of tobacco products. The passage of the Tobacco Settlement Act prohibits teenage tobacco use from being broadcast over television airwaves.

12. 5) Lung cancer is the fifth most common cancer diagnosed in South Carolina…
FALSE
Lung Cancer was the most common cancer diagnosed in South Carolina in 2012.
(SC DHEC Cancer Profile September 2015) (
and was the leading cause of cancer death. In South Carolina there were 3,785 new lung cancer cases diagnosed and 2,850 lung cancer deaths in 2012.

13. 6) The nicotine found in tobacco is not as addictive as heroin or cocaine…
FALSE
All three drugs are addictive. Nicotine reaches the brain in just seven seconds.
Heroin that is injected into a vein takes 14 seconds to reach the brain. Therefore, nicotine reaches the brain twice as fast as heroin!
When cocaine is snorted, it reaches the brain in 10 to 12 seconds. (American Lung Association). All of these drugs have powerful effects on the brain and may produce a feeling the users want to repeat. The body adapts, and it takes more of the drug to get the same feeling (tolerance). This is part of the cycle of addiction. When you try to stop using any of these drugs, your body experiences physical withdrawal symptoms such as heart palpitations, shaky hands, headache, nausea, and irritability among others.

14. 7) E-cigarettes are safe alternatives to cigarette use and pose no harmful risks to the user…
FALSE
In 2014 studies found higher levels of formaldehyde, another cancer causing chemical, in e-cigarettes with higher voltage levels.
(American Lung Association) (
Also, calls to the nation’s poison control centers for e-cigarette exposure poisonings continue to increase according to the Centers for Disease Control and Prevention.

15. 8) Hookah smoke contains many of the same toxic chemicals found in cigarette smoke.
TRUE
According to a study published in the 2012 issue of CDC's Preventing Chronic Disease, hookah smoke contains many of the same harmful toxins as cigarette smoke.
Centers for Disease Control) (
and has been associated with lung cancer, respiratory illness, low birth weight, and periodontal disease.

16. 9) There are approximately 7,000 chemicals found in tobacco smoke…
TRUE
Cigarette smoke is a toxic mix of more than 7,000 chemicals.
Source: Health and Human Services, 2015
American Lung Association, 2015
Some of the harmful chemicals found in tobacco occur naturally in the plant while others are absorbed from the soil and fertilizers. Some are formed when the tobacco is processed and cigarettes are manufactured. And when the cigarette burns, new chemicals are created.

17. 10) Tobacco products contain chemicals that slow the heart rate creating a calming or relaxing effect…
FALSE
Nicotine is classified as a stimulant and therefore actually increases your heart rate – “exciting” you rather than calming you down.
Sometimes smokers feel calmer because of the slow, steady, deep breaths involved in smoking a cigarette. The next time you are stressed, breathe in and out, taking slow, steady, deep breaths, and see if this helps you feel more relaxed without the dangers of cigarette smoke. Deep breathing using your diaphragm muscle located just below your ribs is a known technique for increasing relaxation and decreasing body tension and stress.
Some of the harmful chemicals found in tobacco occur naturally in the plant while others are absorbed from the soil and fertilizers. Some are formed when the tobacco is processed and cigarettes are manufactured. And when the cigarette burns, new chemicals are created.

18. 11) The average tobacco user tries quitting five to six times before succeeding…
TRUE
Due to the strong addictive qualities of nicotine, it is not an easy process to “just quit” using tobacco at will. It will be easier to quit smoking as a teenager than if you wait until you are in your 20s or older.

19. 12) I believe that I can easily stop using tobacco products later…
Agree or Disagree
Nicotine is so addictive that most people who start smoking or using tobacco products before the age of 19 wind up smoking or using tobacco throughout their lifetimes.
Nine out of 10 smokers start using before the age of 19, even though the legal age for access is 18. One-third of young people who are just “experimenting” end up being addicted by the time they are 20. Only three out of 100 high school smokers think they will be smoking in five years. But in reality, 60 out of 100 will still be smoking seven to nine years later
Quitting isn’t easy but it can be done and will benefit your health at any age. The sooner you quit, the sooner your body will begin to heal. In fact, research shows that if you quit when you are still young, your health could become almost as good as a non-smoker’s.

