A Comprehensive Approach to Tobacco Prevention & Cessation: … · 2015-10-05 · Ten tactics other...

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A Comprehensive Approach to Tobacco Prevention & Cessation: Tools for Rhode Island Schools Resources

Transcript of A Comprehensive Approach to Tobacco Prevention & Cessation: … · 2015-10-05 · Ten tactics other...

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A Comprehensive Approach to Tobacco Prevention & Cessation:

Tools for Rhode Island Schools

Resources

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Tobacco Prevention in Health Education Health Literacy for All Students: The Rhode Island Health Education Framework encompasses the state’s health education standards. All elementary and secondary schools in Rhode Island are required to align their health education to this framework, as well as to the accompanying document, Rhode Island Comprehensive Health Instructional Outcomes, as required by the Rules and Regulations for School Health Programs. These two documents lay out what all RI students should know and be able to do as a result of K-12 health education. The Framework defines the seven health education standards broadly. The Outcomes provides more detail, broken out by health content area. The seven Rhode Island Health Education Standards are:

1. Students will understand the concepts related to health promotion and disease prevention as a foundation for a healthy life.

2. Students will demonstrate the ability to access valid health information and health-promoting products and services.

3. Students will demonstrate the ability to practice health-enhancing behaviors and reduce health risks.

4. Students will analyze the influence of culture, media, technology and other factors on health.

5. Students will demonstrate the ability to use interpersonal communication skills to enhance health.

6. Students will demonstrate the ability to use goal-setting and decision-making to enhance health.

7. Students will demonstrate the ability to advocate for personal, family, community, and environmental health.

In the Comprehensive Health Instructional Outcomes, tobacco is primarily covered under “Substance Use and Abuse Prevention” and the “Disease Prevention and Control” health content areas. Links:

• Health Literacy for All Students: The Rhode Island Health Education Framework http://www.thriveri.org/documents/RI_HE_Framework.pdf

• Rhode Island Comprehensive Health Instructional Outcomes http://www.thriveri.org/documents/RI_CHI_Outcomes.pdf

• Rules and Regulations for School Health Programs http://www.thriveri.org/documents/Rules_Regs_School_Health.pdf

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Effective Tobacco Prevention Curricula Evidence-based Tobacco Prevention Curricula The federal Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a searchable database of curricula and programs that have evidence of being effective at preventing youth substance abuse (including tobacco) http://nrepp.samhsa.gov/ The Rhode Island Department of Health Tobacco Control Program strongly encourages districts to adopt one of these three curricula at the middle school level:

1. Project Towards No Tobacco Use (TNT) http://pub.etr.org/ProductDetails.aspx?id=450000&prodid=R521

2. All Stars http://www.allstarsprevention.com/

3. Project Success http://www.sascorp.org/

Characteristics of Effective Health Education Curricula Curricula that have been shown in research studies to be effective in delaying or preventing tobacco use have certain elements in common. These curricula:

1. Focuses on specific behavioral outcomes. 2. Is research–based and theory-driven. 3. Addresses individual values and group norms that support health–

enhancing behaviors. 4. Focuses on increasing the personal perception of risk and harmfulness of

engaging in specific health risk behaviors as well as reinforcing protective factors.

5. Addresses social pressures and influences. 6. Builds personal competence, social competence, and self efficacy by

addressing skills. 7. Provides functional health knowledge that is basic and accurate, and

directly contributes to health–promoting decisions and behaviors. 8. Uses strategies designed to personalize information and engage students. 9. Provides age–appropriate and developmentally–appropriate information,

learning strategies, teaching methods, and materials. 10. Incorporates learning strategies, teaching methods, and materials that are

culturally inclusive. 11. Provides adequate time for instruction and learning. 12. Provides opportunities to reinforce skills and positive health behaviors. 13. Provides opportunities to make positive connections with influential others. 14. Includes teacher information and plans for professional development and

training that enhances effectiveness of instruction and student learning. From: Centers for Disease Control & Prevention http://www.cdc.gov/healthyyouth/SHER/characteristics/index.htm

