1. Promoting a Tobacco-Free Lifestyle

2. Outline: Introduction Prevalence And Cost
Tobacco Use And Academic Performance
Factors That Influence Tobacco Use
Guidelines For Classroom

3. INTRODUCTION
Tobacco use is an issue that young people will frequently face many will be tempted to try tobacco products as they advance through late elementary and middle school. Teachers can help students avoid tobacco products and ultimately prevent premature death. This section introduces teachers to the number of young people who use tobacco, how much tobacco costs society, the relationship between tobacco use and performance, and the factors that influence tobacco use.

4. Prevalence and Cost
Cigarette smoking and/or use of other tobacco products is the single most preventable cause of death in the United States today. 1 in every 5 deaths in the United States is tobacco- related. Each year, more than 443,000 people die of smoking- related illnesses

5. Tobacco Use and Academic Performance
The few research studies that have been conducted in the area of tobacco use and academic performance all show similar results. Preadolescents and adolescents who smoke tend to perform less well academically than their nonsmoking peers.

6. Factors That Influence Tobacco Use
Protective Factors:
Parent and family connectedness.
Adolescents who experience a high degree of closeness, caring. and satisfaction with parents are less likely to use tobacco.
Parental/adolescent activities.
Adolescents who participate in activities with their parents on a consistent basis are less likely to use tobacco products.
Parental academic expectations.
Adolescents whose parents expect them to graduate from high school or college are less likely to use tobacco products.
Behavioral and social skills.
Adolescents who can demonstrate and use effective refusal and stress management skills are less likely to use tobacco.

7. Risk Factors : Household access to tobacco
Family suicide or attempt of suicide
Low socioeconomic status
Tobacco availability
Tobacco acceptability
Parental smoking
Peer smoking
Perceived norms
Academic achievement
Risk taking, rebelliousness, and deviant behavior
Behavioral and social skills
Self-esteem
Body image concerns
Aggressive behavior

8. State of the Art Develop and enforce a school policy on tobacco use.
Provide instruction about the short- and long-term negative physiological and social consequences of tobacco use, about social influences on tobacco use about peer norms regarding tobacco use, and about refusal skills
Provide tobacco use prevention education in kindergarten through twelfth grade.
Provide program-specific training for teachers.
Involve parents or families in support of school-based programs to prevent tobacco use.
Support cessation efforts among students and all school staff who use tobacco.
Assess the tobacco use prevention program at regular intervals.

9. GUIDELINES FOR CLASSROOM
Important Background for k-8 Teachers
Preventing Tobacco Use Among Young People was the first surgeon general's report to focus on tobacco as it relates to adolescents.
Following are some of the major conclusions of that report:
Tobacco use usually begins in early adolescence, typically by age 16.
Most young people who smoke are addicted to nicotine and report that they want to quit but are unable to do so.
Tobacco often is the first drug used by young people
who use alcohol and illegal drugs.
Among young people, those with poorer grades
and lower self-images are most likely to begin using
tobacco.
Cigarette advertising appears to increase young people's
risk of smoking by implying that smoking has social
benefits and is far more common than it really is.

10. Smoking Tobacco
There are three ways persons smoke tobacco: pipes, cigars, and cigarettes. Because cigarettes are the most popular way for adults and adolescents to smoke tobacco. More than seven times more likely to start using marijuana nerve than individuals who had never used tobacco. If the number of teenagers who begin smoking can be reduced through educational prevention programs, then the prevalence of smoking and other drug use among adults can be decreased.

11. Smoking Tobacco consequences
Tobacco has many negative short-term consequences, including the following:

Increased heart rate
Increased blood pressure
Decreased skin temperature
Decreased hand steadiness
Increased carbon monoxide levels
Bad breath
Fires and burns
Lung cancer
Cardiovascular disease
Secondhand smoke health effects (sudden infant death syndrome (SIDS),
acute lower respiratory tract)
Aesthetic effects (destroys much of a person’s sense of smell and taste)
Chronic Obstructive Lung disease

12. STRATEGIES FOR LEARNING AND ASSESSMENT
NHES1 I Core Concepts
Students will comprehend concepts related to health promotion and disease prevention to enhance health.

