1. Youth Tobacco Presentation

2. Cost of Tobacco: Dollars and Sense
$5.50 a pack
X 1 pack a day 365 days a year
$ on cigarettes a year
Ask participants, “Let's take a look at what smoking really costs in terms of dollars.” We will use $5.50 as the average cost for a pack of cigarettes. We will also figure that the average smoker smokes one pack per day. $5.50 per day for 365 days a year is $ a year!
What could you do with $ a year?

3. Cost of Tobacco: Dollars and Sense
$9,900 in five years. $19,800 in ten years. $39,600 in twenty years.
Tell participants if, instead of spending it on cigarettes, you were to just save that $2, every year in a cookie jar, you would have the following: $9,900 in five years. $19,800 in ten years. $39,600 in twenty years.
Ask participants, “What could you buy or do with that money?”
What would you buy!?

4. The Real Cost of Tobacco
Tell participants, “Let’s watch a short commercial that the FDA has recently developed for your age group. You may see them on TV. It is called “The Real Cost.”
Click on video in slide or paste this link below into a web search engine to play the video:
Smoking may stain your teeth and turn your fingers yellow. It can also harm your skin by destroying its elastic fibers and weakening its ability to repair. This can lead to wrinkles and other signs of premature aging — we’ve all seen it before, but it can come on a lot faster when you smoke.
For additional videos, check out “The Real Cost” Campaign at

5. Where do you see tobacco in your everyday life?
Activity: Tobacco in My Life
Time: 5 minutes
Materials needed: Dry erase board or poster board, markers
Directions:
Tell the participants that we want to start off our discussion today by discussing about where we see tobacco in our lives.
Ask participants to think about where they might see tobacco in their own lives.
“Can you think of examples of where you see tobacco in your daily life?”
Ask participants to pair up with a classmate sitting next to them and ask their classmate the question and discuss as a pair.
“Where do you see tobacco in your every day life?”
Tell participants that we will take a few minutes for you all to talk with your partner. Each pair will need to report back something that they discussed together to the larger group.
After about 2 minutes ask the class to reconvene back together as a large group.
Ask each of the pairs to report back something that they discussed together.
Write down the on the dry erase board or poster board examples that participants give.
Potential Responses:
Advertising (magazines, billboards, posters)
Convenience, pharmacy, grocery stores
Movies, TV
Friends, family members
People in public
Clothing

6. Tobacco in your life Someone you know Television Movies Music
Advertising
Convenience/Grocery Stores
Tell participants that tobacco affects everyone in this room. Someone you know likely uses tobacco
products (family member, friend, coach or teacher).
Tell participants that in fact tobacco use is still very common, 1 in 5 people use tobacco products in
North Carolina (20.9% of the population).
Many movies and television shows have characters that use tobacco products:
Action/adventure movies seem to have a lot of tobacco use (For example: Casino or detective movies).
Disney (For example: the hookah caterpillar in Alice in Wonderland).
It is still mentioned in a lot of music lyrics (Ex. Blake Sheldon song, ”Chew Tobacco, Spit”).
It is still in our advertising (Ex. magazines, buses, bill boards).
It is very visible at convenience and grocery stores.

7. 90% of all smokers begin before age 20.
99% of smokers begin before age 26.
Tell participants, “Everyone knows that tobacco is bad for you and your health. Yet, youth tobacco use rates are still on the rise. The majority of people who smoke, begin when they are young.”
Read these statistics from Centers for Disease Control and Prevention (CDC):
Nearly 90% of smokers begin before age 20.
99% of all smokers begin before the age of 26.
Tell students, “Most people do not start using tobacco products thinking that they will be lifelong smokers or dip/chew users. There are many different reasons why a person might begin to use tobacco.” Ask students, “Can you think of some examples of how people might begin using tobacco?”

8. Reasons Why People Use Tobacco?
Social (to fit in)
Relaxation/Stress Relief
Peer Pressure
Look older
Try something new
Bored/alone
Cultural
Write and review participants’ answers on the board.
Potential Responses:
Social (to fit in, be liked by peers)
Boredom/Alone
Nervous
Relaxation
Stress relief
Look older
Feel cool
Peer pressure
Drinking and smoking together
Try something new
Cultural
Environmental
Tell participants that you would like to read one example to them. “Emily started smoking occasionally on weekends at parties. All her friends were smoking outside and she did not want to feel left out or seem uncool. She liked how it made her feel independent and older and she liked having something in common with her friends.”
Explain to participants that people may think that they will just smoke socially with friends, at a party, or once in a while when they are out. However, a lot of times these behaviors lead to an addiction that is very hard to break, maybe even a lifetime of addiction.