20. 13) I am worried about the effects of tobacco use on my health at this time…
Agree or Disagree
The use of tobacco products can reduce your breathing capacity, leading to colds and other respiratory infections.
Other side effects may include a faster heart rate, poor circulation in the legs and feet, yellowing of the teeth, and wrinkled skin.

21. 14) I believe youth tobacco use is not a big deal…
Agree or Disagree
It is a big deal!
In 2014, an estimated 66.9 million people aged 12 or older were current users of a tobacco product, including 55.2 million cigarette smokers.
In 2014, an estimated 66.9 million people aged 12 or older were current users of a tobacco product, including 55.2 million cigarette smokers. These 2014 numbers correspond to 25.2 percent of the population being current users of tobacco products and 20.8 percent being current cigarette smokers. The percentage of people aged 12 or older in 2014 who were current users of tobacco products was lower than in 2002 to 2012.
2014 NSDH Report

22. 15) I expect to be using tobacco products at the age of 30…
Agree or Disagree
Only 6.25% of people who attempted to quit smoking were successful in 2014.
In 2014, 1.6 million smokers tried to quit and 100,000 were successful.
2014 Surgeon General’s Report

23. ACTIVITY 2 “The Graffiti Board”
Create two categories on the board or flipchart paper, with one side indicating “Reasons Why?” and the other one indicating “Reasons Why Not?” and begin asking for volunteers within the group to offer ideas as to why people smoke or use tobacco products and others to offer ideas as to the reasons why people should not or just don’t smoke or use tobacco products. This list may give the group facilitator an idea as to possible myths occurring within the group and possible misinformation regarding tobacco use. It’s a way to ascertain the opinions/values placed on tobacco use by the current group attending this program.

24. SECTION 2: Consequences

25. Insert your local school policy here
Tobacco Policies
Insert your local school policy here
If you would like, hand out the actual school policy. You may be able to go to your local school district’s web site to find a listing of the tobacco policy.
Think about the effects of second-hand smoke and fire dangers on other students and faculty. There are consequences if the rules are broken. What are the consequences at your school? Include policies for other locations (mall, church, local commission, parks, etc.)

26. Youth Access To Tobacco Prevention Act of 2006
Effective August 21, 2006, it is unlawful for a minor under the age of 18 to purchase, possess, or attempt to possess tobacco products and/or to present false proof of age in order to purchase a tobacco product.
Break the Law, Pay the Price…
Civil Fines, Court-Ordered Prevention or Smoking-Cessation Program, Court-Ordered Community Service
Tobacco Prevention Act of 2006:
(F)(1) A minor under the age of eighteen years must not purchase, attempt to purchase, possess, or attempt to possess a tobacco product or an alternative nicotine product, or present or offer proof of age that is false or fraudulent for the purpose of purchasing or possessing these products. (2) A minor who knowingly violates a provision of item (1) in person, by agent, or in any other way commits a noncriminal offense and is subject to a civil fine of twenty-five dollars. The civil fine is subject to all applicable court costs, assessments, and surcharges. (3) In lieu of the civil fine, the court may require a minor to successfully complete a Department of Health and Environmental Control approved smoking cessation or tobacco prevention program, or to perform not more than five hours of community service for a charitable institution. (4) If a minor fails to pay the civil fine, successfully complete a smoking cessation or tobacco prevention program, or perform the required hours of community service as ordered by the court, the court may restrict the minor's driving privileges to driving only to and from school, work, and church, or as the court considers appropriate for a period of ninety days beginning from the date provided by the court. If the minor does not have a driver's license or permit, the court may delay the issuance of the minor's driver's license or permit for a period of ninety days beginning from the date the minor applies for a driver's license or permit. Upon restricting or delaying the issuance of the minor's driver's license or permit, the court must complete and remit to the Department of Motor Vehicles any required forms or documentation. The minor is not required to submit his driver's license or permit to the court or the Department of Motor Vehicles. The Department of Motor Vehicles must clearly indicate on the minor's driving record that the restriction or delayed issuance of the minor's driver's license or permit is not a traffic violation or a driver's license suspension. The Department of Motor Vehicles must notify the minor's parent, guardian, or custodian of the restriction or delayed issuance of the minor's driver's license or permit. At the completion of the ninety-day period, the Department of Motor Vehicles must remove the restriction or allow for the issuance of the minor's license or permit. No record may be maintained by the Department of Motor Vehicles of the restriction or delayed issuance of the minor's driver's license or permit after the ninety-day period. The restriction or delayed issuance of the minor's driver's license or permit must not be considered by any insurance company for automobile insurance purposes or result in any automobile insurance penalty, including any penalty under the Merit Rating Plan promulgated by the Department of Insurance
Definitions:
(6) "Alternative nicotine product" means a product, including electronic cigarettes, that consists of or contains nicotine that can be ingested into the body by chewing, smoking, absorbing, dissolving, inhaling, or by any other means. (7) "Electronic cigarette" means an electronic product or device that produces a vapor that delivers nicotine or other substances to the person inhaling from the device to simulate smoking, and is likely to be offered to, or purchased by, consumers as an electronic cigarette, electronic cigar, electronic cigarillo, or electronic pipe.