13. Grades K-2 (KWL on Tobacco)
Students can talk about their knowledge of tobacco use by making a Know-Wonder-Learn (KWL; three-column) chart.
Teachers can use a large piece of chart paper to list all the things students say they know (or think they know) about tobacco in a "Know” column, listing the children's names beside the facts they provide. Next, ask students what they wonder about tobacco (the "Wonder" column).
Assessment I Following the completion of the "Learn" column of the KWL chart, students should then draw a picture of how they are going to use what was learned in the KWL on tobacco to help them stay healthy and avoid tobacco.
For assessment criteria, students should provide accurate information and demonstrate relationships between behaviors and health through their drawing.
Constructs: Intention to act in healthy ways,
attitudes toward behavior, perceived behavioral control

14. Grades 3-5 Forms of Tobacco - One Better than the Other?
Draw two three-circle Venn diagrams. Label one diagram "Physical effects" and the other one "Social effects." Use the following labels for the circles:
"smoking tobacco or cigarettes," "smokeless tobacco," and "environmental tobacco smoke or secondhand smoke."
In pairs, students can complete the Venn diagram identifying ways each of these forms of tobacco affect a person's physical and social health. In the overlapping portions of the three circles, students should identify the ways in which the three forms of tobacco affect one's physical and social health in similar ways. The Kids' Health website ( can be used to locate core concepts information to support this activity.
Assessment I Following an oral sharing of the Venn diagrams, students can work with their partners to write a letter to one form of tobacco noting ways in which that form of tobacco is no better or worse than the other forms; for example, "Dear cigarettes" or "Dear secondhand smoke." Students should be sure that all their information is correct and should draw conclusions about connections between tobacco use and health.
(Construct: attitudes toward behavior.)

15. Grade 6-8 Carousel Activity
After discussing the short-term physical, long- term physical, social, economic, and cosmetic effects of smoking, conduct a carousel activity with students. Divide students into five groups. Tape five large pieces of chart paper or newsprint around he room with the headings "Short-Term Physical," "Long-Term Physical," "Social," "Economic," and "Cosmetic." Have each group start at one of the papers to brainstorm the consequences of that type that could result from using tobacco. After a short time, students should rotate to the next piece of paper, read, and add new consequences. After each group returns to their original paper, have them decide on the five consequences they would least like to have.
Assessment I Students should write a paper indicating why they don’t want to smoke. For assessment criteria, students should include at least five consequences in their paper from the carousel activity.
(Construct: Attitudes toward behavior.)

16. NHES2 | Analyze Influences
Students will analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors.

17. Grades K-2 What I Would Do? What Would My Parents Want Me to Do?
Have students draw a picture of what they would do if friend or older sibling offered them a cigarette or smokeless tobacco. Then students should draw a picture of what they believe their parents would want them to do if they were offered a cigarette or smokeless tobacco by a friend or older sibling.
Have students take their drawings home to share with their parents.
Prepare a family letter explaining the in-class assignment and the at-home task. Encourage parents and students to discuss the drawings, including the similarities and differences of how students responded and how they thought their parents would want them to respond.
Parents should be encouraged to share their hopes for their child regarding how to respond to any offer to use tobacco.
Assessment I Following the take-home activity, students can draw, write, or act out ways in which their parents and families encourage them to be healthy and avoid tobacco use.
For assessment criteria, students should explain how the influence of their parents and families, as well as their personal beliefs, impacts their health choices and behaviors.
(Constructs: Attitudes toward behavior, perceived behavioral control.)

