Prevent/Reduce Use and Harmful Consequences of Tobacco Use Written By Amy Knutson

Don’t Smoke Or You’ll Croak! Grade 10 Standard 1 – Students will comprehend concepts related to health promotion and disease prevention to enhance health 1.12.5 Propose ways to reduce or prevent injuries and health problems 1.12.7 Compare and contrast the benefits of and barriers to practicing a variety of healthy behaviors 1.12.8 Analyze personal susceptibility to injury, illness or death if engaging in unhealthy behaviors. MN Benchmark – The student will analyze the role of public health policies and laws in the prevention and control of disease and other health problems. Standard 2 – Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors 2.12.3 Analyze how peers influence healthy and unhealthy behaviors MN Benchmark – The student will select and assess a school or community health issue resulting from the influence of culture, media, technology and other factors and implement a solution for that issue. Standard 4 – Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks. 4.12.1 Utilize skills for communicating effectively with family, peers, and others to enhance health 4.12.2 Demonstrate refusal, negotiation, and collaboration skills to enhance health and avoid or reduce health risks. 4.12.3 Demonstrate strategies to prevent, manage or resolve interpersonal conflicts without harming self or others. 4.12.4 Demonstrate how to ask for offer assistance to enhance the health of self and others. MN Benchmark – The student will evaluate the effectiveness of communication methods for accurately expressing health information and ideas. Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health 5.12.1 Examine barriers that can hinder health decision making 5.12.2 Determine the value of applying a thoughtful decision making process in health related situations 5.12.4 Generate alternatives to health-related issues or problems 5.12.6 Defend the healthy choice when making decisions. MN Benchmark – The student will evaluate different strategies to use when making decisions related to the health needs and risks of young adults. Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health 8.12.2 Demonstrate how to influence and support others to make positive health choices. 8.12.3 Work cooperatively as an advocate for improving person, family and community health MN Benchmark – The student will evaluate the effectiveness of communication methods for accurately expressing health information and ideas. The student will adapt health messages and techniques to the characteristics of a particular audience.

Lesson Plan 1 – Scope and Sequence I. Understanding Tobacco Use A. “Tobacco use, including cigarette smoking, cigar smoking, and smokeless tobacco use, remains the leading preventable cause of death in the United States” (Centers for Disease Control, 2008, para. 1). B. Are high school students using tobacco? 1. “The National Academy of Pediatrics reports that nine out of ten American smokers began using tobacco before they were 19 years old” (Merki, Merki, 2004, p. 541). 2. “Each day in the United States, approximately 4,000 young people between the ages of 12 and 17 years initiate cigarette smoking, and an estimated 1,140 young people become daily cigarette smokers” (CDC, 2006). 3. In 12th grade, 51% of males and 48% of females have smoked part or all of a cigarette (Minnesota Student Survey, 2007). 4. In 12th grade, 42% of males and 27% of females have used tobacco products during the past 30 days from when this survey was conducted (Minnesota Student Survey, 2007). 5. 5% of 12th grade males during the last 30 days used chewing tobacco, snuff or dip on each of those days. 81% did not use in the past 30 days ( Minnesota Student Survey, 2007). 6. 45% of 12th grade males and 73% of 12th grade females have never smoked a cigar or used chewing tobacco (Minnesota Student Survey, 2007). 7. If the student used tobacco, 67% of males and 57% of females bought it at gas stations or convenience stores (Minnesota Student Survey, 2007). 8. 18% of 12th grade males and 11% of 12th grade females used tobacco on 20 or more days of the past 30 days (Minnesota Student Survey, 2007). 9. “Each time a smoker lights up, that single cigarette takes about 5 to 20 minutes off the person's life” (Hirsch, 2007, para. 7). C. Why do people use tobacco? 1. “Current adolescent smokers are more likely to believe that cigarette smoking helps people when they are bored, helping people relax, helps reduce stress, helped people feel more comfortable in social situations, and helps keep their weight down” (Meeks, Heit & Page, 1994, p. 179). 2. Media Influence a. Define Media 1) Various forms of mass communication (Meeks, Heit, Page, 2009, p. G-25) b. Types 1) Television