27. What your friends will notice…
Dry Skin and Wrinkles
Premature Gray Hair and Hair Loss
Bad Breath
Stained Teeth
Smelly Hair and Clothes
Picture with mirror?

28. What your doctor will notice…
Wheezing and Coughing
Bleeding Gums
Frequent Mouth Sores
Tooth Loss
Frequent Colds and Chronic Bronchitis
Decreased Sense of Smell and Taste
Difficulty Breathing When Playing Sports

29. Effects of Use Short term effects
Increase in blood pressure, heart rate, and the flow of blood from the heart
Arteries will begin to narrow
Carbon monoxide reduces the amount of oxygen the blood can carry.
Source:

30. Effects of Use Long-term effects
Increased risk for coronary heart disease, stroke, lung cancer
Can cause cancers almost everywhere in the body (bladder, esophagus, larynx, liver, pancreas, stomach, etc.)
Blockages caused by smoking can also reduce blood flow to your legs and skin
Lung diseases including COPD, emphysema and chronic bronchitis
Worsen symptoms of asthma
Smoking can make it harder for a woman to become pregnant and can affect her baby's health before and after birth
Source:

31. ACTIVITY 3 “Straw Experiment”
Option A – “Running in Place”: Pass out coffee stirring straws to each participant and invite them to run in place with you for 30 seconds. Once you say “Stop,” instruct them to pinch their noses and try to breathe through the straw. Discuss how they felt, what they observed within themselves or others, was it easy to breathe, and did people begin coughing. Inform them that this exercise was to demonstrate just how nicotine begins to affect the ability of the lungs to take in and release oxygen.
Option B – ‘Fruit Juice Relay”: Provide each participant with a small “Dixie cup” and break the group into two teams. Provide each person with a drinking straw. (NOTE: To save on expenses, cut the straws into two or three sections before the start of the session). Fill all cups with fruit punch or fresh water, and on the signal to “GO,” each team member drinks in order of their lineup and discusses how easy or difficult that was to do. Then, in Round 2, pass out the drinking straws and fill cups with water or juice again. After all have had the experience of racing to drink through the narrow straw, you process with the group how it felt, question the ease or difficulty in drinking the second time vs. the first, what they witnessed happening, etc.
Option C – “How Did You Learn?”: Ask for volunteers (10 if your group is large enough), and pass out a section of a drinking straw to each volunteer, informing them that the straw represents a cigarette. Request that they show the group just how it is for them to typically handle/hold the cigarette and how they place it in their mouth, how they usually stand, etc. You then ask them just where it is that they learned how to hold their cigarette and how they learned their technique for smoking, from whom or from watching whom or what? If you indeed had 10 volunteers, ask the 10 which one of them feels lucky today? You indicate that nine out of 10 people begin smoking before the age of 19 and that the earlier age at which you begin, the more difficult it is to stop. More then likely, those nine will continue smoking throughout their lifetime.

