HealthHints topic index | HealthHints issue date index | Health Information for Texans | FCS Home

HealthHints Newsletter, Texas AgriLife Extension Service, The Texas A&M University System

Mobilizing Your Community for Tobacco Prevention

Volume 6, Number 6 - July/August, 2002

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Download PDF version of this Newsletter [185K]

Inside HealthHints....

Mobilizing Your Community for Tobacco Prevention

"Almost all first use [of tobacco] occurs before young people graduate from high school" (Centers for Disease Control, 1994).

"The number 1 preventable cause of death in America is tobacco." - Louis Sullivan, Secretary of Health and Human Services, 1991 (from Scheer, 1996)

"To achieve the individual behavior change that supports the nonuse of tobacco, communities must change the way tobacco is promoted, sold, and used while changing the knowledge, attitudes, and practices of young people, tobacco users, and nonusers. Effective community programs involve people in their homes, work sites, schools, places of worship and entertainment, civic organizations, and other public places (Centers for Disease Control, 1999a)."

"Given that tobacco use is the largest preventable cause of death in the United States, reducing tobacco use and ETS [environmental tobacco smoke, also called secondhand smoke] exposure should be relevant to most communities. In selecting and implementing interventions, communities should strive to develop a comprehensive strategy to reduce exposure to ETS, reduce initiation, and increase cessation (Centers for Disease Control, 2000a)."

In light of these facts, it is the goal of this issue of HealthHints to look at ways to help you help your community:

Your community goals should also include reducing exposure to Environmental Tobacco Smoke (ETS), also called secondhand smoke. By working toward and reaching cessation goals, ETS exposure would ultimately be reduced. Until this happens, however, there can be major health consequences from secondhand smoke. Please see the June/July 2001 issue of the HealthHints Newsletter for more information about secondhand smoke.

Van Zandt County S.W.A.T. Team: Mobilized for Tobacco Prevention

Through the use of funds from the Texas A&M University System Health Science Center, Van Zandt County Extension has set out to mobilize their community for tobacco prevention. To make this happen, Van Zandt County Extension Agents, DeeLee Smith and Tommy Phillips, have taken the lead in setting up an advisory board, providing training, and ultimately developing the Van Zandt County S.W.A.T. Team, which stands for Students Working Against Tobacco.

Goals

Reduce youth tobacco use in rural communities.

Action Steps

Action steps for the Van Zandt County S.W.A.T. Team include:

Advisory Board Membership

The first step in reaching these goals was to set up an advisory board made up of Van Zandt citizens interested in tobacco use prevention and policy changes within the county. Key leaders were asked to join the team, including doctors, dentists, law enforcement, fire fighters, local and county government, banking officers, civic organizations, all local Independent School Districts (ISDs), educators, business people, and 4-H leaders. Key members of the Van Zandt County Advisory Board include: Sheriff and Sheriff Deputy, bank officer (also an American Cancer Society Relay for Life Coordinator), Ag/Livestock Marketing Publicist, registered nurse, dentist, school counselors and nurses.

The advisory board will work with the S.W.A.T. team, local officials, and groups such as restaurant owners to increase the number of smoke-free public areas and to promote enforcement of current tobacco laws and ordinances.

Adult Trainings

An initial meeting was held to brief advisory board members on the purpose of S.W.A.T. and their role as an advisory board member. Dates were set for an American Cancer Society (ACS) "Communities of Excellence" training, and each advisory board member was asked to recruit community representatives for the training, as well as for advisory board membership.

One month after this initial meeting, the ACS "Communities of Excellence" training was conducted by ACS representative, Lana Heriman, and Texas A&M School of Rural Public Health, Health Education and Rural Outreach (HERO) Specialist, Luwana Rider. The American Cancer Society's Communities of Excellence in Tobacco Control training guides adults in:

Advisory board members were trained to use the Communities of Excellence program to build a plan focused on the needs of Van Zandt County. During the training, members identified tobacco initiatives deemed appropriate and needed in their community. They then assessed the needs of the community related to the chosen initiatives. Ninety percent of the factors evaluated were rated poor to fair in the county.