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2) Radio 3) Magazines 4) Newspapers 5) Internet 6) Books 7) Music 8) Theater 9) Movies c. Messages about Tobacco (Krantzler & Miner, 1995, p. 43) 1) Normal 2) Safe 3) Healthy 4) Attractive and successful people use it 5) Relaxing in social situations 6) Right of passage to adulthood d. Strategies Used (Giarratano, 1997, p. 62) 1) “Proof Of” a) This appeal emphasizes the facts. For example, it may point out that each cigarette has a certain number of mg of tar as proof that it is a better cigarette. 2) Emotional a) This appeal uses imagery calculated to appeal to the emotions to encourage users to try the product. For example, the ad may show a glamorous woman or man smoking the product in a beautiful setting. 3) Comparison a) This appeal compares the company’s product with a similar product. The ad may compare two cigarette packages, filter vs. no filter, contents, or even price, to encourage people to buy the product. 4) Medical or Health a) This appeal is not often used in advertising cigarettes. However, some ads emphasize a certain brand’s low tar and low-nicotine content, thereby implying there are health “benefits” to smoking this particular cigarette. b) One of the following labels is required on cigarette packages: SURGEON GENERAL'S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy. SURGEON GENERAL'S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health. SURGEON GENERAL'S

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WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight. SURGEON GENERAL'S WARNING: Cigarette Smoke Contains Carbon Monoxide (Federal Trade Commission, n.d.). 5) Bandwagon a) This appeal attempts to convince consumers that everyone is using the product. Although the ad may show only one person smoking, the other people in the ad are smiling or hold a pack of cigarettes. 6) Star or Glamour a) This is a type of emotional appeal that uses glamorous situations or famous people to sell the product, such as showing an athlete using smokeless tobacco. e. How to Evaluate Advertisements (Meeks, Heit, Page, 2009, p. 71-72) 1) Identify people and things that might influence you 2) Evaluate how the influence might affect your health behavior and decisions a) Does this influence promote healthful behavior? b) Does this influence promote safe behavior? c) Does this influence promote legal behavior? d) Does this influence promote behavior that shows respect for myself and others? e) Does this influence promote behavior that follows the guidelines of responsible adults, such as my parents or guardians? f) Does this influence promote behavior that demonstrates good character? 3) Choose positive influences on health 4) Protect yourself from negative influences on health 3. “To relieve tension” (WebMD, 2007). 4. “To control weight” (WebMD, 2007). 5. “To be part of the group” (WebMD, 2007). 6. “Teens may think smoking is a way to look more mature, independent, and self-confident to their peers. They may smoke to rebel against their parents” (WebMD, 2007). Lesson Plan 2 – Scope and Sequence II. What kinds of tobacco are most commonly used? A. Cigarettes

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1. “Cigarette-a small roll of finely cut tobacco wrapped in paper for smoking” (Giarratano, 1997, p. 47). 2. “Cigarettes account for about 85% of the tobacco used in the United States. The remainder is used to make cigars, smoking tobacco, chewing tobacco and snuff. Chewing tobacco and snuff are the primary forms of smokeless tobacco used” (Krantzler & Miner, 1995, p. 7). B. Smokeless Tobacco 1. “Smokeless tobacco is tobacco that is sniffed through the nose, held in the mouth, or chewed. These products are not a safe alternative to smoking. Like tobacco that is smoked, smokeless tobacco contains nicotine in addition to 28 carcinogens, all of which are absorbed into the blood through the mucous membranes or the digestive tract” (Merki & Merki, 2004, p. 542). 2. “Because smokeless tobacco is often held in the mouth for a length of time, it delivers both nicotine and carcinogens to the body at levels that can be two to three time the amount delivered by a single cigarette” (Merki & Merki, 2004, p. 542). III. Why should we not use tobacco? A. “Cigarette smoking is a social and medical problem worldwide. An international report estimated that, worldwide, smoking is killing 3 million people a year and that by the year 2020 the rate might be as high as 10 million per year” (Ksir, Hart & Ray, 2005, p. 252). B. “Tobacco use is a factor in 4 out of the 5 leading causes of death in the United States: cardiovascular disease, cancer, cerebrovascular disease, and pulmonary disease” (Giarratano, 1997, p. 56). C. “Young people offer the following reasons for not dating smokers: they have bad breath, you can’t get close to someone with a cigarette, it tastes bad to kiss them, they cough a lot, you have to breathe their smoke, their hair and clothes smell, their teeth are yellow” (Krantzler & Miner, 1995, p. 51). D. “The life expectancy for heavy smokers is an average of eight years less than for smokers” (Krantzler & Miner, 1995, p. 39). E. “A burning cigarette releases more than 4,000 chemicals, including 43 that are known to cause cancer and 401 that are toxic” (Krantzler & Miner, 1995, p. 5-6).