32. What your autopsy will show…
Lung Cancer
Mouth Cancer
Throat Cancer
Bladder Cancer
Pancreatic Cancer
Kidney Cancer
Once cancer gets in your lymph nodes, it can spread to many areas of your body.

33. What your autopsy will show…
Stroke
Emphysema
Chronic Lung Disease
Gastric Ulcers
Coronary Heart Disease

34. What your autopsy will show…
A healthy lung is peach-colored and spongy, with air pockets to capture oxygen.
Pic 1. The lung on the left is healthy vs. the lung on the right
Pic 2. This lung already shows black spots of tar.
Pic 3. This picture shows a cancerous lung sliced in half. Again, note the white area of cancer. By the time this area shows up on an x-ray, the prognosis is very poor for survival.

35. Cigars and Pipes Health Effects
Increase risk for cancers (lung, esophagus, larynx, oral cavity
Gum disease and Tooth loss
Heavy users may be at an increased risk for developing coronary heart disease and lung diseases (i.e. emphysema and chronic bronchitis.
Source:
Large cigar- Cigar that typically contains at least one-half ounce of aged, fermented tobacco (i.e., as much as a pack of cigarettes) and usually takes 1 to 2 hours to smoke
Cigarillo- A short (3–4 inches) and narrow cigar that typically contains about 3 grams of tobacco and usually does not include a filter

36. Smokeless Tobacco
Smokeless tobacco products include: snus, dissolvable tobacco (orbs, snuff, chew, dip, sticks and strips).
Many regular smokeless tobacco users have:
receding gums,
gum disease,
cavities and tooth decay,
scratching and wearing down of teeth,
bone loss around the teeth.
Source:
Source:
Other harmful health effects of smokeless tobacco include: Heart disease and high blood pressure, Increased risk of heart attack and stroke, and Increased risk of early delivery and stillbirth when used during pregnancy

37. The Dangers of Dip…
Gruen Von Behrens first used chewing tobacco at age 13. At age 25, he had multiple surgeries to remove cancer, including the removal of half of his neck muscles, lymph nodes, and one-third of his tongue.
Source:
Just 13 and on a camp-out with friends, when one pulled out a can of snuff he’d stolen from his father’s dresser drawer. “I thought, ‘Why not?’ ” he said. “I was 13. I had not a care in the world. So I took a dip. At first it made me kind of sick and real dizzy. Next thing I knew, I was addicted.”
By age 14, Gruen Von Behrens was seriously hooked on nicotine. At his peak, he was consuming more than half a can a day. Then it happened. At 16 he noticed a small white spot on his tongue, a spot that would gradually start to grow.
Something was gradually eating away at his tongue and Gruen was slowly beginning to realize that he likely had cancer. He decided to hide it from his mother, a nurse. When his mother kept asking why he was slurring his speech, drooling, and why he couldn’t seem to keep food in his mouth he’d tell her that it was his wisdom teeth.
At the age of 17 years old, Gruen would undergo 13 hours of surgery followed by a month of recovery in the hospital. Then came the radiation treatments. Within six weeks, he’d lose 70 pounds, lose the skin on his face, his mouth would become a blistery white mess, and his teeth would rot.
At 19, doctors transplanted three inches of bone from his back to his face to give him a jaw. The transplant lasted two days. Then his body rejected it.
Now age 27 and 40 operations later, his lower face severely disfigured, his lower teeth and jawbone gone, half his tongue and neck muscle missing, his face patched with skin and muscle from his leg, Gruen pleads with all who’ll listen, “Don’t do it. It ruined my life.”
Source:

38. Electronic Cigarettes / Vaping
Unlike cigarettes, e-cigarettes are not regulated by the Food and Drug Administration.
E-cigarettes are filled with e-liquids. Because there is no government oversight of these products, nearly 500 brands and 7,700 flavors of e-cigarettes are on the market, all without an FDA evaluation determining what’s in them.
Source:
E-cigarettes, including e-pens, e-pipes, e-hookah and e-cigars, are known collectively as electronic nicotine delivery systems (ENDS). According to the FDA, e-cigarettes are devices that allow users to inhale an aerosol (vapor) containing nicotine or other substances.