9. What is Tobacco? Cigarettes Cigars, cigarillos, pipes, bidis, cloves
Dip, snuff, chew
Hookahs
Electronic cigarettes (e-cigarettes)
Tell participants that we are going to begin our discussion by making sure that we are all on the same page in terms of information about tobacco.
Ask students to identify different types of tobacco. “What are some popular brands of tobacco products that people use?”
Potential Responses:
Cigarettes: Kool, Winston, Marlboro, Camel, Parliament, Pall Mall, New Port, Capri, Virginia Slims
Smokeless tobacco (also called chew, dip, or snuff)): Kodiak, Grizzly, Skoal, Copenhagen
Tell participants that:
Tobacco use includes a number of products that produce smoke like cigars, cigarillos (little cigars), cigarettes, pipes, bidis, cloves, and hookahs.
It also includes the use of smokeless tobacco products, like dip, snuff, and chew.
There are also some new smokeless tobacco products like the dissolvable (orbs, strips, or sticks), Ariva (lozenges), and Snus (pouches) that we will talk about more later on today.
Electronic cigarettes (e-cigs) and other electronic nicotine delivery devices, called ENDS, are also considered tobacco products, because they contain many of the same addictive properties and harmful chemicals that other tobacco products contain. We will talk about these later in the presentation.

10. Tobacco Products
Ask participants to identify the photos. “What sort of products are on shown here?”
Top left: Brands of smokeless tobacco (Kodiak, Grizzly, Skoal, Copenhagen)
Bottom left: Electronic-cigarette with water vapor smoke
Middle: Hookah
Top right: Tobacco pipe
Bottom right: Cigarette

11. What is in a cigarette?
Tell participants, while nicotine is the active ingredient in tobacco products, such as cigarettes, tobacco products also contain many other ingredients. Tobacco and tobacco smoke is a toxic mix of more than 7,000 chemicals. This slide shows just a few of the “other” ingredients found in cigarettes.
Read participants the following:
Acetone – found in nail polish remover
Acetic Acid –  an ingredient in hair dye
Ammonia – a common household cleaner (Toilet Cleaner)
Arsenic – used in rat poison
Benzene – found in rubber cement
Butane – used in lighter fluid
Cadmium – active component in battery acid
Carbon Monoxide – released in car exhaust fumes
Hexamine – found in barbecue lighter fluid
Lead – used in batteries
Naphthalene – an ingredient in moth balls
Methanol – a main component in rocket fuel
Nicotine – used as insecticide
Tar – material for paving roads
Toluene - used to manufacture paint (Industrial Solvent)
Ask participants, “Does anything on this list surprise you?” Are any of these products considered to be “natural”?

12. Tobacco Exposure First-hand smoke Second-hand smoke Third-hand smoke
Explain to participants that when we talk about tobacco use, and more specifically exposure to tobacco products, there are three terms that we use: first-hand smoke, second-hand smoke, and third-hand smoke.
Ask participants what each type of tobacco exposure is (first, second, and third hand).
Potential Responses:
First-hand smoke is the smoke that a tobacco user inhales into their own lungs. There are many health implications associated with first-hand exposure.
Second-hand smoke is tobacco smoke that is in the air that’s involuntarily inhaled by someone who isn’t smoking. Second-hand smoke can still cause similar negative health effects as first-hand.
Third-hand smoke is the smoke particulates and matter that are deposited from another smoker on any surface they come into contact with, for example hair, clothing, wood, furniture, or curtains. Third-hand smoke also causes all the same negative health effects.
Third-hand smoke

13. New Tobacco Products Dissolvable Orbs Strips Sticks Ariva Snus
Sweet Flavored Tobacco Products
Ask participants, “Are there any other popular tobacco products that you have seen that we have not discussed yet today?”
In fact, in the recent few years there have been many new types of tobacco products that have been created.
Discuss the following products with participants:
Dissolvable (top right): These come in many forms (orbs, sticks or strips). Strips are flat sheets of ground tobacco. Sticks are made to resemble tooth picks and are coated in tobacco or made with ground tobacco. Orbs are flavored pellets that look a lot like Tic-Tacs. All these products dissolve in a person’s mouth (eliminating the need to spit but still satisfying nicotine cravings).
Ariva: Tobacco lozenge in the shape of a small pellet that looks like candy with a sweet flavoring (Ex. Wintergreen, Java).
Snus (bottom right): A form of smokeless tobacco that comes in small pouches called a sachet. It is placed between the check or teeth and the gums. It does not require spitting.
Sweet flavored tobacco products (top left): Cigars, cigarillos, or smokeless tobacco products that are flavored in sweet flavors to make their products more attractive (Ex. Strawberry, Grape, etc.)
FYI:
These products are often marketed as way for a person to use tobacco products in places where smoking is prohibited. However, they are aggressively marketed towards youth that may have never used tobacco products previously. All these products contain nicotine, and therefore, are harmful to youth. These products also may hook a younger person on nicotine which makes it easier for them to start using cigarettes or chew/dip.