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F. “Cigarette smokers are also more likely to get into fights, carry weapons, attempt suicide, suffer from mental health problems such as depression, and engage in high-risk sexual behaviors” (American Cancer Society, 2007, para. 10). IV. Making Good Decisions to Avoid Tobacco Use (Herman, 2008, p. 62-63) A. Define “decision” 1. A choice reached after careful consideration. B. Types of Influences on our Decisions 1. Safety 2. Family 3. Friends 4. Healthy 5. Legal 6. Values 7. Finances C. Define “risk behavior” 1. Engaging in a behavior that is unhealthy and/or unsafe D. Healthy Decision Making Process 1. Identify a decision to be made and state as a question 2. Identify and describe possible options or choices a. Need three or more possible options 3. Identify criteria for making decisions a. What do you think about when you make a decision, formatted in questions 4. Weigh options against criteria a. Use a T-Chart to compare your options against criteria 5. Make decision and explain reasoning. a. Explain the best choice by counting up no’s and yes’s in the TChart Lesson Plan 3 – Scope and Sequence V. What is in tobacco that makes it harmful? A. “The following ingredients are always present in tobacco smoke and are responsible for most smoking-related disease: nicotine, tar, carbon monoxide” (Krantzler & Miner, 1995, p. 6). 1. Nicotine

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a. “It is the chief ingredient in the tobacco used in cigarettes, cigars, pipes, and smokeless tobacco. Nicotine is a highly toxic poison” (Krantzler & Miner, 1995, p. 6). b. Physical Effects (Krantzler & Miner, 1995, p. 6). 1) Heart rate increases 2) Blood pressure increases, 3) Intestinal cramps 4) Oxygen consumption and respiration increase 5) Body temperature decreases 6) Bronchial tubes constrict c. At higher doses, the effects of nicotine include (Krantzler & Miner, 1995, p. 7): 1) Dizziness 2) Faintness 3) Rapid pulse 4) Cold clammy skin 5) Nausea 6) Vomiting 7) Diarrhea d. “It only takes 5-7 seconds for nicotine to reach the brain after a person inhales tobacco smoke. In those seconds, the nicotine is absorbed into the blood stream through the lining of the mouth and through the lungs” (Merki & Merki, 2004, p. 541). e. “Nicotine goes straight to the brain and acts on areas of the brain that control feelings of pleasure” (Meeks, Heit & Page, 2009, p. 303). f. Nicotine causes major heart and blood vessel disease and cancers. 2. Tar a. “The high temperatures created in a burning cigarette cause the particulates to stick together, forming a gummy substance known as tar” (Krantzler & Miner, 1995, p. 7). b. A carcinogen is “…a chemical that is known to cause cancer. Most of the carcinogens in tobacco smoke are found in tar” (Meeks, Heit & Page, 2009, p. 304). c. What Happens When Tar is Breathed In (D'Onofrio, 1991, p. 103)? 1) Sticks to the cilia (little hairs) in the bronchial tree and makes them stiff and sticky 2) The cilia then cannot sweep the mucus up and into the throat, so it gets stuck in the windpipe. 3) This creates the “smokers cough”. 4) It also sticks to tiny air sacs in the lungs. This causes the lungs to turn from bright pink to black.

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5) It hardens around the air sacs so they cannot stretch as well anymore. The air sac can break because of this and smokers that have many broken air sacks have hard time breathing. 6) Tar causes more than cancer; emphysema and chronic bronchitis (covered later) 3. Other Carcinogens (American Cancer Society, 2007, para. 22) a. Cyanide 1) Present in Second Hand Smoke (Hydrogen Cyanide in Second Hand Smoke) 2) “Hydrogen cyanide at room temperature is a volatile, colorless-to-blue liquid. It rapidly becomes a gas that can produce death in minutes if breathed” (Hydrogen Cyanide in Second Hand Smoke). b. Benzene (American Cancer Society, 2006) 1) Smoking greatly increases the blood level of benzene. 2) Evidence linking it to cause acute myeloid leukemia c. Formaldehyde (Formaldehyde in Cigarette Smoke, 2008) 1) Responsible for some of the nose, throat and eye irritation smokers experience when breathing in cigarette smoke 2) Colorless, flammable gas with a strong odor d. Ammonia (Ammonia, 2008) 1) Toxic, colorless gas with a very sharp odor 2) Used to boost the impact of nicotine in manufactured cigarettes 4. Carbon Monoxide a. “Carbon monoxide, another compound found in cigarette smoke, is a colorless, odorless, and poisonous gas that is taken up more readily by the blood than oxygen is. Carbon monoxide replaces oxygen in the blood, thereby depriving the tissues and cells of oxygen” (Merki, Merki, 2004, p. 541). b. Carbon Monoxide causes heart attacks, stroke, Cardiovascular Disease, and hypertension. c. Physical Effects of Carbon Monoxide (American Lung Association, 2008, para. 3) 1) Headaches 2) Dizziness 3) Sleepiness 4) Nausea 5) Vomiting 6) Confusion 7) Disorientation Lesson Plan 4 – Scope and Sequence