39. What’s in an e-cigarette?
Nicotine, the addictive substance in cigarettes is the main chemical in the e-juice. Even some e-juice that claims to have 0mg of nicotine have been found to have traces of the chemical.
Health Concerns
Nicotine addiction
Nicotine poisoning
Symptoms: nausea, vomiting, seizures, respiratory depression
Secondhand emissions- Studies have found traces of formaldehyde, acetaldehyde and other potential toxins
Burns from battery explosions
The FDA has conducted initial tests on some of these products and have found that the e-juice may contain levels of toxic cancer-causing chemicals.

41. HOOKAH Hookah Smoke and Cancer Other Health Effects of Hookah Smoke
The charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals.
Hookah tobacco and smoke contain several toxic agents known to cause lung, bladder, and oral cancers.
Tobacco juices from hookahs irritate the mouth and increase the risk of developing oral cancers.
Other Health Effects of Hookah Smoke
Hookah tobacco and smoke contain many toxic agents that can cause clogged arteries and heart disease.
Infections may be passed to other smokers by sharing a hookah.
Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors.

42. Hookah Smoking Compared With Cigarette Smoking
An hour-long hookah smoking session involves 200 puffs, while smoking an average cigarette involves 20 puffs.
The amount of smoke inhaled during a typical hookah session is about 90,000 milliliters (ml), compared with 500–600 ml inhaled when smoking a cigarette.
Hookah smokers may be at risk for some of the same diseases as cigarette smokers.
These include:
Oral cancer, Lung cancer, Stomach cancer, Cancer of the esophagus, Reduced lung function, Decreased fertility

43. Tobacco Advertising
Tobacco companies spend $22 million every day on advertising (Journeyworks Publishing, “Why Tobacco Companies Want You to Smoke?”).
Option for Facilitator for further discussion: “What’s in a Commercial or Advertisement?”: Facilitator has a prepared list of popular TV or magazine ads for famous everyday companies, and once the “slogan” or “message” is read out loud, the group calls out which company is responsible for the quote/message or slogan. Examples: “Did somebody say…” or “We love to see you smile…” = McDonalds; “Easy, Breezy, Beautiful” = Cover Girl; “Taste the Rainbow” = Skittles; “Relax, Go Nuts” = Planters Peanuts; “Obey Your Thirst” = Sprite. Gather a list of 20 or so and keep them current by getting staff and friends to record common ones every six months or so. Then, inform the group that by playing this game it becomes evident that the techniques being used by the advertising industry are “working” and then review several of those common techniques with the group: “Stargazing or Personal Testimony”…the use of a celebrity or authority figure to try and get you to use the product; “Comparison”…the product being sold is “proven” beyond a doubt to be better than its competition; “Now Even Better”…it’s the same product with something new added; “Special Words”…words that evoke an emotional response (e.g., “refreshing,” “American,” “100% pure & natural”) and the use of repetition of important words, the use of rhymes, sayings, catchy music or cartoons; “Bandwagon”…everyone’s doing it; “Home-style”…using the colors red, white and blue, you must have it to have fun, makes our life easier, provides us more time to “relax.”

44. SECTION 3: Chemicals and Addiction

45. ACTIVITY 4 What’s In your snack? Activity 4. What’s In Your Snack?
Try to provide snacks that are in individual wrappers with the Nutrition Facts labeling on the side of the wrapper. Ask the participants to hold onto their snack until you give them directions that it is OK to eat the snack. If money is a problem, try to provide each of the participants with a picture of a snack and a photographed copy of the Nutrition Facts label.
Ask the kids to remove their snacks from the wrappers, paying careful attention not to damage the Nutrition Facts label. Ask the participants if they are able to guess what kind of ingredients are in the snack without looking at the label. If the snacks are cakes, you will look for answers like milk, flour, sugar, cream, etc. After the participants have taken their guess, have them read the ingredients according to the Nutrition Facts label. Be sure to highlight how the ingredients are not so simple and how the manufacturer includes a lot of ingredients that we the consumer would never think of. It is OK at this point to give the participants approval to eat the snacks.