18. Constructs: Subjective norms
Grades 3-5 (Family)
Students can interview an adult family member about his or her feelings and attitudes toward youth smoking. Students can ask,
How would you feel if I started smoking?
What are our family rules and consequences about smoking?
What advice can you give me about how to deal with pressures to smoke?
Knowing the attitudes and Beliefs of their families is important for young people. Students can report on their interviews to the rest of the class and tell what their family attitudes and beliefs mean to them.
Assessment I The reports students make on their interviews are the assessment task for this activity..
For assessment criteria, students should discuss how their family members' attitudes and beliefs influence their ideas about smoking.
Constructs: Subjective norms

19. Grade 6-8 Looking at Tobacco Inside and Out
Students can really show the difference between the way tobacco use is portrayed in the media and the effects it has inside the body by making a shoebox or diorama display. Students can bring old shoeboxes from home and ask family, friends, and colleagues to donate old shoeboxes for this project. As students learn more about tobacco, they can design the inside of the shoebox to show tobacco's effects on the body, while designing the outside of the shoebox to show how advertising and other media glamorize tobacco use. Students can design the lid to give instructions to the user about viewing the inside and outside of the box. Display the boxes for other classes or in the school library.
Assessment I The shoebox display or diorama is the
assessment task for this activity. Students should
decide what would make a "great tobacco inside
and out shoebox display." Use the students'
criteria to assess and help them assess their work.
(Constructs: Attitudes toward behavior, subjective norms.)

20. NHES3 I Access Information, Products, and Services
Students will demonstrate the ability to access valid information and products and services to enhance health.

21. Grades K-2 Interview Older Kids
Younger students often model their behavior after older siblings, friends, and students in their school. Arrange for a group of upper-elementary students to visit younger students for the purpose of being interviewed about their knowledge of and views on tobacco. The children can prepare a list of questions they want to ask. Younger students will learn that most of the older students don't smoke and don't like to be around smokers.
Assessment I For an assessment task, the younger students can provide their own answers to all the questions on their list after the older students have finished talking with them.
For assessment criteria, the older students should make sure the younger students provide accurate answers and tell why the older students are a valid source of information.
(Construct: Subjective norms.)

22. Grades 3-5 Community Resources on Tobacco
Students can use phone books (ask friends and colleagues to save them for your class) to find community resources on tobacco use (American Lung Association, American Cancer Society, American Heart Association). Small groups of students can write to different agencies to request class materials on tobacco use prevention.
Assessment I For an assessment task, students can create a directory of tobacco education and cessation resources.
For assessment criteria, students should identify the sources of their information and explain why their sources are valid.
(Construct: Perceived behavioral control.)

23. Grades 6-8 Check Out TobaccoFreeKids.org
Middle-level students can access
all kinds of information on tobacco by visiting
The site contains reports on topics such as candy-flavored cigarettes, cigarette taxes, smoke-free laws, and Kick Butts Day.
Students can click on links such as "Youth Action," "Research and
Facts," and "Tobacco Ad Gallery.”

Assessment I For an assessment task, allow students to take charge of
designing the different kinds of tobacco prevention projects they would like to complete using this website as a starting point.
For assessment criteria, students should discuss and agree on a list of expectations for "great project presentations." Use the students' criteria to assess and help them assess their work. At a minimum, students should identify their information sources and explain why they are valid.
(Constructs: Attitudes toward behavior, perceived behavioral control,
subjective norms.)


24. NHES4 I Interpersonal Communication
Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks.

25. Grades K-2 Supporting Family Members Who Want to Stop Smoking
Children shouldn't be told that people who smoke are bad or stupid, and children shouldn't be sent home to nag their parents or caregivers about smoking. These tactics usually backfire on the children and their teachers. However, sometimes children know that a family member is trying to stop smoking, and children can be supportive of these efforts. Ask children to imagine that their parents, caregivers, aunt, uncle, or grandparents have said they want to stop smoking. What can children say to let these relatives know that they are on their side? Children can role-play supportive communication without nagging or scolding.
Assessment I For an assessment task, pairs or small groups of children can create short skits to show what they can say to support a particular family member who wants to stop smoking.
For assessment criteria, students should demonstrate appropriate communication behaviors, such as eye contact, a respectful tone, attentive listening, and expressions of empathy, understanding, and support.
(Construct: Subjective norms.)

26. Grades 3-5 Letters Communicating with People We Care About
Although teachers don't teach students to nag or scold adults in their family
who smoke, teachers often encounter the genuine concern many children feel about the health and well-being of smokers in their families.
Some teachers and children have found a healthy compromise by having children who are concerned write a simple, caring letter to the smokers in their families. In the letter, children express their concern, support, and love. Writing a letter lets children express what they are feeling while recognizing that people make their own choices about smoking and no one else can control those choices. 