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VI. What are the short-term effects of tobacco use? A. “Bad breath and smelly hair, clothes, and skin” (Merki & Merki, 2004, p. 542) B. “Dulled taste buds and reduced appetite” (Merki & Merki, 2004, p. 542) C. “Increased respiration and heart rate” (Merki & Merki, 2004, p. 542) D. Stained teeth (Krantzler & Miner, 1995, p. 26) E. Shortness of breath (Krantzler & Miner, 1995, p. 26) F. Increased coughing and wheezing (Krantzler & Miner, 1995, p. 26) G. Allergy flair ups (Krantzler & Miner, 1995, p. 26) H. More colds, flu and pneumonia (Krantzler & Miner, 1995, p. 26) I. Wearing off of tooth enamel (Krantzler & Miner, 1995, p. 26) J. Cracking, bleeding and wrinkling of lips and gums (Krantzler & Miner, 1995, p. 26) K. Receding gums and sores and white spots in the mouth (Krantzler & Miner, 1995, p. 26) L. Acid in the stomach (NDARC, 2001) M. Decreased blood flow to extremities; particularly noticeable in fingers and toes (NDARC, 2001) N. Brain and central nervous activity stimulated and then reduced (NDARC, 2001) VI. What are the long-term effects of using tobacco? A. “Cancer is a disease in which cells multiply out of control, destroying healthy tissue and endangering life” (Krantzler & Miner, 1995, p. 31). B. “Cigarette smoking alone is directly responsible for approximately 30 percent of all cancer deaths annually in the United States” (National Cancer Institute, 2004). C. “Cancer-causing agents (carcinogens) in tobacco smoke damage important genes that control the growth of cells, causing them to grow abnormally or to reproduce too rapidly” (Centers for Disease Control, 2004).

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1. Cancers Due to Smoking (National Cancer Institute, 2008) a. Lung Cancer 1) Cancer that forms in tissues of the lung, usually in the cells lining air passages 2) The two main types are small cell lung cancer and nonsmall cell lung cancer. These types are diagnosed based on how the cells look under a microscope 3) Estimated in 2008: New Cases: 215,020 Deaths: 161,840 4) Symptoms (National Cancer Institute, 2008) a) A cough that gets worse or does not go away b) breathing trouble, such as shortness of breath c) Constant chest pain d) Coughing up blood e) A hoarse voice f) Frequent lung infections, such as pneumonia g) Feeling very tired all the time h) Weight loss with no known cause 5) “Cigarette smoking causes 87 percent of lung cancer deaths” (National Cancer Institute, 2004). b. Bladder Cancer 1) Cancer that forms in tissues of the bladder (the organ that stores urine). Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). 2) Estimated in 2008: New Cases: 68,810 Deaths: 14,100 3) Symptoms (National Cancer Institute, 2008) a) Blood in the urine b) Pain during urination c) Frequent Urination or feeling the need to urinate without results c. Throat Cancer 1) Cancer that forms in tissues of the pharynx (the hollow tube inside the neck that starts behind the nose and ends at the top of the windpipe and esophagus). 2) Cancer of the larynx (voice box) may also be included as a type of throat cancer. 3) Estimated in 2008: New cases: 12,250 (laryngeal); 12,410 (pharyngeal) Deaths: 3,670 (laryngeal); 2,200 (pharyngeal) 4) Symptoms (National Cancer Institute, 2008) a) Hoarseness or other voice changes b) A lump in the neck c) A sore throat or feeling that something is stuck in your throat d) A cough that does not go away

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e) Problems breathing f) Bad breath g) An earache h) Weight loss d. Pancreas Cancer 1) A disease in which malignant (cancer) cells are found in the tissues of the pancreas. 2) Estimated in 2008: New cases: 37,680 Deaths: 34,290 3) Symptoms (National Cancer Institute, 2008) a) Pain in the upper abdomen or upper back b) Yellow skin and eyes, and dark urine from jaundice c) Weakness d) Loss of appetite e) Nausea and vomiting f) Weight loss Lesson Plan 5 – Scope and Sequence VII. Other Cancers Due To Smoking A. Liver Cancer 1. Primary liver cancer is cancer that forms in the tissues of the liver. 2. Secondary liver cancer is cancer that spreads to the liver from another part of the body. 3. Estimated in 2008: New Cases: 21,370 Deaths: 18,410 4. Symptoms (National Cancer Institute, 2008) a. Pain in the upper abdomen on the right side b. Swollen abdomen c. Weight loss d. Loss of appetite and feelings of fullness e. Weakness or feeling very tired f. Nausea and vomiting g. Yellow skin and eyes, and dark urine from jaundice h. Fever B. Kidney Cancer 1. Cancer that forms in tissues of the kidneys. 2. Renal cell carcinoma (cancer that forms in the lining of very small tubes in the kidney that filter the blood and remove waste products) 3. Renal pelvis carcinoma (cancer that forms in the center of the kidney where urine collects).