46. What’s In Your Pack? Activity 4 Continued
Activity 4 Continued: After you have discussed the ingredients of the snacks, then pull out an actual pack of cigarettes. Pull out one of the cigarettes and ask the participants to identify what ingredients are found in a cigarette. You will probably get answers like tobacco, paper, filters, etc. Then read all the writing found across the pack of cigarettes. Pay careful attention to highlight how there is a brief and inconsistent warning on the package, but that a listing of ingredients cannot be found on any part of the pack. Explain to the participants that there are more than 4,000 toxic chemicals found in a cigarette and that the manufacturers do not want you to know about them. This activity will provide a good transition into your discussion on the ingredients found in tobacco and how they affect one’s health.
Activity 4 Continued

47. Overview of Ingredients found in Cigarettes
Nicotine
Tar
Carbon Monoxide
Ammonia
Formaldehyde
Arsenic
Cyanide
Butane

48. Tar: Particle matter made up of dozens of compounds
Tar: Particle matter made up of dozens of compounds. Some are cancer-causing substances, others are poisonous, and still others are harmless. Tar cools and forms a sticky substance in the lungs which damages delicate lung tissue. Carbon Monoxide: A gas found in car exhausts that drives oxygen from the red blood cells. Affects non smokers who are exposed to second-hand smoke.
Black spots of tar beginning to show on the human lung

49. Ammonia: An irritant used as a disinfectant in household cleaners
Butane: Highly flammable, colorless, odorless, easily liquefied gas.
Ammonia: An irritant used as a disinfectant in household cleaners
Black spots of tar beginning to show on the human lung

50. Formaldehyde: A poisonous gas used as a preservative for biological and medical specimens and as a disinfectant Arsenic: A strong poison that can build up in the body over a period of time. At one time used as an insecticide.
Ammonia changes the pH of nicotine and makes it more addictive.

51. Cyanide: An extremely poisonous gas used in gas chambers to execute prisoners. Creosote: Toxic germicide used in barn deodorants, disinfectants and wood preservatives. Nicotine: An addictive substance that constricts blood vessels, cutting down on the flow of blood and oxygen which makes the heart beat faster.

52. Second-Hand Smoke:
Between 150,000 and 300,000 children who have been exposed to tobacco smoke are diagnosed each year with lower respiratory tract infections, such as pneumonia and bronchitis. They suffer from a higher number of middle ear infections, asthma attacks, and chronic coughing and wheezing.

53. Handout: Signs of Addiction
Does this sound like you?
You can be addicted to a lot of different things.
Handout: Signs of Addiction

54. Addiction:
A strong and harmful need to regularly have something (such as a drug) or do something (such as gamble)
An unusually great interest in something or a need to do or have something
Merriam-Webster Dictionary

55. 1) I generally use a tobacco product within five to 30 minutes after I wake up in the morning.
Because the body has been deprived of nicotine for seven, eight or more hours, the craving for tobacco is especially strong.

56. 2) I find it difficult to not use tobacco in places where I shouldn’t, such as school, church, movies, at the library, on a bus.
An addicted person begins to feel an urge for nicotine within 30 minutes after the last cigarette.
(Source: American Lung Association)

57. 3) I use tobacco when/if I am sick and in bed with an illness.
Cravings for tobacco continue even when you are ill.

58. 4) When not using tobacco, I often think about smoking/dipping or planning my next opportunity to use tobacco.
Tobacco becomes the top priority over the other activities you enjoy doing. Tobacco now has control of your life!

59. 5) When I try to quit or cut down on my tobacco use, I feel sick or miserable.
You may experience the following withdrawal symptoms because of your dependency on tobacco:
Anxiety
Stress
Depression
OPTIONAL HANDOUT: American Lung Association – How long before your lungs, etc., start to recover.

