DOC/STATS Program at UCLA
A web page designed to help educate children about smoking

The following information is intended to guide UCLA medical students
in holding an hour-long discussion with Jr. High and High School students about smoking.


The following is an outline of topics to discuss in the classroom:
    Reasons people smoke
    What's in cigarette smoke?
    Effects of smoking
    What about second-hand smoke?
    Tobacco companies and advertising

Demonstrations
    Emphysema
    Lung Demonstration

Be prepared!
    Common questions
    What to bring
    What should you expect in the classroom?
    Links


Reasons People Smoke
(about 5 minutes)

After you introduce yourself to the class, ask them to list reasons why people smoke.  It is helpful to list these reasons on the board.  If they are quiet, list one to get them started.  Encourage any response with candy.  Don't worry about correcting them if they say something inaccurate, just list everything.  Typical responses include:
    peer pressure (their friends are doing it)
    looks cool
    feels good
    see famous people smoking
    look older
    parents smoke
    stress
You may be surprised at the variety of reasons they give!  Be encouraging, even if the class is a little noisy.  Just politely ask them to be quite when someone is speaking.  Usually the teachers will step in if the class gets too noisy.
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What's in cigarette smoke?
(less than 5 minutes)

Ask them to guess how many chemicals are in cigarette smoke.  After you take several guesses, surprise them by telling them over 4,000 chemicals are in cigarette smoke.  Ask if they know any of them.  You don't have to write these down, but be sure to mention:
    nicotine - what makes it addictive
    carbon monoxide - car exhaust
    cyanide - rat poison
    formaldehyde - preserves frogs in biology class the lung you brought
    ammonia - in household cleaners
    acetone - fingernail polish remover
    acetylene - jet fuel
    tar - the black stuff used to pave streets
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Effects of Smoking
(about 20 minutes)

Ask them what they think are some good effects of smoking (there shouldn't be too many!).  Here it is ok to politely correct them if they say something really inaccurate, just be careful not to discourage them.  Write these down as well.  Typical responses include:
    it gives you a "high"
    helps people relax
    loose weight
    tastes good

Then, ask them to list some bad effects of smoking.  Write these down.  Typical responses include:
    causes cancer
    emphysema (although most don't know what this means!)
    smells bad
    its addictive
    makes you cough
    turns teeth yellow
    its expensive
    ect, ect, ect...

Once your done writing these down, have them look at both lists and compare them.  Show them how there are a lot more bad effects of smoking than good.  Also show them how most of the "good" effects of smoking don't last very long, and that the more you smoke, the shorter they last.  Here is a good time to spit out a few trivia facts:
    - Smoking kills over 500,000/year (more than AIDS, cocaine, heroin, suicide, murder, car accidents, and fire combined!)
    - Accounts for 1/5 of all deaths in the US
    - Increases your chance of lung cancer by 22 times
    - 90% of people know smoking is bad for you, but still over 50 million Americans smoke (powerful addiction)
    - Overall, smoking kills about 1/2 of all long-term users
    - Smokers, on average, live about 15 years shorter than non-smokers
    - Over 90% of teenagers believe they can quit smoking, but only 1.5% actually succeed
    - Despite all this, youth smoking has been increasing since 1992 (about 3000 teenagers begin smoking each day)
    - Most children experiment with smoking by age 12
    - Most teenagers (even those who smoke) say they would rather date a non-smoker

At this point, focus on the bad effects of smoking.  Start with the list on the board (but save emphysema for last so you can do the demo) and explain what they mean in simple terms!  Be sure to explain:
Cancer (lung, mouth, throat, bladder, kidney, ect...)
    For younger children, explain cancer as similar to weeds growing in a garden.   Eventually, the weeds take over the entire garden and kill all the good plants.  For older kids, explain it as a bunch of cells that start growing out of control, until they eventually take over your entire body.
Heart attack and Stroke
    The nicotine in cigarette smoke helps to clog up your blood vessels, making it hard for your heart or brain to get blood.
Osteoporosis
    Weak bones, easier to break as you get older.
Trouble sleeping
Tooth Decay
Low Physical Endurance
    They won't be able to run or exercise very well.
Wrinkled skin
    Nicotine dries out the skin and causes premature wrinkling.
Bronchitis, Pneumonia, Flu
    Smoking makes the lungs less able to fight off infections.
Emphysema(*DEMONSTRATION*)
    This is a difficult topic to explain, but this a good time for the demo.  Ask for 5-10 volunteers to come to the front of the class.  Once they are up there, explain that emphysema is a disease that makes it hard to breathe.  Give the volunteers a plastic drinking straw and tell them to do 30 jumping jacks.  Immediately after they do the jumping jacks, they have to put the straw in their mouth and plug their nose.  Have them do the jumping jacks together (get the class to count with you).  They won't be able to breathe through the straw very long, and will usually struggle, then start laughing.  Ask some of them to explain what it feels like.  Be sure to collect the straws before they sit down, else they could be a distraction.

This is a good point to ask for questions.