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4. It also includes Wilms tumor, which is a type of kidney cancer that usually develops in children under the age of 5. 5. Estimated in 2008: New Cases: 54,390 Deaths: 13,010 6. Symptoms (National Cancer Institute, 2008) a. Blood in the urine b. Pain in the side that does not go away c. A lump or mass in the side or the abdomen d. Weight loss e. Fever f. Feeling very tired or having a general feeling of poor health C. Acute Myeloid Leukemia 1. Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream. 2. Estimated in 2008: New Cases: 44,270 Deaths: 21,710 3. Symptoms (National Cancer Institute, 2008) a. Fevers or night sweats b. Frequent Infections c. Feeling weak or tired d. Headache e. Bleeding and bruising easily f. Pain in the bones or joints g. Swelling or discomfort in the abdomen h. Swollen lymph nodes, especially in the neck or armpit i. Weight loss 4. “Benzene is a known cause of acute myeloid leukemia, and cigarette smoke is a major source of benzene exposure. Among U.S. smokers, 90% of benzene exposures come from cigarettes” (Centers for Disease Control, 2004). VIII. Cancers Due To Chew (National Cancer Institute, 2008) A. “Smokeless tobacco contains 28 cancer-causing agents (carcinogens). It is a known cause of human cancer, as it increases the risk of developing cancer of the oral cavity” (Centers for Disease Control, 2007). 1. Oral Cancer a. Cancer that forms in tissues of the lip or mouth. b. Estimated in 2008: New Cases: 22,900 Deaths: 5,390 c. Symptoms (National Cancer Institute, 2008) 1) Patches inside your mouth or on your lips that are white, a mixture of red and white or red 2) A sore on your lip or in your mouth that will not heal

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3) Bleeding in your mouth 4) Loose teeth 5) Difficulty or pain when swallowing 6) A lump in your neck 7) An earache 2. Esophagus Cancer a. Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). b. Estimated in 2008: New cases: 16,470 Deaths: 14,280 c. Symptoms (National Cancer Institute, 2008) 1) Difficult or painful swallowing 2) Severe weight loss 3) Pain in the throat or back, behind the breastbone or between the shoulder blades 4) Hoarseness or chronic cough 5) Vomiting 6) Coughing up blood d. The combination of smoking and alcohol consumption causes most laryngeal cancer cases (Centers for Disease Control, 2004). 3. Stomach Cancer a. Cancer that forms in tissues lining the stomach. b. Estimated in 2008: New Cases: 21,500 Deaths: 10,880 c. Symptoms (National Cancer Institute, 2008) 1) Discomfort in the stomach area 2) Feeling full or bloated after a small meal 3) Nausea and vomiting 4) Weight loss IX. Respiratory Problems Caused By Smoking A. Chronic Obstructive Pulmonary Disease 1. “Smoking is a known cause of most cases of chronic obstructive pulmonary disease (COPD) which includes emphysema and chronic bronchitis” (Campaign for Tobacco Free Kids, 2009, para. 4). a. Chronic Bronchitis (Merki & Merki, 2004, p. 542-544) 1) Repeated tobacco use can damage the cilia in the bronchi until they no longer function. This leads to a buildup of tar in the lungs, causing chronic coughing and excessive mucus secretion. b. Emphysema (Merki & Merki, 2004, p. 542-544)

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1) This disease destroys the tiny air sacs in the the air sacs become less elastic, making it more difficult for the lungs to absorb oxygen. 2. “In the United States, an estimated 10 million adults had a diagnosis of COPD in 2000, but data from a national health survey suggest that as many as 24 million Americans are affected” (Centers for Disease Control, 2003, para. 4). 3. Lung Cancer (already covered above) is caused by tobacco use. Lesson Plan 6 – Scope and Sequence XI. Cardiovascular Problems Associated with Smoking A. Coronary Heart Disease 1. Define a. Caused by atherosclerosis, the narrowing of the coronary arteries due to fatty build-up of plaque (American Heart Association, 2008) 2. Symptoms (American Heart Association, 2008) a. High Blood Pressure b. High blood cholesterol c. Chest pain 3. Relate to Tobacco Use a. “Cigarette smokers are two to four times more likely to develop CHD than nonsmokers” (American Heart Association, 2008) b. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn't as great as cigarette smokers (American Heart Association, 2008). c. Exposure to other people's smoke increases the risk of heart disease even for nonsmokers (American Heart Association, 2008). B. Stroke 1. Define a. “A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts” (American Stroke Association, 2008). 2. Symptoms (American Heart Association, 2008) a. Sudden numbness or weakness in the face, arm or leg, especially on one side of the body b. Sudden confusion, trouble speaking, or understanding c. Sudden trouble seeing in one of both eyes d. Sudden trouble walking, dizziness, loss of balance, or coordination e. Sudden, severe headache, with no known cause 3. Relate to Tobacco Use