S.W.A.T. Team Membership

Students Working Against Tobacco (S.W.A.T.) team members were identified from four sources: 4-H, school nurses and counselors, community key leaders and advisory board members. As youth were identified, each was sent a S.W.A.T. team application. Once an application is complete, youth attach one reference from an adult and return it to the county Extension agent(s). The county Extension agent(s) and advisory board members review the applications for acceptance.

S.W.A.T. Applicants

Youth are accepted based on recommendations and character attributes, including honesty, fairness, cooperativeness, trustworthiness, responsibility, and respect by peers.

The following attributes were considered when reviewing applications:

Although all youth selected are a part of the S.W.A.T. team program, all will not participate in all aspects of the program. Youth are placed in the parts of the program in which they are most interested and for which they are best suited.

S.W.A.T. Team Responsibilities

Youth Trainings

Youth selected for the S.W.A.T. Team are participating in two trainings during the summer of 2002. (Other trainings may be offered as needed.)

Health Tech Camp 2002 - Sponsored in College Station by the Texas Cancer Council

Eight S.W.A.T. youth attended the Health Tech Camp 2002 in College Station during the last week of June. These youth were involved in intense web page training and briefed on tobacco use prevention. A brief look at the week:

S.W.A.T. Camp - Brownwood

Thirty campers will attend S.W.A.T. Camp at Brownwood. Objectives for the campers include:

Campers will participate in the L.E.A.P. Challenge Course (the name of the Texas 4-H Center Ropes course). Campers will experience more tobacco education by participating in games. In turn, they will use their education to develop skits and dramas with a professional drama coach. Skills learned during this camp will be used during the 2002-2003 school year to raise awareness of tobacco issues and promote change with their peers.

Curriculum

A curriculum will be developed using the experiences, training, materials developed, and knowledge gained from Van Zandt County S.W.A.T. so that others can replicate the same within their counties across the state. It will be ready to roll out across the state to all agents -- Fall 2003!

Note: Through sponsors and donations raised by county Extension agents and community advisory board members, Van Zandt County is purchasing a livestock trailer with a 6' tack room to carry exhibits and tobacco resources. An anti-tobacco message will be on both sides of the trailer. Sponsors names will be imprinted on the trailer (placement depending on level of sponsorship). Youth will showcase the trailer as well as their livestock at major livestock shows across the state. Youth will staff exhibits during the shows. Anti-tobacco efforts will be extended beyond Van Zandt county with this trailer as S.W.A.T. members participate in district and state-level competitions.

Initiation of Tobacco Use: Why Youth are Our Focus

"Youth begin to smoke at an increasingly alarming rate at about age 12 (seventh grade). Weekly smoking is 6% in seventh grade, and goes up about 3% per year throughout high school. These percentages fluctuate somewhat from year to year. They decreased between 1970 and 1990, but have been increasing 1 to 2% per year since 1991 (Sussman, et. al., 1998)."

So why are youth our focus? According to the Centers for Disease Control, "tobacco use usually begins in early adolescence, typically by age 16. Almost all first use occurs before young people graduate from high school. If adolescents can be kept tobacco-free, most will remain tobacco-free for the rest of their lives (Centers for Disease Control, 1994)."

In a report of the U.S. Surgeon General (1994), the following conclusions draw out the importance of prevention and communitywide intervention:

Best Practices for Prevention and Cessation: What Works?

For a current listing of the tobacco regulations and restrictions in your area see "Indoor Clean Air Ordinances: Summary of Restaurant Smoking Regulations in Texas" (http://fcs.tamu.edu/health/Health_Education_Rural_Outreach/Health_Hints/
2001/june-july/indoor-clean-air-ordinances.htm).

According to the U.S. Surgeon General's Report (1994), programs that work for tobacco use prevention among youth include the following:

Other promising prevention and cessation approaches include:

Know the Truth About Tobacco

Understanding the facts about tobacco and it's ill effects on health is paramount in helping to educate those in your community. It is important to understand what tobacco is and the effects it can have on one's health.

Tobacco: What It Is

Tobacco is a plant. It's brown-colored leaves are cured and dried to be used in differing products. Tobacco can be smoked in the form of a cigar, cigarette, or pipe. Tobacco can also be chewed or snorted as snuff (smokeless tobacco) (Sussman, et. al., 1998).