14. Electronic Cigarettes
Electronic Nicotine Delivery Systems (ENDS)
Includes: e-cigarettes, e-hookahs, hookah pens, vape pens, e-cigars
Battery-powered devices that deliver nicotine to users
“Vape” or “vaping” is used to define the act of using a ENDS product
Ask participants, “Has anyone ever seen an e-cigarette before?”
Tell participants that:
Electronic cigarettes, also known as e-cigs, are a relatively new invention.
Electronic cigarettes are part of a larger class of products called Electronic Nicotine Delivery Systems (ENDS) or vapor products.
There are many different types of ENDS which include e-cigarettes, e-hookahs, hookah pens, vape pens, e-cigars, and other vapor products.
ENDS are battery-powered devices in the shape of a cigarette that provides doses of nicotine and additives in an aerosol form.
Some electronic cigarettes contain different flavors.
The expression “vaping” is defined as ‘to inhale and exhale the vapor produced by an electronic cigarette or similar device’.

15. What are e-cigarettes? Rechargeable – Replacement Cartridges
Explain to participants that there are 3 broad categories of ENDS which include:
Disposables: These are one use products. (on the left)
Rechargeable: These are rechargeable, and you can purchase replacement nicotine cartridges. (in the middle)
Refillable: These have a refillable tank that you can refill with new liquid when the original liquid has run out. (on the right)
Rechargeable –
Replacement Cartridges
Rechargeable –
Refillable Tank System
Disposables
Image Sources: WFBH; hookah-shisha.com

16. How e-cigarettes work
Discuss with participants how an electronic cigarette works.
This is an example of an e-cigarette. Most ENDS products work similarly. They are battery powered and when a person inhales on the mouthpiece, the vaporizer turns on and heats the liquid nicotine solution in the cartridge. This coverts the liquid into an aerosol, which contains nicotine and any other additives to the nicotine solution. The user then inhales this aerosol. In some devices, the end of the device then lights up to mimic a cigarette. The user then exhales a vapor that simulates smoke. This vapor also contains nicotine and other additives.
Legacy Foundation

17. Tobacco and Your Health: Quiz
Activity: Tobacco Quiz
Time: 25minutes
Materials needed: One copy of the Tobacco Quiz for each participant found in the Teacher’s Guide in Appendix B. The teacher answer sheet can be found in Appendix C.
Explain to participants the process for the tobacco quiz.
Tell students that this quiz is not for a grade.
Pass out copies of the tobacco quiz.
Explain that some questions have more than one correct answer.
Have participants first take the tobacco quiz individually, circling their answers on their sheet of paper.
Once all participants have completed their individual quiz, convene the class together.
Proceed through the questions and answers with the subsequent slides.
Have participants keep track of their correct and incorrect answers.

18. Nicotine’s Affects on Your Body
What does nicotine do to my body?
Acts as a stimulant
Creates a temporary pleasant sensation
Makes you sleepy
Creates a tolerance and addiction to tobacco
None of the above
Review the answers to the tobacco quiz with participants.
Answer: A., B., and D.

19. Nicotine Addiction Happens faster than people think
Creates a tolerance to tobacco
Causes withdrawal symptoms
Becomes a habit
Leads to dependence and addiction to product
Explain that the common trait across all tobacco products is nicotine, the main addictive substance found in all tobacco products. One cigarette has approximately 1 milligram of absorbed nicotine.
Ask participants, “What is nicotine?” “What does it do to the body?” “How does it become addictive?”
Potential Responses:
Nicotine is the main addictive substance found in all tobacco products, including electronic cigarettes.
It is a stimulant. It speeds up bodily functions, like heart rate, and makes your body have to work harder than normal.
Creates a temporary pleasant feeling by altering mood-processors in your brain.
The pleasant feeling from nicotine makes you want to use tobacco more.
Using tobacco products more often can lead to dependence and addiction to nicotine.
When people try to quit using tobacco products, it’s often nicotine’s addictive effects that cause them to be unsuccessful.
FYI:
Explain to students that many people may not realize that they are becoming addicted to tobacco. People become addicted to the physical sensation as well as the emotional response of tobacco. A young person may start smoking on the weekends with their friends and before they realize it they have developed a tolerance to tobacco. When this person can't get tobacco they start to have withdrawal symptoms (irritability, restlessness, shaky, tired, headache, etc.). The act of using tobacco products is also a difficult habit to stop. A person may feel more confident at party with a cigarette in their hand or on the baseball field with dip in their mouth. Tobacco becomes a person’s friend or side kick they can turn to when they are not bored or not feeling well. A person may also use it for stress relief. Over time, the habit of smoking on their lunch break becomes associated with the stress relief they feel from the cigarette. All these things make tobacco products very addictive. Most people don’t know that new tobacco users can become addicted to tobacco quickly. While possible, an addiction to tobacco is very difficult to break. It is best to just never begin at all.