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a. “Studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system” (American Stroke Association, 2008). b. “Cigarette smoking approximately doubles a person’s risk for stroke” (American Heart Association, 2008). C. Atherosclerosis 1. Define a. “Plaque builds up in arteries over time and may become large enough to significantly reduce blood flow” (American Heart Association, 2003). 2. Symptoms (American Heart Association, 2008) a. Pain b. Changes in skin color c. Sores or ulcers d. Difficulty walking e. Heart Attack f. Stroke 3. Relate to Tobacco Use a. “Tobacco smoke greatly worsens atherosclerosis and speeds its growth in the coronary arteries, the aorta and arteries in the legs” (American Heart Association, 2003) b. Carbon monoxide and Nicotine both speed up plaque build-up in the arteries. D. Hypertension 1. Define a. The heart is working harder to pump blood to the body and it contributes to hardening of the arteries or atherosclerosis and the development of heart failure (WebMD, 2006). 2. Symptoms (WebMD, 2006) a. Severe headache b. Fatigue or confusion c. Vision problems d. Chest pain e. Difficulty breathing f. Irregular heartbeat g. Blood in the urine 3. Relate to Tobacco Use a. Nicotine causes a rise in blood pressure and heart rate. E. Heart Attack 1. Define

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a. “A heart attack occurs when the blood supply to part of the heart muscle itself — the myocardium — is severely reduced or stopped” (American Stroke Association, 2008). 2. Symptoms (American Heart Association, 2008) a. Chest Discomfort b. Discomfort in other areas of the upper body c. Shortness of breath d. Cold sweat e. Nausea f. Lightheadedness 3. Relate to Tobacco Use a. This is usually caused by the buildup of plaque, a process called atherosclerosis (American Heart Association, 2008). b. Nicotine and Carbon Monoxide both contribute to the build up of plaque. Lesson Plan 7 – Scope and Sequence XI. Dangers of Tobacco Use During Pregnancy A. How many women smoke? 1. The most recent CDC survey (from 2006) showed that nearly 1 in 5 American women aged 18 years or older (18%) smoked cigarettes (American Cancer Society, 2008). 2. The highest rates were seen among American-Indian and Alaska-Native women (29%), followed by white (20%), African-American (19%), Hispanic (10%), and Asian women (5%) (American Cancer Society, 2008) 3. Women with less than a high school education are more than twice as likely to smoke as college graduates (American Cancer Society, 2008). B. How many pregnant women smoke? 1. An estimated 6 million women become pregnant each year in the United States, and more than 11,000 give birth every day. Between 12 and 22% of these women will smoke during pregnancy (CDC, 2004). 2. 18 to 25% of women quit smoking once they become pregnant (CDC, 2004). C. Why would women smoke while they are pregnant? 1. Addiction 2. “To relieve tension” (WebMD, 2007) 3. Uneducated on the risks of smoking while pregnant D. Risks to Fetus 1. Stillbirth (Giarratano, 1997, p. 56) 2. Bleeding during pregnancy (Giarratano, 1997, p. 56) 3. Spontaneous abortion (Giarratano, 1997, p. 56)

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4. Prenatal mortality (Giarratano, 1997, p. 56) 5. Sudden infant death syndrome (Giarratano, 1997, p. 56) 6. Retardation of fetal growth (Giarratano, 1997, p. 56) 7. Lower the amount of oxygen the baby gets (Hitti, 2005) 8. Increase the baby’s heart rate (Hitti, 2005) 9. Raise the baby’s risk of developing lung problems (Hitti, 2005) 10. “Differences in body size, neurological problems, reading and mathematical skills, and hyperactivity at various ages” (Ksir, Hart & Ray, 2005, p. 252). XII. Other Consequences of Tobacco Use A. Legal consequences. (Merki & Merki, 2004, p. 545) 1. Selling tobacco products to persons under the age of 18 is illegal in all states. 2. Schools prohibit the use of tobacco products on school property, and a student may be suspended or expelled for breaking these rules B. Social consequences (Merki & Merki, 2004, p. 545) 1.Many people find secondhand smoke and the smell of tobacco offensive, so tobacco users may be excluded from social gatherings. 2. Having bad breath, yellowed teeth, and stained fingers may also harm a tobacco user’s social life. C. Financial consequences 1. “Use of tobacco products can be very expensive. Someone who smokes a pack of cigarettes a day can spend more than $2,000 each year just on cigarettes” (Merki & Merki, 2004, p. 545). 2. “According to a recent report, the total economic cost of tobacco use to taxpayers in the United States, including medical costs, is about $97 billion a year” (Merki & Merki, 2004, p. 545). Lesson Plan 8 – Scope and Sequence XIV. Second Hand Smoke or Environmental Tobacco Smoke (ETS) A. Define 1. Sidestream smoke is smoke that comes from the end of a lighted cigarette, pipe, or cigar (American Cancer Society, 2008) a. “Sidestream smoke carries the same carcinogens – more than forty of them – as mainstream smoke. But the particles are smaller and can travel more deeply into a nonsmoker’s lungs” (Krantzler & Miner, 1995, p. 34). 2. Mainstream smoke is smoke that is exhaled by a smoker (American Cancer Society, 2008)