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Trainings to be Administered: Training For Whom Purpose General Tobacco Information

School staff, parents/parent organizations, student leaders, and community members

To give background information on the dangers of tobacco use, and communicating the need for an enforced policy

School Tobacco Policy

School staff, parents/parent organizations, student leaders, and community members

To inform all of the tobacco policy and of their responsibilities pertaining to it

Enforcement All school staff, law enforcement officers

To communicate how enforcement will take place and the duties therein

Curriculum

Teachers specifically responsible for teaching tobacco prevention curriculum

To enable teachers to become proficient in the tobacco prevention curriculum they will be teaching

Cessation

Cessation coordinators, school nurse teachers, student assistance counselors, other mental health or social service providers

To train cessation program facilitators in the chosen program

Youth Empowerment Peer leaders, staff working with peer leader groups

To empower youth to defend themselves against tobacco, teach other youth and get involved with other activities

* Building Networks and Coalitions

School Tobacco Prevention Team, advisory committee or others interested

To build capacity in developing and/or improving diverse community partnerships

*Optional training ideas Adapted from: Utah Tobacco Prevention & Control Program. A School’s Guide to Comprehensive Tobacco Control.

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thrive e-Academy

ONLINE PROFESSIONAL DEVELOPMENT FOR RI TEACHERS OF HEALTH

Preventing Youth Tobacco Use:

Promising Curricula & Other Strategies

• Open to all Rhode Island Teachers of Health • No Registration Fee! • Earn 30 Contact Hours upon successful

completion! • Flexible schedule… no need to log in at any

specific times • All learning modules and assignments take place

on-line. • Must have computer with Internet access

(preferably high-speed) and MS Word • Other software can be downloaded for free (e.g.

Adobe Reader & Flash Player) • Must complete weekly assignments & participate

actively in online discussions

Sponsored by the RI Departments of Education and Health and RIEAP/Student Assistance Services

Course Facilitators

1. Jan Mermin - Health Education Specialist, Rhode Island Department of Education

2. Laura Hosley - Tobacco Prevention & Control Project Manager, RIEAP/Student Assistance Services

Course Goal Participants will gain up-to-date information, knowledge, resources and skills necessary to: 1. Teach tobacco effectively, following the Rhode

Island Health Education Framework; 2. Implement other tobacco prevention and

intervention activities; and 3. Support youth in tobacco cessation.

Course Objectives Participants will be able to:

List the health consequences of smoking, smokeless tobacco, and secondhand smoke

Identify the economic, social, financial, legal, and cosmetic costs of tobacco

Explain the physiology and psychology of addiction and how nicotine affects the brain

Locate local and national statistics on tobacco use and exposure among youth

Identify the risk factors of tobacco use Define evidence-based or model curricula Identify at least three model tobacco curricula

and the advantages of each List at least ten elements of effective prevention

curricula Describe how tobacco fits into the seven RI

health education standards Identify what students in each grade span

should know and be able to do, related to tobacco

Appreciate the limitations of curricula and the importance of other approaches to prevention

Define and explain how environmental strategies may prevent or intervene with tobacco use

Find and analyze the effectiveness of a district or school tobacco policy

Identify ways to include parents in lowering youth’s tobacco risks

Identify the benefits of quitting tobacco Access resources to assist people who want to

quit smoking Access other web-based tobacco resources

For course dates: go to www.thriveri.org/moreinfo/professional_development.html

To register: go to www.thriveri.org/pd/course_registration.htm For more information: contact Jan Mermin at 401-222-8954 or [email protected]

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Got A Minute? Give It to Your Kid