20. Smoking Effects on Your Body
Which of the following health problems are related to smoking?
Cancer
Emphysema
Heart disease
Warts
None of the above
Review the answers to the tobacco quiz with participants.
Answers: A, B, C Cancer, Emphysema, and Heart Disease (plus many more!)

21. Health Risks & Concerns: Smoking
Explain to participants that in fact smoking harms every organ of the body, causes many diseases and damages your health in general. This is not only true for the user themselves, but second-hand and third-hand smoke have been linked with a number of diseases as well.
Ask participants to look at the slide and if any of the health impacts show on the slide surprise them.
Highlight that smoking causes the following:
Lung cancer
Other cancers such as mouth, esophagus, pancreas, bladder, larynx, cervix in women, liver, colorectal
Chronic obstructive lung disease (emphysema, bronchitis, asthma)
High blood pressure
Coronary heart disease
Stroke
FYI:
Smoking increases the risk for lung cancer in men and women 25 times for men and women
Source:

22. Health Risks & Concerns: Smoking
Explain to participants that because a smoker breathes the smoke into their lungs when they take a puff from a cigarette, the organ most likely to be damaged is the lungs.
Ask students about differences between the healthy lung on the left and the damaged lung on the right.”
Potential Reponses:
The damaged lung on the right demonstrates what a lung looks like after extensive smoking.
Toxins in smoke caused cells in the damaged lungs to deteriorate and die.
Tar and toxins stay inside the lungs and cause the lungs to become hard, not expanding well, making it more difficult to breathe.
Once the air sacs (alveoli) in the lungs are hardened, they can no longer squeeze air out and they can not longer hold oxygen.
This condition leads to COPD. COPD stands for Chronic Obstructive Pulmonary Disease. COPD can be one of 2 things: emphysema or chronic bronchitis
Explain to the participants this causes severe, chronic shortness of breath. We will do an activity to demonstrate this right now.

23. Straw Activity
Experience what it’s like to breathe with COPD/Emphysema
Grab your straw!
Activity: Chronic Obstructive Pulmonary Disease Simulation
Time: 5 minutes
Materials needed: One straw for each participant
Directions:
Tell participants that this exercise is to demonstrate what it’s like to breathe for a person who has emphysema. Explain that the effort needed to breathe through the straw resembles the characteristic shortness of breath caused by emphysema.
Verify if participants have any health restrictions before they take part in the exercise.
Explain directions to the participants:
Pass out straws to each of participant.
Ask the participants to place the straw in their mouth.
Ask participants to clamp/pinch their nose, only breathing through the straw.
Ask them to breathe through the straw for 30 seconds like this.
Lead a discussion about student’s reactions.
How difficult was it to only breathe through the straw?
Did they gulp for air after the 30 seconds passed?
Remind participants that people with emphysema don’t get to gulp like that.
After this exercise, it’s easy to see how people with COPD can’t do very much without becoming short of breath. They are limited in their activities.
Did you find yourself wanting to un-pinch your nose and breathe normally?
How do you think this difficulty breathing might affect your life?
Ask participants their thoughts after the activity.

24. Smoking Effects on Your Body
Smoking increases your risk of coronary heart disease and stroke by 2 to 4 times?
True
False
Review the answers to the tobacco quiz with participants.
Answer: True

25. Smoking Effects on Your Body
Heart and blood vessel effects:
Heart disease
Stroke
Poor circulation
Increased heart rate
High blood pressure
Explain to participants that the toxins and particles found in smoke also damage your blood vessels and your heart.
The damaged vessels make it difficult for blood to flow, leading to poor circulation in the body.
Lack of blood flow to your brain can cause a stroke.
Lack of blood flow to your heart can cause a heart attack and other heart diseases.
Your heart has to work harder to pump blood since the blood vessels are damaged. This causes an increased heart rate.
Nicotine causes your blood vessels to constrict, which makes your blood pressure higher too.

26. What is in e-cigarettes?
E-cigarette may contain the following:
Flavoring
Nicotine
Toxins and carcinogens
None of the above 1
Review the answers to the tobacco quiz with participants.
Answers: A, B, and C.