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B. Consequences of Second Hand Smoke 1. Consequences for Children a. Sore throats (Merki & Merki, 2004) b. Ear infections (Merki & Merki, 2004) c. Upper respiratory problems (Merki & Merki, 2004) d. Increased risk of developing asthma, bronchitis and pneumonia (Mayo Clinic, 2008) e. “Children who live with smokers have double the risk of developing lung cancer than children of nonsmokers” (Merki & Merki, 2004, p. 552). 2. Health Effects for Those who Breathe In Second Hand Smoke (Mayo Clinic, 2008) a. Chronic coughing, phlegm and wheezing b. Eye and nose irritation c. Reduced lung function d. Irritability e. Dental cavities

     

C. Laws Regarding Second Hand Smoke (American Lung Association, 2008) 1. Smoking is prohibited in almost all public places, public meetings, places of employment and public transportation, which includes bars and restaurants. 2. No person shall at any time smoke or use other tobacco products in public schools. 3. Smoking is prohibited in places of employment, the definition of which includes government agencies with two or more employees.   4. Smoking is prohibited in any area of a hospital, health care clinic,     doctor’s office, licensed residential facility for children or other health     care‐related facility.   5. Laws vary by state.

Lesson Plan 9 – Scope and Sequence XIV. How to Quit Using Tobacco A. Why teens decide to quit (Merki & Merki, 2004, p. 548) 1. They begin to have health problems, such as asthma. 2. They have the desire, will and commitment to stop. 3. Realize how expensive the habit is 4. Realize that using tobacco can lead to other risky behaviors, such as the use of alcohol and other drugs 5. Realize the damaging effects of secondhand smoke and don’t want to harm their families and friends B. Who Can Help?

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1. “Combining counseling and pharmacological treatments increases the odds of quitting” (Ksir, Hart & Ray, 2005, p. 257) a. Chemical Dependency Centers b. Therapists c. Doctors d. Support Groups 1) Nicotine Anonymous e. Dentists C. How Friends Can Help 1. Help a Friend STOP using Tobacco (Merki & Merki, 2004, p. 549). a. S – Show Concern. Approach the person in a caring, nonjudgmental manner. Use “I” messages to let the person know that you care about his or her health. T – Take Time To Plan. Putting a plan on paper makes it easier to set objectives. You may need to help the person create a physical activity program. Set a date to quit, locate formal tobacco cessation programs, and devise strategies to cope with tobacco cravings. O – Offer Support. Put the plan into action. For example, you might bring the person sugarless gum. Ride a bike, shoot hoops, or take a walk together to help him or her get physical activity. Arrange to attend a class together to learn relaxation techniques. P – Promote Success. Let the person know that you are proud of him or her for quitting. Celebrate each week of abstinence. If the person relapses, continue to encourage him or her. Keep in touch with the person after he or she has quit D. Benefits of Quitting (American Lung Association, 2008) 1. At 20 minutes after quitting: blood pressure decreases, pulse rate drops, body temperature of hands and feet increases 2. At 8 hours: carbon monoxide level in blood drops to normal, oxygen level in blood increases to normal 3. At 24 hours: chance of a heart attack decreases 4. At 48 hours: nerve endings start regrowing, ability to smell and taste is enhanced 5. 2 weeks to 3 months: circulation improves; walking becomes easier, lung function increases 6. 1 to 9 months: coughing, sinus congestion, fatigue, shortness of breath decreases 7. 1 year: excess risk of coronary heart disease is decreased to half that of a smoker 8. At 5 years: from 5 to 15 years after quitting, stroke risk is reduced to that of people who have never smoked. 9. At 10 years: risk of lung cancer drops to as little as one-half that of continuing smokers, risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases, risk of ulcer decreases