Tobacco is also a drug. A drug is "a non-food substance that can cause changes in the functions of the body and/or mind. Tobacco leaves contain a complex mixture of chemicals that affect the body in many ways (Sussman, et. al., 1998)." Nicotine is one of the main ingredients in tobacco, and is responsible for the addiction to or craving for the product. Nicotine is a stimulant, which means it speeds up bodily functions. In particular, nicotine causes the heart to work harder to circulate blood (Sussman et. al., 1998).

Nicotine, however, is not the only harmful ingredient in tobacco. In fact, tobacco smoke contains at least 300 different toxic chemicals (Sussman et. al., 1998). Here is a short list of some of the chemicals found in tobacco products:

Tobacco: Health Effects

In light of all the chemicals found in tobacco and tobacco products, it is not so hard to understand tobacco's harmful effects on health.

In fact, the following health warning labels are required on tobacco products:

Immediate Health Effects

Nicotine narrows the blood vessels and puts added strain on the heart (Centers for Disease Control, 2002). "After smoking one cigarette, the heart beats faster, blood vessels constrict, and blood pressure goes up (Sussman, et. al., 1998)." Cigarette smokers have a lower level of lung function and reduced oxygen available to the muscles (Centers for Disease Control, 1996a; Centers for Disease Control, 2002).

Long-term Health Effects

"Smoking is also the major cause of bronchitis and emphysema, and the most important preventable cause of heart disease; 30 to 40% of deaths related to the heart or circulatory system are attributed to tobacco use (Scheer, 1996)." "Between 80 and 90% of all deaths from lung, mouth, and larynx cancer, and from emphysema and bronchitis are due to tobacco use (Scheer, 1996)."

Health Effects During Pregnancy

"Nicotine freely crosses the placenta to an unborn child. It has been found in amniotic fluid and the umbilical cord blood. Nicotine is also found in breast milk. In fact, all the toxins in cigarette smoke that reach the pregnant woman's blood are transmitted to the fetus (Scheer, 1996)."

Smoking while pregnant increases the risk of having a baby with low birth weight two-fold, compared to those who do not smoke. Low birth weight can lead to many complications, including infant death. Tobacco use also increases risks for birth defects (Scheer, 1996).

The Cost of Tobacco Use

Not only does tobacco cost in terms of individual health effects, it also costs the individual and society monetarily. "According to the American Lung Association, the costs of smoking amount to $65 billion a year. These costs include lost productivity, health care costs in Medicare and Medicaid payments, and disability expenses. Employees who use tobacco are absent more often and cost employers higher insurance premiums (Scheer, 1996)." Additionally, fires started by cigarettes kill nearly 2,000 people and cause approximately 5,000 injuries each year. "In 1 year, Americans lost property valued at $410 million in fires caused by smoking (Scheer, 1996)."

"If all the costs of smoking were included in the price of cigarettes, cigarettes would cost $2 more per pack (Scheer, 1996)."

Important Facts and Figures

Cigarette smoking is the single most preventable cause of premature death in the United States (Centers for Disease Control, 2001a).

Each year more than 400,000 Americans die from cigarette smoking (Centers for Disease Control, 2001a).

One in every five deaths in the United States is smoking related (Centers for Disease Control, 2001a).

Exposure to secondhand smoke causes an estimated 3,000 deaths from lung cancer among American adults, annually (Centers for Disease Control, 2001a) (this number does not include ill effects among U.S. children).

In Texas...

Annual deaths related to smoking (1990-1994) were 24,789 persons.

Death rate was 358 per 100,000 persons.

Medical costs for one year amounted to $2,914,520,000 (Centers for Disease Control, 1999b).

(For more information on Texas statistics, see the following website: http://www.cdc.gov/tobacco/statehi/htmltext/tx_sh.htm.)

About Addiction

Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. In other words, an individual knows tobacco is bad for him, but uses it anyway because he can't make himself stop.

"Most people know that tobacco use causes disease, but they are not aware of all the negative consequences associated with using it. At least they don't think that anything bad can happen to them. People don't realize that new tobacco users can become addicted to nicotine very quickly. Soon they have a habit they cannot control. Addiction slips up on them, and nicotine addiction is very hard to break (Sussman, et. Al., 1998)."

"Among high school seniors, 73% of daily smokers who think they won't be smoking daily in 5 years still are."

"43% of young people (ages 10 to 12 years) who smoke as few as 3 cigarettes go on to become regular smokers."