27. Health Risks & Concerns: E-Cigarettes
Contains nicotine
May contain toxic chemicals, irritants, and known carcinogens
Vapor air is not clean air
Not regulated
Can lead to trying other nicotine products
Not a tobacco cessation aid
Tell participants that electronic cigarettes, also known as e-cigarettes, have been advertised as a safer cigarette. However, there is no proof that they are safe to use. Since these products are so new, the health effects of e-cigarettes are not completely known yet. Recent research is beginning to show that there are some major health risks and concerns associated with e-cigarettes that users and non-users should be aware of.
Tell participants that we know that:
E-cigarettes contain nicotine, a highly addictive chemical that has been proven to affect adolescent brain development and can have lasting consequences.
Various studies conducted by the Food and Drug Administration (FDA) have found:
Irritants and harmful toxins in e-cigarette cartridges.
Detectable levels of toxic chemicals and known carcinogens in e-cigarettes
Many brands that claim to be nicotine free in fact contain nicotine.
The vapor air emitted from e-cigarettes is not clean air and exposes users and non-users to toxic chemicals and nicotine.
E-cigarettes are not currently regulated, meaning companies do not have to tell what is in their products. Consumers do not really know what they are purchasing or inhaling. Levels of nicotine and chemicals can vary greatly between brands.
E-cigarette use can lead to using other tobacco products. Once someone uses e-cigarettes regularly, they may become addicted to nicotine. This can lead to them trying other, more harmful nicotine sources like cigarettes in order to satisfy their nicotine craving.
E-cigarettes are not an approved smoking cessation aid. Safe and effective choices such as the nicotine patch, gum, lozenge, and inhaler are recommended to help people quit tobacco.
E-cigarette use and exposure poses a risk during pregnancy. Nicotine can pass through the placenta to the fetus and can negatively affect lung, heart, and brain development.

28. Smoking Effects on Pregnancy
Smoking during pregnancy can impact the fetus (developing baby) by the following:
Preterm delivery
Stillbirth
Dark hair
Sudden infant death syndrome (SIDS)
None of the above
Review the answers to the tobacco quiz with participants.
Answer: A True

29. Smoking Effects on Pregnancy
In pregnant women, smoking can cause:
Preterm delivery
Stillbirth
Low birth weight
Sudden infant death syndrome (SIDS)
Explain to participants that using tobacco during pregnancy can hurt the unborn baby.
As we talked about earlier, smoking damages blood vessels.
If a mother smokes, the damage to her vessels can lead to the baby not getting enough oxygen and nutrients.
This can cause the baby to die in utero (still birth).
Also can lead to a baby being born too early (preterm delivery).
If a baby is born to a mother who smokes, it’s more likely to have below average weight. This puts the baby at risk for sickness, difficulty for feeding, and breathing.
The baby of a smoking mother is also more likely to die from Sudden Infant Death Syndrome (SIDS), the leading cause of death in all babies from 1 month to 1 year of age.

30. Smokeless Tobacco Health Effects
Smokeless tobacco, like snuff, dip and chew, have fewer toxins than cigarettes.
True
False
Review the answers to the tobacco quiz with participants.
Answer: B False

31. Smokeless Tobacco Health Effects
Which of the following health problems are related to smokeless tobacco?
Cancer
Joint pain
Bad breath
Muscular degeneration
Review the answers to the tobacco quiz with participants.
Answer: A, C

32. Health Risks & Concerns: Smokeless Tobacco
Nicotine addiction
Mouth, tongue, throat cancers
Stomach, pancreatic cancers
Heart disease, heart attacks
Teeth break down and loss
Stained and discolored teeth
Bad breath
Smokeless tobacco is not a safe alternative to smoking. Smokeless tobacco is associated with many health problems and is just as harmful as cigarettes. Smokeless tobacco still has all the same toxins, including nicotine, as smoking tobacco.
Explain to participants that that using smokeless tobacco:
Causes cancer of the mouth, esophagus (the passage that connects the throat to the stomach), and pancreas (a gland that helps with digestion and maintaining proper blood sugar levels).
Is associated with diseases of the mouth (gum disease, tooth decay, and tooth loss).
Can increase the risk for early delivery and stillbirth when used during pregnancy.
May increase the risk for death from heart disease and stroke.
Causes stained and discolored teeth and bad breath.
Source:

33. Tootsie Roll Activity Unwrap your tootsie roll DO NOT EAT IT!
Place it either in the side of your mouth
OR between your lip and your bottom row of teeth
Try not to swallow the juices
Hold it in your mouth until after next few slides
Activity: Tootsie Roll Demonstration
Time: 5 minutes
Materials needed: One tootsie roll for each participant, napkins readily available. An alternative option is to use Jolly Ranchers in place of tootsie rolls.
Explain directions to the participants:
Tell the participants that this activity also demonstrates what it is like to use smokeless tobacco products (dip/chew).
Pass out one tootsie roll to each participant.
Ask the participants to unwrap their tootsie roll.
Ask the participants not to eat the candy!
Ask the participants to place the tootsie roll in their mouth in the way someone who uses smokeless tobacco would.
Ask them to place the candy either in the side of the mouth (cheek) or between their bottom lip and bottom row of teeth.
Explain that smokeless tobacco users do not swallow tobacco juices, due to the toxicity of the product.
Ask them not to swallow the tobacco juice.
Ask them to hold the tootsie roll in their mouth for about five minutes.
Proceed with the presentation or teaching points while this activity goes on.