Getting more involved with your preteen today will help you stay connected tomorrow. Not only that, it will help your child make better decisions, even about things like smoking, which kills one out of every three people it hooks. We know it's not always easy. We know there's not always time. Ten tactics other parents have used to stay involved in their child's life: 1. Schedule time for you and your child. Plan for it, like you might a business meeting. Write an appointment with your child on your calendar. Most importantly: Hold yourself to it. Even scheduling a short time–say, 10 minutes–can show your child he or she is important. 2. Catch your child doing something right. We often focus on the bad things our kids do. "Catching" your child doing something right, then offering a compliment, can encourage good behavior and keep the communication lines open. This can be as easy as saying, "hey, your room looks great." 3. Prove you're listening: Ask questions. Pretending to listen is easy. Really listening is tougher. You have to pay attention and ask follow-up questions. If you rarely listen to your child when he or she wants to talk, your child will be less likely to open up when you really want to connect. 4. Post a family calendar. A good way to keep your family connected is to write everything down: soccer practice, hair appointments, work schedule, and family outing to the park. In this way, you can better monitor your child's plans, as he or she gets older and more independent. In the meantime, your child will feel more connected to you simply by knowing where you are. 5. Create rules, and then enforce them. Rules are the boundaries that every kid needs. Say yes when you can, but make no stick. Only the rules you enforce will matter. Don't set rules you do not intend to enforce. That will only create confusion. 6. Regularly share a meal with your preteen. Not everybody has the luxury of eating a regular meal with his or her child. If you do, take advantage of it; teens that report eating meals with their family are less likely to smoke or use drugs. Even if you cannot always eat with your kids, maybe you can find a few days a week when you can. It will encourage each of you to catch up with the other. One other suggestion: Forget the television. It inhibits conversation. 7. Share your day. Every parent has heard it: "How's your day,'' the parent asks the child. "Fine," the child responds. Then silence. One way to help your child open up is to share a brief story about your day first, especially if you saw something funny. 8. Write your child a thank-you note. Some preteens say one of the reasons they know their parents care is because they get thank-you notes left at the dinner table, stuck in a book, or slipped under a pillow. You don't need to thank your child for anything really big. It can be for setting the table, helping a friend, or saying something nice. 9. Ask him for advice. Sure, you may not consult your child about approaching your boss or refinancing your home. But there are lots of smaller issues where your child will appreciate being asked for input. What to wear to a school event or where to position the television are two examples. It shows you value their opinion, especially if you occasionally act on their advice. 10. Give your preteen family responsibilities. Assign your preteen a chore that helps the whole family, like organizing your home recycling effort or caring for the dog. By giving your child responsibilities you are implicitly saying you trust his or her competence and are allowing them to feel more "adult" -the same benefit cigarettes falsely offer teens.

http://www.cdc.gov/tobacco/parenting/index.htm

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TIPS ON RAISING YOUR PRE-TEENS AND TEENS

Let's Talk About...

Helping Your Child Say "No" to Tobacco

Every day tobacco companies get about 3,000 new customers – kids1. Cigarette smoking by children and teenagers in the United States is a major public health problem. Smoking in youth seems to determine lifetime smoking habits, as most adult smokers started when they were preteens or teenagers. There's also evidence that people who begin smoking before the age of 20 have the highest rate and earliest beginnings of long-term illnesses such as heart disease and high blood pressure.

Tobacco is the number one preventable cause of death in the United States. Each day in the United States, approximately 4000 youths aged 12 to 17 try their first cigarette.2 If current patterns of smoking continue, about 6.4 million of today’s children will die too soon from a smoking-related disease.3 Although the percentage of high school students who smoke has gone down in recent years, rates remain high: 22% of high school students report cigarette use.4

Here in Rhode Island:

• 19% of high school students smoke; • 2,600 kids under age 18 become new smokers each year; • 53,000 kids are exposed to secondhand smoke each year; and • 2.7 million packs of cigarettes are bought or smoked by kids each year.

Research shows that if your child does not use tobacco products before 18 years of age it is not likely that he or she will begin using them later in life.

Children are learning about smoking and tobacco everyday—in school, from friends, from TV and movies. As parents, you can play an important role in helping your child understand the dangers of tobacco use, and teaching them how to stay away from it.