"70% of 12 to 18-year-olds who smoke indicated that they would not have started if they could choose again."

(Centers for Disease Control, 2001b)

Nicotine is a psychoactive drug. It is compared to cocaine, heroin, and morphine. Though most smokers identify tobacco as harmful and express a desire to quit, they often can't due to the "addiction."

"Approximately three quarters of young people (ages 10 to 22 years) who use tobacco daily report that they use it because 'it's really hard to quit'. Findings were the same for cigarette smokers and for smokeless tobacco users (Centers for Disease Control, 2001b)."

Tobacco addiction occurs in five simple stages:

Nicotine effects the body in many ways. Here are a few of the effects on the...

Though some of these effects may seem beneficial (e.g., increased concentration or appetite suppression,) the ultimate outcome could not be further from beneficial. If tobacco use continues, the result will likely be among the following:

Calling It Quits

The most important thing a tobacco user can do is "call it quits." The most important thing the non-tobacco or former tobacco user can do is to support smoking cessation in the local community. It is important to understand that it is not easy to quit. Though tobacco may seem unappetizing to you, to the user it is a substance they cannot do without. It is also important to understand that the tobacco user will most likely experience symptoms of withdrawal as they try to quit. These symptoms may include one or more of the following:

Quitting tobacco is hard, but it is one of the most important things you can do for yourself and those around you. Here are five keys to quitting that have been shown to help others quit and stay quit for good:

  1. Get ready. Set a quit date. Get rid of all your cigarettes. Don't let people use tobacco in your home.
  2. Get support. Tell your family, friends, and co-workers you're trying to quit tobacco. Ask them not to use tobacco products around you. Tell your health care providers so they can help support you. Get individual, group, or telephone counseling. These types of counseling programs are often offered by hospitals and health centers.
  3. Learn new skills and behaviors. Learn what leads you to use tobacco. Try to use distractions from tobacco use (e.g., go for a walk, talk with a friend, get busy on a task). Change your routine. Do something to relieve stress (e.g., exercise, take a bath, read a book). Drink a lot of water and other fluids. Plan something enjoyable to do every day.
  4. Get medication and use it correctly. Talk with your health care provider about whether medications might work for you. The US Food and Drug Administration (FDA) has approved five medications to help with cessation: Bupropion SR, nicotine inhaler, and nicotine nasal spray all available by prescription only; nicotine patches available by prescription and over-the-counter; and nicotine gum available over-the-counter.
  5. Be prepared for relapse or difficult situations. Most relapses occur in the first three months after quitting. If you start using tobacco again, don't be discouraged. Many people try several times before giving up tobacco for good. Reassess what you've learned and try again. Also, be aware of stumbling blocks. Avoid alcohol, which lowers your chance for success. Try to avoid being around someone using tobacco, which may initiate your urge. Be prepared for bad moods -- there are ways other than tobacco use to improve your mood. Don't let weight gain distract your efforts to quit. Most individuals who gain weight while quitting gain less than 10 pounds. Eat a healthy diet and stay active. Talk with your doctor about medications that may help delay weight gain (Centers for Disease Control, 1996b).

Activity Ideas

Need ideas for your tobacco prevention programs? Try the following activities in your programming for a little impact. These visual activities and demonstrations can help your participants remember what you've taught them.

How Much Tar?

Demonstrate the amount of tar that a one pack-a-day smoker would inhale in one year (approximately one cupful, according to the American Cancer Society). Pour one cup of thick, dark syrup or molasses slowly into a tall, thin, clear container. Let participants guess when you will stop pouring. Ask participants if they were surprised at the amount. Ask participants what would happen if this were a two pack-a-day smoker (Scheer, 1996)?

Tar's Effects

Dramatize the effects tar has on the cilia that line the trachea and bronchi. Have participants stand shoulder-to-shoulder and pass 12 stacked books quickly down the line (keep the books stacked, don't pass individually). Next, while in the same line shoulder-to-shoulder, have participants pretend they are standing in gooey tar. Provide some resistance by holding participants arms as they pass the books.

Explain that the cilia that line the trachea and bronchi act like sweepers to clean the lungs of foreign particles. Tar from cigarettes, however, can paralyze the cilia, rendering them unable to clean the lungs (Scheer, 1996).