34. Legal Consequences
Legal age to purchase tobacco products in North Carolina is 18
Things that will get you into trouble:
Purchasing
Attempting to purchase
Using a fake ID
Distribution of tobacco products to those under 18
Tell participants that a lot of students do not know about these legal problems that you can get into if you attempt to use tobacco
products under age.
Legal age to purchase tobacco products in North Carolina is 18 years old (including e-cigarettes).
If you purchase, attempt to purchase, use fake identification, or distribute while you’re underage, you will most likely get in trouble.

35. Legal Consequences If caught: Guilty of Class 2 misdemeanor
Criminal offense
30 days community service
$1000 fine
Permanent record
Tell participants that the consequences if caught potentially include the following:
Class 2 misdemeanor filed in permanent record
30 days of community service
$1000 fine
Goes on your permanent record

36. Chatham County Schools Policy
The policy defines tobacco product as:
“…includes but is not limited to, cigarettes, cigars, snuff, pipes, bidis, smoking tobacco, smokeless tobacco, nicotine, nicotine-delivering devices, and chemicals or devices that produce the same flavor or physical effect of nicotine substances or emit nicotine vapor.”
Tell participants that the Chatham County Schools Policy prohibits tobacco products that, “…includes but is not limited to, cigarettes, cigars, snuff, pipes, bidis, smoking tobacco, smokeless tobacco, nicotine, nicotine-delivering devices, and chemicals or devices that produce the same flavor or physical effect of nicotine substances or emit nicotine vapor.”
Tell participants that this includes electronic cigarettes and other vapor products.
FYI:
In 2013 the Chatham County Schools updated the Tobacco and Smoking Policy, which outlines a 100% tobacco free policy prohibiting the use of all tobacco products by individuals on school grounds, in school buildings and facilities, on school property or at school-related or school-sponsored events.

37. School Disciplinary Consequences
In Chatham County Schools, if you’re caught using, possessing or displaying tobacco products (including e-cigarettes):
First offense: After school detention to 1 day OSS. Meeting with student, parents/guardian, and school principal.
Second offense: Up to 3 days OSS
Third offense: 3 to 5 days OSS
Tell participants that there are penalties for tobacco use in our schools too. If a student is caught using, possessing, or displaying any tobacco products (including e-cigarettes) in school:
First offense: After school detention to 1 day out of school suspension (OSS). Meeting with parents/guardians and principal is held with the student.
Second offense: Up to 3 day out of school suspension (OSS)
Third offense: 3 to 5 days out of school suspension (OSS)
In addition to parents/guardians and the principal, the school resource officer (SRO) will also most likely be involved in this process.

38. Tootsie Roll Activity You can eat your tootsie roll now!
How did you feel?
Did you want to swallow?
How does chew affect those who use it?
Activity: Tootsie Roll Demonstration
Tell participants that they can eat their tootsie rolls now. Ask participants, “What thoughts were running through your head during this activity?”
Lead a discussion about the student’s reactions.
Did you find yourself wanting to swallow the tobacco juices?
Smokeless tobacco users can’t swallow the juices due to toxicity.
Tobacco users usually spit their juices in a spit cup or jar.
How do you think chew affects those who use it?
Potential Answers: Difficulty speaking, awkward social situations (always having to spit)

39. Reasons Why People Use Tobacco
Social (to fit in)
Relaxation/Stress Relief
Peer Pressure
Look older
Try something new
Bored/alone
Cultural
Tell participants, “Most people do not start using tobacco products thinking that they will be lifelong smokers or dip/chew users. There are many different reasons why a person might begin to use tobacco.” Ask participants, “Can you think of some examples of how people might begin using tobacco?” Ask participants, “With all these health consequences and potential legal problems why do people still use tobacco products?”
Write and review participants’ answers on the board.
Potential Responses:
Social (to fit in, be liked by peers)
Boredom/Alone
Nervous
Relaxation
Stress relief
Look older
Feel cool
Peer pressure
Drinking and smoking together
Try something new
Cultural
Environmental
Tell participants that you would like to read one example to them. “Emily started smoking occasionally on weekends at parties. All her friends were smoking outside and she did not want to feel left out or seem uncool. She liked how it made her feel independent and older and she liked having something in common with her friends.”
Explain to participants that people may think that they will just smoke socially with friends, at a party, or once in a while when they are out. However, a lot of times these behaviors lead to an addiction that is very hard to break, maybe even a lifetime of addiction.