Assessment I The letters students write are the assessment task for this activity. This activity can be a voluntary one that involves only some members of the class, or all students can choose to participate. Link this project to language arts by involving teachers who teach letter writing.
For assessment criteria, students should express their own needs, wants, and feelings in a clear way while writing respectfully to the
smoker.
(Construct: Subjective norms.)

27. NHES5 I Decision Making
Students will demonstrate the ability to use decision- making skills to enhance health.

28. Grades k-2 Reasons to Be Tobacco-Free
Focus health education strategies on what students should do, rather than what they should not do. Students should brainstorm a list of reasons to be tobacco-free and then list the positive and negative consequences of their reasons.
Students Can use their list and its consequences to counter the reasons people give for starting to smoke. Young children might not know the word consequences. Teachers can help them by asking, "What could happen if you ...?" In relation to a decision to be tobacco-free, students might list as positive consequences that they could hang out and do things with other kids who don't smoke and that they could save money for other purchases. A negative consequence might be that students who are smokers could leave them out of their plans.

Assessment I For an assessment task, students can state a reason to be tobacco-free and discuss the consequences of their decisions.

For assessment criteria, students should identify two positive consequences of their decisions.
(Construct: Attitudes toward behavior.)

29. Grades 3-5 Fortunately and Unfortunately:
Thinking About Consequences Students probably are accustomed to thinking about the short-term consequences of tobacco use in terms of physical outcomes. Have students expand their thinking about short-term consequences to social, emotional, financial, and family categories. Post five large pieces of paper, such as newsprint or chart paper, around the room.
Label each with one category: "Physical," "Social," "Emotional,"
"Financial," "Family." Send a group of students to each of the
papers to start.
First, ask students to write the words fortunately or Unfortunately
at the top of each of two columns on their paper. Students should tell
what these words mean before starting the activity. Teachers can use
examples to be sure students understand the concept. Next, have students list "Fortunately" and "Unfortunately" things that might happen
applicable to their category if they do or don't smoke.


Assessment I The Fortunately/Unfortunately charts students make are the assessment task for this activity. Students should identify the three most important points on their charts when they get back to the place they started.
For assessment criteria, students should explain how
these three most important points would influence their decisions about tobacco use and share their answers with the class.
(Constructs: Attitudes toward behavior, subjective norms.)

30. Grades 6-8 Laws, Rules, and Policies on Tobacco Use
Students can invite a school administrator and a community official, such as a police officer, to class to explain the laws, rules, and policies on tobacco use by minors in the school and in the community. The police officer also might be able to share information about tobacco sales compliance checks of community merchants. Have students prepare a list of questions in advance. Students can discuss the consequences of underage smoking from a school-rule and legal standpoint. How do these consequences affect their decision making about tobacco?
Assessment I For an assessment task, students can share their thinking about how tobacco laws, rules, and policies affect their decisions about tobacco use.
For assessment criteria, students should describe the laws, rules, and policies in terms of alternatives and consequences that affect their decisions.
(Construct: Subjective norms.)

31. NHES6 I Goal Setting
Students will demonstrate goal-setting skills to enhance health.

32. Grades 3-5
Class Goals
Students can work together to set a class goal about smoking for their graduating group
Students should list the steps they will need to take, ways to overcome barriers they might encounter, ways they can support each other, and a method for assessing their progress.
Assessment I Working through a simple goal-setting process is the assessment task for this activity .
For assessment criteria, students should
(1) State their class goal in measurable terms (they will be able to tell whether they accomplished the goal),
(2) Make a plan for reaching their goal, stating specific steps they will carry out
(3) Identify sources of support they can count on and barriers they will need to overcome and how, and
(4) Design a way to assess their progress along the way.
(Construct: Subjective norms.)

33. NHES7 I Self-Management
Students will demonstrate the ability to practice health- enhancing behaviors and avoid or reduce health risks.