Try It, You'll Like It

Divide participants into three groups:

  1. Risk behavior group -- This group participates in an action that may be harmful to themselves or others.
  2. Risk situation group -- For this group, another person's behavior threatens the health of the group or individual.
  3. Healthful behavior group -- This group practices healthful behaviors, regardless of the actions of group 1 or 2.

Give each person in groups 1 and 2 a Tootsie Roll. No one in group 3 gets a Tootsie Roll. Explain that peer pressure is the influence that a person your age uses to encourage you to make decisions they want you to make. Explain that group 1 is to eat their Tootsie Rolls in front of group 2. While enjoying the candy, they are to encourage members of group 2 to unwrap and eat their Tootsie Rolls. They are to be as convincing as possible. After a few minutes stop to see if any group 2 members have eaten their candy. Discuss the kinds of pressure members of group 1 used to try to encourage them to do so.

Next, have members of group 2 who did not eat their Tootsie Roll unwrap them and take a small bite. Then they are to hold the remaining piece of candy near their mouth without eating it. Again, ask members of group 1 to encourage/pressure group 2 members to eat their candy. After a few minutes stop and ask members of group 2 if they were more tempted to eat the Tootsie Roll before or after they unwrapped it and had a small bite.

Take group 3 members aside so that the other groups cannot hear your instructions. Tell members of group 3 to say "No, I do not want to eat the Tootsie Roll" each time they are pressured by a member of group 1 or 2. Instruct them not to touch the Tootsie Roll. After they are pressured three times, they are to move away from the person offering them the candy.

Now, give members of groups 1 and 2 Tootsie Rolls and instruct them to pressure/encourage members of group 3 to eat the candy.

Discuss the results of the entire scenario. When members of group 1 pressured group 2, what convincing techniques were used? After group 2 unwrapped and took a small bite of the candy, was it more tempting to continue eating the Tootsie Roll? Explain that it usually is, which is why it is important to set limits on which is why it is important to set limits on most behaviors to avoid participating in risk behaviors in which you have previously said you would not participate.

Discuss what happened when group 3 members were pressured. The members avoided the risk behavior by firmly saying "No." They also avoided the behavior by not touching the Tootsie Roll. Members of group 3 left the situation when the pressure continued.

This activity can be used related to tobacco use, as well as to other risk behaviors (adapted from Meeks, et. Al., 1995).

Cash or Credit?

Prepare ahead for this activity by getting the prices of several brands of cigarettes and smokeless tobacco products.

Begin by reviewing the health consequences of using tobacco products with your participants.

Share the price information you've gathered with participants. Have participants compute the following costs:

Calculate the same for 1, 2, and 3 packages of snuff.

Write the final figures on a board for all to see. On the same board, have participants list prices of items they need, would like to have, or entertainment they would like to enjoy (e.g., compact discs, concerts, movies, soccer shoes, new coat, etc.).

Divide participants into six groups, where group 1 represents those who smoke one pack of cigarettes per day, group 2 represents those who smoke two packs of cigarettes per day, group 3 represents those who smoke three packs of cigarettes per day, group 4 represents those who use one package of snuff per day, group 5 represents those who use two packages of snuff per day, and group 6 represents those who use three packages of snuff per day.

Using construction paper, scissors, and markers, have participants create a credit voucher/memo for the amount of money that could be saved by not purchasing these tobacco products. On the opposite side of the credit, have participants list the purchases that might be made and the prices of each. All purchases must be healthful.

Have each group share the amount their credit voucher is worth and the healthful purchases they could have made (adapted from Meeks, et. Al., 1995).

Extension Resources

County Extension Agents -- need resources for your tobacco free programming? Extension has so many great exhibits and teaching resources available that they are too numerous to mention here. You can go to the Cancer Prevention Resources Section on the Family and Consumer Sciences website for all your resource needs at http://fcs.tamu.edu/health/.

Also, don't forget about the following websites designed by and for youth:

Websites with Reliable Information

References

HealthHints topic index | HealthHints issue date index | Health Information for Texans | FCS Home

Texas AgriLife Extension Service

Last updated: 7 January, 2008

You will need the free Adobe Reader in order to view and print Adobe Portable Document Format (PDF) files. If you do not have Adobe Reader, you may download the software from the Adobe web site, and install it on your computer.

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.