• Be a good role model. Set a good example for your children by not smoking or using other tobacco products – quit now or never start. If you smoke, try to stop right away. In the meantime, don’t use tobacco in front of your children. Don’t offer it to them and don’t leave it where they can easily get it.

• Talk to your children about smoking and tobacco. Start talking to your children about tobacco use at age five or six, and keep talking through their high school years. Many kids start using tobacco by age 11, and many are

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addicted by age 14. Look for opportunities to talk about the dangers of smoking. Talk directly to children about the risks of tobacco use; if friends or relatives died from tobacco-related illnesses let your kids know. Bring up the subject if you see something about smoking on TV or in the newspaper. Discuss with your kids how tobacco companies use billboards, magazines, movies, and TV try to make smoking look cool.

• Teach your children how to say “no”. Know if your kids’ friends use tobacco. Talk about ways to say “no” to tobacco. Young people need encouragement and support to stay tobacco free. Help them make a list of reasons not to smoke. Say, “Lets practice saying no. Pretend I’m a friend offering you a cigarette.” Teach your children to stand up for what they believe, which can earn them respect from good friends.

• Protect children from secondhand smoke. Make your home smoke-free. Ask people who visit not to smoke inside your home. Avoid smoking in the car or other closed areas. Teach your children the dangers of secondhand smoke and ways to avoid exposure to somebody else’s smoke.

REMEMBER: You can make a difference! Help your children grow up tobacco free!

If your child is smoking or chewing tobacco, it will be up to him or her to quit. But you can help. Here’s how:

• Try to avoid threats and punishment. Find out why your child is smoking. Your child may be influenced by peer pressure or may want to get your attention. Talk to your child about ways to say “no” to tobacco.

• Show your interest in a helpful way. Find out what changes can be made in your child’s life to help him/her stop.

• If you smoke, quit. If you did smoke and have already quit, talk to your child about your experience. Tell them what helped you quit.

• Talk to your child’s doctor. He or she may be able to help. • Suggest to your child’s friends that they quit together, if a group of them

smoke. Offer to help and support them. • Be supportive. You and your child need to prepare for the mood swings and

crankiness that can come with nicotine withdrawal. • Finally, reward your child when he or she quits. Plan something special for

you to do together. Helping your child is one of the best parenting activities you could ever do.

Resources:

Rhode Island Department of Health Tobacco Control Program:

401-222-7463

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American Lung Association Resource Center:

401-421-6487

http://www.trytostop.org/

www.cdc.gov/tobacco

http://www.parentlinkri.org/links/Tip18.php

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Consejos para criar sus adolescentes y pre-adolescentes

Hablemos sobre...

Cómo ayudar a que su hijo le diga “No” al tabaco

Todos los días, las compañías tabacaleras adquieren 3.000 clientes nuevos – muchachos .l El fumar cigarrillos entre niños y adolescentes es un problema de salud pública muy grave en los Estados Unidos. El comenzar a fumar durante la adolescencia parece ser un factor determinante de tal hábito ya que la mayor parte de adultos que fuman comenzaron a hacerlo antes o durante su adolescencia. También existe evidencia que las personas que comienzan a fumar antes de cumplir los 20 años, tienen la tasa más alta y temprana de inicio de enfermedades prolongadas tales como enfermedades cardiacas y alta presión arterial.

El tabaco es la causa prevenible número uno de muertes en los Estados Unidos. Diariamente en los Estados Unidos, aproximadamente 4000 adolescentes entre las edades de 12 y 17 fuman su primer cigarrillo2. De continuar con los patrones actuales, cerca de 6.4 millones de los niños de ahora morirán pronto de una enfermedad relacionada al cigarrillo3. Aunque el porcentaje de alumnos de secundaria que fuman ha bajado en los últimos años, las tasas continúan altas: un 22% de alumnos de secundaria reportan fumar cigarrillos4.