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10. At 15 years: risk of coronary heart disease is now similar to that of people who have never smoked, risk of death returns to nearly the level of people who have never smoked E. Effective Ways To Quit Smoking 1. Nicotine Replacement a. “Can help with the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes” (American Cancer Society, 2008). b. Doctor should be involved to carefully monitor c. Nicotine Patch 1) “Measured dose of nicotine through the skin” (American Cancer Society, 2008) 2) “Weaned off nicotine by switching to lower-dose patches over a course of weeks” (American Cancer Society, 2008) d. Nicotine Gum 1) “Nicotine is taken in through the mucous membrane of the mouth” (American Cancer Society, 2008). 2) “Tapering the amount of gum chewed may help you stop using it” (American Cancer Society, 2008). e. Nicotine Nasal Spray 1) Delivers nicotine to the bloodstream as it is quickly absorbed through the nose” (American Cancer Society, 2008). 2) Only available by prescription 3) Relieves withdrawal symptoms very quickly f. Nicotine Inhalers 1) Only available by prescription 2) “Delivers most of the nicotine vapor to the mouth” (American Cancer Society, 2008) 3) Closest thing to a cigarette g. Nicotine Lozenge 1) Like a cough drop 2) Newest Nicotine replacement drug out there (American Cancer Society, 2008) 2. Zyban (American Cancer Society, 2008) a. Prescription anti-depressant in an extended-release form that reduces symptoms of nicotine withdrawal that does not contain Nicotine b. Acts on chemicals in the brain that are related to nicotine craving 3. Chantix (American Cancer Society, 2008) a. Newer prescription medicine b. It works by interfering with nicotine receptors in the brain.

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1) Lessens the pleasurable physical effects a person gets from smoking 2) Reduces the symptoms of nicotine withdrawal. 4. Telephone Based Help (American Cancer Society, 2008) a. As of 2008, all states run some type of free telephone-based program such as the American Cancer Society’s Quitline tobacco cessation program that links callers with trained counselors. b. These specialists help plan a quit method that fits each person’s unique smoking pattern. 5. Behavior Modification Model (Herman, 2008) a. Assess Knowledge and Skills b. Assess Beliefs and Attitudes c. Assess Values d. Assess Life Experiences e. Stages of Behavior Change 1) Precontemplation 2) Contemplation 3) Preparation 4) Action 5) Maintenance 6. Make sure to evaluate what you are thinking about using before starting to use it. 7. Join a program like Nicotine Anonymous. 8. Don’t give up! F. “About 46 million Americans have quit smoking for good” (American Cancer Society, 2008). Lesson Plan 10 – Scope and Sequence XV. Prevention or Abstinence is Best Decision A. Use Refusal Skills 1. “Techniques that can help you refuse when you are urged to take part in unsafe or unhealthful behaviors” (Merki & Merki, 2003, p. 803). B. Resistance Skills Model (Meeks, Heit & Page, 2009, p. 76) 1. Say “no” with self-confidence. a. Look directly at the person or people to whom you are speaking. Say “no” clearly. b. Be assertive with words and body language 2. Give reasons for saying “no.” a. No, I want to promote my health. b. No, I want to protect my safety. c. No, I want to follow laws. d. No, I want to show respect for myself and others.

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e. No, I want to follow the guidelines of my parents and other responsible adults. f. No, I want to demonstrate good character. 3. Repeat your “no” response several times. a. You strengthen your “no” response every time you repeat it. 4. Use nonverbal behavior to match verbal behavior. 5. Avoid situations in which there will be pressure to make wrong decisions. 6. Avoid people who make wrong decisions. 7. Resist pressure to engage in illegal behavior. 8. Influence others to make responsible decisions. C. Leave situations where there is pressure to smoke. D. Use the Decision Making Model (Herman, 2008, p. 62-63) 1. Healthy Decision Making Process a. Identify a decision to be made and state as a question b. Identify and describe possible options or choices 1) Need three or more possible options c. Identify criteria for making decisions 1) What do you think about when you make a decision? a) Format in questions d. Weigh options against criteria 1) Use a T-Chart to compare your options against criteria e. Make decision and explain reasoning. 1) Explain the best choice by counting up no’s and yes’s in the T-Chart E. Remember why abstinence is the best decision! References American Cancer Society. (2007, October, 16). Child and Teen Tobacco Use. Retrieved September 27, 2008, from http://www.cancer.org/docroot/PED/content/PED_10_2X_Child_and_Teen_Toba cco_Use.asp?sitearea=PED American Cancer Society. (2007, October 23). In Questions About Smoking, Tobacco, and Health. Retrieved October 10, 2008, from http://www.cancer.org/docroot/ped/content/ped_10_2x_questions_about_smoking _tobacco_and_health.asp American Cancer Society. (2006, February 2). In Benzene. Retrieved October 10, 2008, from http://www.cancer.org/docroot/ped/content/ped_1_3x_benzene.asp

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