40. Staying Tobacco Free Saying no to tobacco is hard
Direct and Indirect Peer Pressure
Need skills
Refusal strategies
Ask participants about how they plan to personally stay tobacco-free in their own life.
Discuss with participants that:
Avoiding using tobacco products can be very hard.
It’s more difficult when you are surrounded by friends and family that use tobacco.
Ask participants, “What is Peer pressure?”
Potential Responses:
Feeling pressured to do something you would normally not do (whether positive or negative) by someone your own age.
Getting influenced by someone your own age.
Explain to participants that peer pressure can be either direct and indirect.
Ask participants, “What is an example of direct peer pressure?”
Someone hands you a cigarette to smoke.
Someone asks you if you want to smoke.
Someone puts some dip or chew in your hand before the game.
Ask participants, “What is an example of indirect peer pressure?”
You are at a party and everyone is smoking, you feel pressured to join your friends and not feel left out so you ask for a cigarette.
Your older sibling has started going to the hookah bar. You want to appear older and more sophisticated so you try the hookah when the pipe is past around the circle.
Explain to participants that there are A LOT of pressures to use tobacco and avoiding tobacco can be very hard. Sometimes we find ourselves in situations where we might feel pressured to use tobacco products. So it is good to know what you want to do and practice standing up for what you want to do so when that situation arises you are prepared. Let’s talk about some tools that you can use to stay tobacco free.

41. Staying Tobacco Free
There are many ways in which you can confront the peer pressure of tobacco products. Ask participants if they have any strategies that they have used before that have worked for them.
Potential Responses:
Avoidance: Either avoid going to a place or hanging out with people where you know there will be tobacco. Plan ahead for an alternative to a situation you may not feel comfortable in.
Leave the situation: If you find yourself in a place where there is tobacco being used, walk away to another room, go hang out with other people, or leave altogether.
Humor: Humor is an effective way, because it lightens the tension of the situation and conveys to the tobacco user that their habit might be silly.
Reverse the pressure: This makes the user question their habit and is also somewhat condescending to the user, conveying that the person refusing is above their influence.
Ask a question: It makes the user question their habit, creates doubt and uncertainty.
Change the subject: This method is especially great if you’re somewhat scared of confronting the person who’s offering tobacco to you, or if you don’t want to pressure the user back.
Stick with non-tobacco users: The more people around you that are not smoking, the easier it will be to say no to using it.
Give an excuse: “I am allergic to cigarette smoke” or “They give me a headache.”
Be direct: Just be honest and tell your peer, friend, or relative that you don’t want to start using tobacco products.

42. ACTIVITY Optional Activity: Refusal Strategies Time: 10-15 minutes
Materials: paper and pens/pencils
Directions:
Explain that this activity demonstrates how difficult it is to say no to tobacco, and how refusal strategies can be a defense in staying tobacco-free.
Tell participants that we are going practice what they would do in a situation where they might feel pressured to use tobacco products.
Divide the participants into groups of five to six participants per group.
Read the situation below out loud to the class:
“Your friend wants to go to a party. You know there will be some friends there that always go outside and smoke. Last time you hung out with these friends you felt pressured to fit in and ended up smoking a few cigarettes with them. What could you do in this situation to avoid smoking at this party?”
Tell participants, “Thinking about some of the strategies we just discussed, I want you to brainstorm in your group what you could do in this situation to avoid using tobacco.”
Tell the participants that they have five minutes to work in their small groups and write down their ideas.
Tell the participants that volunteers may be asked to role play their scenario in front of the class if there is time.
Afterwards, bring the class back together and brainstorm a list together of ideas of how to avoid smoking at this party.
Write ideas generated by the small groups on the dry erase board or poster board.
Lead a class discussion:
Was the person able to successfully avoid using tobacco products?
Which refusal methods or strategies did the person use?
How likely do you think this situation will happen in your life?
How ready do you feel to say “no”?
Emphasize the importance in practicing refusal skills.
If time, ask for volunteers from one group to role play their particular scenario with a partner in front of class.
If there is not enough time to fully implement this activity, it can be adapted. Instead of asking participants to get into small groups, read the scenario to the entire class and ask participants what they would do by asking for raised hands.

43. Nicotine Replacement Therapy
Provides low doses of nicotine without harmful toxins found in cigarettes or smokeless tobacco.
Relieves nicotine cravings and eases symptoms when someone stops using tobacco products.
Types:
Patch
Gum
Inhalers
Lozenges
Tell participants that the good news is that there are many, many resources that exist now to help people quit. Keep in mind it is much easier to never start than get addicted and have to break an addiction. For those who wish to quit (or may know someone who wants to quit) we want to discuss resources available to you.
One safe option is trying Nicotine Replacement Therapies (NRT). What makes quitting so hard is their addiction to nicotine. NRTs replace the nicotine that tobacco users would normally get from tobacco in a non-harmful way.
Types: patch, gum, inhalers, lozenges, inhalers
Most NRTs are available over the counter or without a prescription at places like Walmart, CVS, Walgreens.
Nicotine replacement therapy provides low, stable doses of nicotine.
NRTs are proven effective methods to quit using tobacco.
NRTS relieve nicotine withdrawal symptoms.
There are also several medications which can help individuals quit. These medications require a prescription from a doctor. Someone interested should contact their doctor.
FYI:
It is not recommended that people use electronic cigarettes to help stop smoking cigarettes. It is actually illegal to market e-cigarettes as a smoking cessation aid. Electronic cigarettes still contain nicotine, often at variable levels, and may keep a person addicted to nicotine products. There is very limited research on e-cigarette’s impact on tobacco cessation and the ones that have been conducted have shown very mixed results. We know that there are much better choices right now that are FDA approved medicines like the nicotine patch, gum, lozenge, and inhaler that have been proven to help people quit. These products have been found to be safe and effective in hundreds of studies. Unfortunately, we do know that most people who use e-cigarettes are also still smoking so it may not be helping people quit tobacco use altogether.