Aquí en Rhode Island:

• El 19% de alumnos de secundaria fuman; • Cada año, 2.600 niños menores de 18 años se convierten en fumadores; • Cada año, 53.000 niños son expuestos a humo de segunda mano; • Cada año, 2.7 millones de paquetes de cigarrillos son comprados o

fumados por niños.

Los estudios demuestran que si su hijo no usa productos de tabaco para cuando cumpla los 18 años, existe poca probabilidad que los comience a utilizar después. Diariamente, los niños aprenden el fumar y el tabaco. Lo aprenden en la escuela, de amigos, de la televisión y las películas. Como padre de familia, usted puede jugar un papel decisivo para ayudar a su hijo a entender los peligros del uso del tabaco y enseñarles cómo mantenerse alejados del mismo.

• Sea un buen modelo a seguir. Dé un buen ejemplo a sus hijos al no

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fumar ni utilizar productos derivados del tabaco, deje de fumar o nunca comience. Si fuma, trate de dejar de hacerlo inmediatamente. Mientras tanto, no use tabaco enfrente de sus hijos. No se lo ofrezca y no lo deje donde ellos puedan tener fácil acceso.

• Hable con sus hijos sobre el fumar y el tabaco. Comience a hablar con sus hijos de este tema cuando tengan entre cinco o seis años de edad y continúe haciéndolo durante todos sus años en secundaria. Muchos niños comienzan a fumar a la edad de 11 años y, para los 14, ya son adictos. Busque oportunidades para hablar con ellos de los peligros de fumar. Hábleles directamente de los riesgos de usar tabaco. Si tiene amigos o familiares que murieron a causa de enfermedades relacionadas al uso del tabaco, dígaselos. Saque a relucir el tema si ve algo sobre el fumar en la televisión o los periódicos. Hable con sus hijos sobre cómo las compañías tabacaleras utilizan las carteleras, revistas, películas y la televisión para dar la impresión que fumar es algo sofisticado.

• Enseñe a sus hijos cómo decir “no”. Averigüe si los amigos de sus hijos fuman. Hable sobre maneras en las que se puede decir “no” al uso del tabaco. Los jóvenes necesitan que se les dé aliento y apoyo para mantenerse alejados del tabaco. Ayúdeles a crear una lista de razones por las que no se debe de fumar. Dígales, “vamos a practicar a decir no. Imagínate que soy uno de tus amigos ofreciéndote un cigarrillo.” Enseñe a sus hijos a defender en lo ellos creen, lo cual les ganará el respeto de sus buenos amigos.

• Proteja a sus hijos del humo de segunda mano. Haga que su hogar sea un lugar libre de humo. Pídale a las personas que les visitan que no fumen dentro de su casa. Evite fumar en el carro o en lugares cerrados. Enseñe a sus hijos los peligros del humo de segunda mano y las maneras de evitar estar expuestos al humo del cigarrillo de otras personas.

RECUERDE

¡Usted puede hacer la diferencia! ¡Ayude a su hijo a crecer libre de tabaco!

Si su hijo fuma o masca tabaco, será decisión de él/ella dejar de hacerlo. Pero, ayúdele. Aquí le sugerimos como:

• Trate de evitar amenazas o castigos. Averigüe las razones por las que su hijo fuma. Pudiera estar bajo la presión de compañeros o quizás quiera llamar la atención suya. Hable con su hijo sobre las maneras de decir que “no” al uso del tabaco.

• Demuestre su interés de forma positiva. Averigüe qué cambios se pueden hacer en la vida de su hijo para ayudarle a dejar de fumar.

• Si usted fuma, deje de hacerlo. Si fumaba y ya no lo hace, hable con su

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hijo sobre su experiencia. Dígale que le ayudó a dejar de hacerlo. • Hable con el médico de su hijo. Quizá pudiera ayudarle. • Sugiera a los amigos de su hijo que dejen de fumar juntos, si es un grupo

de ellos que lo hace. Ofrézcales su ayuda y apoyo. • Demuestre su apoyo. Usted y su hijo necesitan prepararse para los

cambios de ánimo y el mal genio que ocurre cuando se deja la nicotina. • Por último, premie a su hijo cuando deje de fumar. Planee algo especial

que los dos puedan hacer. Ayudar a su hijo es una de las mejores actividades que como padre de familia usted puede hacer.