34. Grades K-2 Keeping Away from Other People's Smoke
Create a list of the different places where people smoke (e.g., home, car, restaurant, ball park, etc.). Have students brainstorm different strategies they can use for avoiding someone else's smoke in each of these settings.
Help students focus on strategies that are within their control. Write the different settings on a slip of paper and place them in a container, enough for pairs of students to each draw one. With a partner, students draw a setting and then act out a situation where they demonstrate one of the strategies for keeping away from other people's smoke.
Assessment I Pairs of students draw another setting and each student acts out a different way of approaching the situation and keeping away from other people's smoke.
For assessment criteria, students should demonstrate a health-enhancing behavior to reduce risk of tobacco smoke and be able to apply the strategies is a variety of situations.
(Construct: Attitudes toward the behavior, perceived behavioral control.)

35. Grades 3-5 Avoiding Risk Situations
Sometimes students don't realize that they will be faced with a difficult situation, such as refusing tobacco.
Other times there are warning signs that tobacco will be part of the scene.
Students can give examples of how they might know that tobacco could be used in a particular situation (an invitation to go to someone's home when his or her parents, who are smokers, aren’t there).
Next, ask students to strategize about how to avoid these situations altogether, rather than having to maneuver to get out of them.
These self-management skills involve communication and the physical act of going elsewhere.

Assessment I For an assessment task, students can illustrate "Don’t Even Go There" posters showing strategies for avoiding risk situations that involve possible tobacco use. Students can make their posters individually or in small groups.
For assessment criteria, students' posters should show a logical sequence of steps for avoiding tobacco risk situations.
(Construct: Perceived behavioral control.)

36. Grades 6-8 Bumper Stickers for Healthy Alternatives
Ask students whether they have seen the popular bumper stickers that begin with the phrase "I'd rather be ..." Depending on the part of the country, the bumper stickers state that the driver would rather be skiing, surfing, skating, sailing, or fishing. Students can create a bumper sticker for their locker or notebook to remind them of things they would rather be doing than smoking.

Assessment I The locker or notebook stickers students create are the assessment task for this activity.
For assessment criteria, students should share their stickers with classmates, explaining how and why their self- management strategies will help them resist pressure to engage in unwanted activities.
(Construct: Subjective norms.)

37. NHES8 I Advocacy
Students will demonstrate the ability to advocate for personal, family, and community health.

38. Grades K-2 Letters of Appreciation
Help students write class thank-you letters to their favorite restaurants that are totally smoke-free. Have all students sign the letters, with parents' and caregivers' permission, and mail them to the restaurants. Students will be excited to see if they receive reply letters or if the restaurants post their letters.
Students also can write a class thank-you letter to the local newspaper, listing the restaurants they visit that are smoke-free.
Assessment I The students' letters are the assessment task for this activity.
For assessment criteria, students should express appreciation for the healthy decision the restaurants have made to go tobacco-free and show strong conviction for why they are appreciative.
(Construct: Subjective norms.)

39. Grades 3-5 I'm Glad I Don't Smoke
This is a good activity to do after reviewing the negative consequences of smoking. On a large sheet of chart paper or newsprint, write the heading "I'm Glad I Don't Smoke Because ...".
Give each student a marker and ask them to write down a response to the sentence stem. The newsprint should then be displayed in a prominent hallway in the school so that other students can read the responses.
Assessment I The student response to the sentence stem is the assessment task for this activity.
For assessment criteria, the students should read their responses to the class and explain how it will help them remain tobacco Tree.
(Construct: Subjective norms)

40. Grades 6-8
Tobacco-Free Advocacy Campaign Begin class by asking students to sign a class pledge about not smoking. (Do not pressure students to sign if they do not want to.) Explain that one of the best ways they can help keep their peers tobacco free is to become an advocate. Brainstorm ways to be an advocate (posters, computer screen saver messages, songs, announcements). Allow students to work in groups to determine the advocacy project they would like to do Have students create a list of steps to complete their project. Allow one to two weeks to implement their advocacy project. Assessment I The advocacy campaign that the students create is the assessment task for this activity. For assessment criteria, students should provide factual information about the benefits of being tobacco free and the message should be convincing and appealing to same-age peers. (Construct: Subjective norms)

41. Thank you