44. Resources to Help Quit QuitLineNC: 1-800-QUITNOW www.quitlinenc.org
QuitSmart (free through the Chatham County Public Health Department)
American Lung Association Freedom from Smoking: LUNG-USA
Become An Ex:
In addition to Nicotine Replacement Therapies, it is also really helpful for people who want to quit to get support. There are many programs that provide guidance and support for individuals wishing to quit. This can happen through an in-person class, over-the-phone counseling, or through an online program. Tell participants that there are many free tobacco cessation resources available for people who want to quit tobacco use (including chew and electronic cigarettes). These are listed on the slide. These resources can be accessed online or over the phone. Tell participants they can also talk with other people like counselors, therapists, and their doctors to help with quitting tobacco.
FYI:
QuitlineNC: QUITNOW ( A free service for adults and teens. Clients can call the Quitline number and will be matched up with a trained professional to assist with the quit process (all tobacco products, including cigarettes, smokeless tobacco, and e-cigarettes).
QuitSmart
QuitSmart: Offered on a bi-annual basis by the Chatham County Public Health Department. QuitSmart is a free 3 session cessation program. Interested individuals should contact the Public Health Department. Call (919) for more information.
American Lung Association Freedom from Smoking : Call our Lung HelpLine at LUNG-USA or
Become An Ex: A free online quit plan.

45. Youth Resources to Help Quit
SfT Teen (Smokefree Teen):
 SmokefreeTXT:
Quit START app:
Tell participants that there are also tobacco cessation resources that are specifically designed for teenagers and young adults. These are listed on the slide. These resources can be accessed online or over the phone.
Pass out the Tobacco Cessation Resources sheets to each participant found in the Teacher’s Guide in Appendix F.
FYI:
SfT (Smokefree Teen):
A web site that provides free, accurate information and assistance to help teens quit smoking and stay tobacco-free.
SmokefreeTXT:
A free mobile service designed for teens across the US. It provides 24/7 advise, encouragement and tips to help teens stop smoking for good.
Quit START app:
Free smart phone app (track cravings, moods, personal messages to assist individual in quit process.)

46. Tobacco Advocacy Kick Butts Day www.kickbuttsday.org/
The Real Cost Campaign
Truth Campaign
TRU Campaign
Campaign for Tobacco-Free Kids
Tell participants, “If this is something you are really excited about, here are some great youth tobacco advocacy organizations and campaigns that you can check out and get involved in.”
FYI:
Kick Butts Day is celebrated in March of every year. This is a day of activism for youth in the United States and around the world. The next Kick Butts Day will be held March 16, 2016.
Tobacco 21 has more information on the movement to raise the age of tobacco sale from 18 years to 21 years.
Campaign for Tobacco-Free Kids has actions that youth can take to help reduce tobacco use in the United Stated and around the world.
The Real Cost and Truth Campaigns have cool, interactive sites with videos that you can share with others.

47. Debrief
Ask participants to recap what we discussed today in class.
Ways to prevent youth tobacco use
Different refusal strategies that people use to stay tobacco-free
Tobacco cessation resources to help youth and adults quit tobacco
Youth advocacy resource websites
Ask participants to recap overall what they learned from all four sessions.
Potential Questions:
“Did you learn anything new or surprising?”
“What things did you find interesting?”
“What skills did you learn that you may use now or in the future?”
“What sort of things would you tell your friends or family about tobacco now?”
Optional Activity:
Hand out the activity sheet “I choose to be tobacco-free” to each participant found in the Teacher’s Guide in Appendix G.
Tell participants that this form is a way to make a personal commitment to stay tobacco-free.
Tell participants if their completed sheets are going to displayed in a public place or if they will keep it for their personal use.
Ask each participant to fill out their sheet, sign, and date the sheet.
Either collect participants’ forms and display them in the classroom or around school, or ask each participant to hold onto it for them to reflect on from time to time.
Thank participants for their participation in the tobacco prevention session.