13000/day new customers: JAMA, January 6, 1989

2Substance Abuse and Mental Health Services Administration. Summary of findings from the 2001 National Household Survey on Drug Abuse: Volume II. Technical appendices and selected data tables. Rockville, Maryland: U.S. Department of Health and Human Services, 2002;NHSDA Series H-18; DHHS publication no. (SMA) 02-3759.

3CDC. Office of Smoking and Health, 2002 calculations based upon: Smoking attributable mortality and years of potential life loss— United States, 1984. Morbidity and Mortality Weekly Report 1997;46:444–451.

4A Grunbaum JA, Kann L, Kinchen SA, Ross JG, Hawkins J, Lowry R, et al. Youth Risk Behavior Surveillance-United States, 2003. Morbidity and Mortality Weekly Report 2004;53(SS-2):1–95.

5http://www.tobaccofreekids.org/

http://www.parentlinkri.org/spanish/Tips/tip-tabaco.php

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youyouwhat it means to

The Health Consequences of

Smoking

The 2004Surgeon General’s Report

U.S. DEPARTMENTOF HEALTH ANDHUMAN SERVICES

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aboutaboutthe surgeon general’s report

The Surgeon General is appointed by the President of the United

States to help promote and protect the health of our citizens. As the

nation’s highest-ranking public health offi cer, the Surgeon General

can direct studies on health risks—such as smoking.

The 2004 Surgeon General’s Report on the Health Consequences of

Smoking was prepared by 19 of the country’s top scientists, doctors,

and public health experts. The full report is nearly 1,000 pages

long and took more than 3 years to complete. It is written for a

scientifi c audience. However, the Surgeon General believes that the

fi ndings are very important to everyone and asked that this booklet

be created. This booklet explains what the report says and what it

means to you.

Suggested Citation:

U.S. Department of Health and Human Services. The Health Consequences of Smoking: what it means to you. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Offi ce on Smoking and Health, 2004.

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Since the fi rst Surgeon General’s report on smoking and

health in 1964, medical experts have written 27 more

reports for the Surgeon General on tobacco use. In each

report, leading scientists have found that using tobacco

causes people to become sick, disabled, or to die.

This report goes even further in detailing the bad health effects of

smoking. Everyone knows smoking hurts you. This report shows

that it is worse than you know.

1

Costs of Smokingin Dollars and Lives

Deaths Since 1964

Costs to the Nation

Number of Adults and High School Students Who Smoke

Number of Young People Who Smoke Their 1st Cigarette

12 Million Americans Dead

$157.7 Billion Each Year

About 1 Out of Every 4 Adults and Students

More Than 4,000 Each Day

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The Surgeon General of the United States, working with a

team of leading experts on smoking and health, released

a new report in 2004. After reviewing scientific evidence,

researchers reached these important conclusions:

Smoking harms nearly every organ of your body. It causes diseases and worsens your health.

Quitting smoking has many benefits. It lowers your risk for diseases and death caused by smoking and improves your health.

Low-tar and low-nicotine cigarettes are not safer to smoke.

The list of diseases that we know are caused by smoking has grown even longer. The list now includes cancers of the cervix, pancreas, kidneys, and stomach, aortic aneurysms, leukemia, cataracts, pneumonia, and gum disease.

The 2004 Surgeon General’s

report has new information

about how smoking harms

your health. A new database of

more than 1,600 articles cited in

this report is available on the Internet.

By going to the CDC Web site at

www.cdc.gov/tobacco/sgr/sgr_2004/ you

can search many of the studies cited in this

2

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report. Topics include cancer, cardiovascular diseases, respiratory

diseases, reproductive effects, and other harmful health effects.

seeseethe studies for yourself at www.cdc.gov/tobacco/sgr

3

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smokingsmokingcauses cancer

Cancer was among

the first diseases

found to be caused

by smoking.