60. Triggers Handout: My Style HANDOUT: Signs of Addiction.
Does this sound like you?
You can be addicted to a lot of different things.
Handout: My Style

61. My style:
Think about your typical weekend and identify those times when and where you are likely to use. Include a social or work situation in the evening if it applies to you, and the people that would be with you. What triggers the desire to use, or what feelings are associated with your use?
HANDOUT: My Smoking/Dipping Style (times of the day)

62. When you realize your tobacco habits, you can take back control!
Key Word
HANDOUT: Signs of Addiction.
Does this sound like you?
You can be addicted to a lot of different things.
When you realize your tobacco habits, you can take back control!
Handout: Key Words

63. SECTION 4: Cost Analysis

64. Cost Analysis Handout: Budget HANDOUT: Signs of Addiction.
Does this sound like you?
You can be addicted to a lot of different things.
Handout: Budget

65. What’s it costing you? Example: I smoke one pack per day.
That’s seven packs per week.
My cigarettes cost $5.58 per pack.
$5.58 times 7=$39.06 PER WEEK
$39.06 X 52 Weeks= $
Campaign for Tobacco-Free Kids 2009 US average

66. What’s it costing you? Example: I dip one can per day.
That’s 7 cans per week.
The average cost $3.00 per can.
$3.00 times 7=$21.00 per week
$21.00 X 52 Weeks= $
Suggestion: You may also want to add up the cost of dip.

67. What’s it costing you? Example:
I purchase one e-juice bottle per week.
The average cost of my e-juice bottle is $9.99.
$9.99 x 52 weeks =$519.48
I spend $ per year!!

68. Smoking: Truth or Dare? Show the 29-minute video.
Pam Laffin story can be shown also.

69. What else can you do instead of using tobacco products?
Opportunity for Discussion: In school/out of school – What are some alternatives to breaking the rules?

70. Handout: My Ideal Future
HANDOUT: Signs of Addiction.
Does this sound like you?
You can be addicted to a lot of different things.
Handout: My Ideal Future

71. Get Your Facts Straight!
Please Take Out Your “Get Your Facts Straight” Post-Test.
Upon Completion, return the Post-Test and Evaluation to Get a Signed Certificate.

72. Want to quit using tobacco products?
Call QUIT-NOW ( )
Services include:
One-on-one coaching
Phone or web-based counseling and support
Development of a personalized quit plan.
DHEC offers free nicotine patches, gum and lozenges to South Carolinians without health insurance.
The S.C. Tobacco Quitline is a free counseling service that helps South Carolina smokers and tobacco users quit.

73. Contact Information
Your name and credentials Your address & phone number Your address
Add your information.

74. Marijuana and Alcohol
The following slides can be used if participants wish to discuss alcohol and marijuana.

75. Marijuana: Myths vs. Facts75

76. Marijuana Myth #1 It’s “just a plant.” It can’t hurt me.
Fact: Some plants are harmful.
Heroin is made from the poppy plant.
Cocaine is made from the coca plant.
How do you know what you are getting when you buy marijuana? The Food and Drug Administration makes sure that our food in the grocery store is safe, but there is no one inspecting marijuana. You may be smoking a cheap herb covered with pesticides, or the dealer may have laced the marijuana with cocaine to get you even more addicted.

77. Marijuana Myth #2 It’s safer than cigarettes.
Fact: Marijuana smokers reported higher percentages of some respiratory symptoms than cigarette smokers.
For example: coughing, producing phlegm, and wheezing
Marijuana smokers are subject to:
Coughing and phlegm production on most days;
Wheezing and other chest sounds;
Acute and chronic bronchitis;
Injury to airway tissue, including edema (swelling), increased vascularity, and increased mucus secretion; and
Impaired function of immune system components (alveolar macrophages) in the lungs.
Marijuana smokers reported higher percentages of some respiratory symptoms than cigarette smokers. (shown in the graph above: cough, phlegm, wheezing, chest sounds)

78. Marijuana Myth #3 (National Institute on Drug Abuse, 2015).
Marijuana is used to cure cancer and glaucoma.
Fact: The FDA has not recognized or approved the marijuana plant as medicine.
(National Institute on Drug Abuse, 2015).

79. Marijuana Myth #4
Marijuana is not addictive.
Fact: Estimates from research suggest that about 9% of users become addicted. Increases to about 17% among young users and 25-50% among daily users.
Today’s marijuana is 4x stronger than in 1960 and as much as 18x stronger for marijuana edibles.