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What about second-hand smoke?
(less than 5 minutes)

Ask them if they know what second-hand smoke is.  Ask if they think it is more or less dangerous than smoking.  Be sure to explain that in many ways, second-hand smoke is more dangerous than smoking because it is not filtered.  Some trivia facts to give include:
    - It kills over 50,000 Americans each year (3rd leading cause of preventable death in the US)
    - Children exposed to it have higher rates of middle ear disorders, eye irritation, asthma and other lung infections
    - Classified as a "Class A Carcinogen" by the Environmental Protection Agency
    - Increases risk of lung cancer by 20-30%
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Tobacco companies and advertising
(about 5 minutes)

Now that they have heard all the bad things smoking can do, ask them why the tobacco companies still try to sell cigarettes.
    - Tobacco companies make billions of dollars each year from selling cigarettes
    - They have to target children in order to make money
    - On average, tobacco companies spend about $165 per second on advertisments
How do they get young people to buy cigarettes and get addicted?  Show them magazine cigarrette ads.  Ask them how the ads try to make smoking look "cool" and glamorous.  Be sure to point out how the ads never show the bad effects of smoking (people with yellow teeth and wrinkled skin, ect).  They even use cartoons to get kids attention.
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Lung Demonstration
(at least 15 minutes)

Pass out one glove to each student.  At the front of the class, show them both a smokers lung and a normal lung.  Explain how the tar in cigarette smoke collects in the lung and never goes away.  Have one of you bring the lung around to each student and allow them to touch it if they want to.  Ask them to describe the differences between the two lungs.  Also mention that the bad smelling formaldehyde used to preserve the lung is the same chemical found in cigarette smoke.  While one of you takes the lung around, the other should answer questions they have.  They will have plenty!
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Common Questions

Is marijuana better for you than cigarettes?  No.  Marijuana is also an addictive drug that can potentially be worse than cigarettes since there is no filter to remove dangerous chemicals from the smoke.

Are low-tar cigarettes better for you?  No.  People that smoke low-tar cigarettes tend to take more puffs and inhale deeper.  Thus, they can inhale just as much (or more) dangerous chemicals as people smoking regular cigarettes.

Does quitting smoking really help?  Yes!  Former smokers live nearly as long as non-smokers, and have a lower risk (compared to smokers) of cancer and other diseases associated with smoking.  Your body will begin to heal itself when you stop smoking, and the earlier you quit, the better off you will be.

Do nicotine patches really help people quit?  Yes.  Nicotine patches and nicotine gum can approximately double the success rate of quitting smoking when used along with other methods.  They work primarily by reducing the withdrawal symptoms and appetite for smoking.

Is chewing tobacco or pipe smoke better for you?  No.  Tobacco in any form still contains nicotine and can still cause cancer, along with other diseases.

Why is smoking so addictive?  Nicotine is an extremely powerful chemical that stimulates the nervous system.  It is considered more addictive than alcohol, cocaine, and heroin.  84% of people that have tried to quit smoking but can’t.  Over 90% of teenagers feel like they could quit if they wanted to, but only 1.5% actually can.

What about smoking during pregnancy?  Mothers who smoke during pregnancy have a higher risk of having low-weight or still-born babies.

How do I get my parents to stop smoking?  Have them tell their parents how dangerous smoking is to the health of everyone in the house.  Sometimes just hearing their children tell them to stop smoking can make a big impact on parents.  If the parents won’t quit, try to get them to smoke outside of the house, since second-hand smoke can be very unhealthy for children as well.  The less contact the children have to cigarette smoke, the better.

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What to Bring

1. White coats
2. Candy to pass out to encourage questions
3. Soda straws for the emphysema demonstration
4. Two cadaver lungs: one from a smoker, the other a healthy lung
5. Enough gloves for everyone (one glover per child is enough)
6. Magazine cigarette ads
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What should you expect in the classroom?

    Each class is very unique, and you will probably have to adjust your style for each class.  Be flexible and open-minded.  Always encourage questions, and never tell a student they are wrong.  Try to get all students involved, but don’t force anyone to participate if they really don’t want to.  Most importantly, keep it as interactive as possible.
    A positive attitude is very important, and your attitude will immediately rub off on the students.  Remember that you are serving as a role model in addition to educating them about smoking.  If you come across a “problem” student that is being disruptive (more likely in high school students), having them participate in demonstrations can sometimes help.  However, be careful not to let one or a few students monopolize the class.
    By and large, students will be cooperative and interested in what you are talking about.  Do your best to foster their curiosity, and if they ask a difficult question, give it your best answer – but don’t be afraid to say “I don’t know” if you really don’t.
    Of course, the teachers are very helpful and will not hesitate to help keep the class in line if they get rowdy.  Having one of you wander through the rows as the other talks is a great way to discourage rowdy behavior.  Be sure to thank the teacher after the class has ended.
    The format given on this web site is only one way to structure your session.  Feel free to change it to your style.  However, it is best to save the lung demonstration for the end, since it’s hard to get their complete attention after you have let them touch a real human lung.
    Finally, remember to HAVE FUN!!!  If you enjoy it, so will they.
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Links

There are many wonderful web sites designed to educate people about the dangers of smoking.  Here are a few you may want to check out before your school trip:

www.thetruth.com
www.cdc.gov/tobacco/
www.smokingsucks.nfld.net/

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April 2001
By Jonathan Grein, UCLA MS I
jgrein@ucla.edu