Cancer was among

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Cancer is the second leading cause of death in the United

States. One out of every four people in this country dies

because of cancer. In 2003, researchers estimated that

more than half a million Americans—that’s over 1,500 people a day—

would die of cancer. The cost of treating cancer in the United States

is overwhelming. In 2002, cancer cost our nation over $170 billion.

This included more than $110 billion in lost work by people who were

disabled or who died, and at least $60 billion for medical treatments.

Cancer was among the first diseases found to be caused by smoking. The

earliest major studies, carried out in the 1950s and 1960s, focused on

lung cancer. The number of lung cancer cases among smokers reached

very high levels during that time.

Since the first Surgeon General’s report on smoking in 1964

concluded that smoking causes lung cancer, the list of diseases linked

to smoking has grown to include cancers in organs throughout

the body. Your risk for these cancers increases with the number of

cigarettes you smoke and the number of years you smoke. Your risk

decreases after quitting completely.

5

Your risk

for cancer

increases

with the

number of

cigarettes

you smoke

and the

number of

years you

smoke.

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Smoking causes cancer in organs throughout your body.

Esophagus

Mouth

Throat

Larynx (Voice Box)

Cervix

KidneyPancreas

Lung

Stomach

Bladder

Leukemia (Blood)

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facts facts you should knowSmoking causes cancers of the mouth, throat, larynx (voice box), lung, esophagus, pancreas, kidney, and bladder.

Smoking causes cancers of the stomach, cervix, and acute myeloid leukemia, which is a cancer of the blood.

Cigarette smoking causes most cases of lung cancer. Smokers are about 20 times more likely to develop lung cancer than nonsmokers. Smoking causes about 90 percent of lung cancer deaths in men and almost 80 percent in women.

Using both cigarettes and alcohol causes most cases of larynx cancer.

Certain agents in tobacco smoke can damage important genes that control the growth of cells and lead to cancer.

Smoking low-tar cigarettes does not reduce your risk for lung cancer.

7

Smoking causes

90% of lung cancer

deaths in men and

80% in women.

Stomach

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smoking smoking causes cardiovascular diseases

Cigarette smoke

damages the cells

lining your blood

vessels and heart.

Cigarette smoke

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Heart disease and stroke are cardiovascular (heart and

blood vessel) diseases caused by smoking. Heart

disease and stroke are also the first and third leading

causes of death in the United States.

More than 61 million people in the United States suffer from some

form of heart and blood vessel disease. This includes high blood

pressure, coronary heart disease, stroke, and congestive heart failure.

Nearly 2,600 Americans die every day as a result of cardiovascular

diseases. This is about 1 death every 33 seconds. You are up to four

times more likely to die from heart disease if you smoke. In 2003,

heart disease and stroke cost the United States an estimated $351

billion in health care costs and lost productivity from death and

disability.

The link between smoking and heart disease was noted in the first

Surgeon General’s report in 1964. Later reports revealed a much

stronger connection. Researchers found that smoking is a major

cause of diseases of blood vessels inside and outside the heart.

Most cases of these diseases are caused by atherosclerosis, a

hardening and narrowing of the arteries. Damage to your arteries

and blood clots that block blood flow can cause heart attacks or

strokes.

9

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Cigarette smoking speeds up this process even in smokers in their

20s. Cigarette smoke damages the cells lining the blood vessels

and heart. The damaged tissue swells. This makes it hard for blood

vessels to get enough oxygen to cells and tissues. Your heart and

all parts of your body must have oxygen. Perhaps most important,

cigarette smoking can increase your risk of dangerous blood clots,

both because of swelling and redness and by causing blood platelets

to clump together.

Cigarettes aren’t the only dangerous kind of tobacco. Even smokeless

tobacco can lead to heart and blood vessel disease.