80. S.C. Law Chapter 53, Title 44
Penalties for marijuana possession include:
Possession of 1 oz. or less, 1st Offense: Not more than 30 days in jail or not less than $100 nor more than $200 fine. 2nd or subsequent offenses: Not more than 1 year and/or $200 to $2,000.
Possession of more than 1 oz., 1st Offense: Not more than 6 months and/or not more than $2,000.

81. S.C. Law continued
Manufacture, distribution, or possession with the intent to distribute, 1st Offense: Not more than 5 years in jail and/or not more than $5,000 fine.
SC Law Chapter 53, Title 44

82. Alcohol: Myths vs. Facts82

83. What is Alcohol?
Alcohol is the intoxicating agent in fermented and distilled liquors and beverages. It is primarily made from grains, fruits and berries.

84. Alcohol Myth #1 Alcohol is a stimulant or an “upper.”
Fact: It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream.
Source:

85. Alcohol Myth #2 Alcohol affects everyone the same.
Fact: Age, Gender, Race/Ethnicity, Physical Condition, and Family History can impact how your body reacts to alcohol.
Source:

86. Alcohol Myth #3 I am not “drunk” if my BAC is .08 or lower.
Fact: Operating a vehicle with a Blood Alcohol Concentration (BAC) of .02 or above is considered driving under the influence for anyone under the age of 21
Source:

87. Alcohol Myth #4
Everyone drinks.
Fact: Include your local data

88. Alcohol affects ALL parts of the body
Alcohol can lead to:
Heart muscle damage
Stroke
Cirrhosis of the liver
Injuries
Each year, approximately 50% of all ER visits involve alcohol.
Drinking alcohol leads to a loss of coordination, poor judgment, slowed reflexes, distorted vision, memory lapses, and even blackouts.
Alcohol can damage every organ in your body. It is also absorbed directly into your bloodstream and can increase your risk for a variety of life-threatening diseases, including cancer.
Alcohol affects your self-control. Alcohol depresses your central nervous system, lowers your inhibitions, and impairs your judgment. Drinking can lead to risky behaviors, such as driving when you shouldn’t, or having unprotected sex. You can not consent to sex if you are under the influence.

89. Alcohol affects the brain
Alcohol causes distorted vision, memory lapses, blackouts, slowed reflexes, loss of coordination, and poor judgment.

90. Alcohol affects self-control
Drinking can cause poor judgment and lower inhibitions, which can cause you to do something you normally would not do, such as driving while drinking or having unprotected sex. Each year, alcohol is involved in approximately 75% of sexual assaults.

91. Alcohol Poisoning Confusion, stupor Vomiting Seizures
Slow or irregular breathing
Blue-tinged skin or pale skin
Low body temperature (hypothermia)
Unconsciousness ("passing out")

92. S.C. Law Chapter 7, Title 20
Minor who possesses, purchases, consumes, or attempts to purchase beer, wine, or liquor:
$470 fine or 30 days in jail
120 day driver’s license suspension
Completion of an Alcohol Intervention Program
Loss of scholarship and/or grant

93. S.C. Law Chapter 4, Title 61
Providing false information about age for purchase of beer or wine:
$470 fine or 30 days in jail
120 day driver’s license suspension
Loss of scholarship and/or grant

94. S.C. Law Chapter 1, Title 56
Possession of an altered or other person’s driver’s license or identification card
Use of an altered, fake, or other person’s driver’s license or identification card:
$ fine (plus administrative fees) or 30 days in jail
120 day driver’s license suspension

95. BOTH! S.C. Law Chapter 1, Title 56
Altering a driver’s license or identification card:
More than $2,500 fine or
6 months in jail
BOTH!

96. S.C. Code of Laws
Zero tolerance: SC law prohibits persons under the age of 21 from operating a motor vehicle with a BAC greater than 0.02 percent. A person under 21 who drives with a BAC greater than 0.02 percent faces an automatic suspension of his driver’s license for three months (six months if there is a prior alcohol-related conviction or suspension with the preceding five years). If a person under 21 refuses to consent to BAC testing, his driver’s license will be automatically suspended for six months (one year if there is a prior alcohol-related conviction or suspension within the preceding five years).