10

Stroke

Heart Disease

Aortic Aneurysm

Peripheral Vascular Disease(legs, hands, feet, etc.)

Your heart and blood vessels are damaged by tobacco smoke.

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facts facts you should know

11

Coronary heart disease is the leading cause of death in the United States.

You are up to four times more likely to die from coronary heart disease if you smoke.

In 2000, about 1.1 million Americans had heart attacks.

Even with treatment, 25 percent of men and 38 percent of women die within one year of a heart attack.

Smoking causes atherosclerosis, or hardening and narrowing of your arteries.

Smoking causes coronary heart disease.

Smoking low-tar or low-nicotine cigarettes rather than regular cigarettes does not reduce the risk of coronary heart disease.

Smoking causes strokes.

Smoking causes abdominal aortic aneurysm, a dangerous weakening and ballooning of the major artery near your stomach.

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smokingsmokingcauses respiratory diseases

Smoking causes more

than 90 percent of

deaths from COPD

each year.

Smoking causes more

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Smoking harms your lungs. If you smoke, your lungs can’t

fight infection well and this causes injuries to lung tissues.

Tissue injury leads to chronic obstructive pulmonary disease

(COPD), sometimes called emphysema, and other respiratory

diseases. People with COPD slowly start to die from lack of air.

COPD is the fourth leading cause of death in the United States. It is

responsible for more than 100,000 deaths per year. Smoking causes

more than 90 percent of these deaths.

Most sudden respiratory illnesses, such as bronchitis or pneumonia,

are caused by viral or bacterial infections. They are usually diagnosed

as upper respiratory tract infections (nose, throat, and larynx) or

lower respiratory tract infections (below the larynx). Smokers have

more upper and lower respiratory tract infections than nonsmokers.

This happens because smoking damages your body’s defenses against

infections.

Normally, your body helps keep dangerous viruses and bacteria out

by clearing your nose with mucus. But this defense takes almost

twice as long in smokers as in nonsmokers. Once viruses and bacteria

are inside your body, cells in your immune system usually kill them

and prevent infection. But in smokers, some of the cells that destroy

germs are decreased while others are increased. This imbalance

makes a smoker’s immune system weaker.

13

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Chronic lung diseases are long lasting. They usually affect your

airways and the tiny sacs where oxygen is absorbed into your lungs.

Lung injury in smokers begins when smoke causes lung tissues to

become red and swollen. This releases unwanted oxygen molecules

that damage the lung. It also causes enzymes to be released that can

eat delicate lung tissue.

Normally, your body fights damaging oxygen molecules with

antioxidants. It fights the destructive enzymes with defensive

enzymes. Smoking makes antioxidants and defensive enzymes less

effective. Over time, redness and swelling cause scarring and destroy

your lungs, causing COPD.

Smoking harms people of all ages.

Infants. Effects of smoking on lung development can begin before birth.

When mothers smoke during pregnancy, it hurts their babies’ lungs.

Children. Children and teens who smoke are less physically fit and have

more breathing problems. Smoking at this age can slow lung growth. If

you smoke as a teenager, your lung function begins to decline years earlier

than nonsmokers. This hurts you when you want to be active.

All Ages. At any age, smoking damages your lungs. The more

cigarettes you smoke, the faster this happens. Air pollution, being

overweight, and not eating enough fresh fruit increase your risk of

lung disease even more if you smoke. However, if you quit smoking,

your lungs can gradually return to normal for your age.

14

Mothers who

smoke during

pregnancy

hurt their

babies’ lungs.

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Smoking causes injury to the airways and lungs, leading to a deadly lung condition.

Smokers are more likely than nonsmokers to have upper and lower breathing tract infections.

Mothers who smoke during pregnancy hurt the lungs of their babies.

If you smoke during childhood and teenage years, it slows your lung growth and causes your lungs to decline at a younger age.

Smoking is related to chronic coughing, wheezing, and asthma among children and teens.

Smoking is related to chronic coughing and wheezing among adults.

After stopping smoking, former smokers eventually return to normal age-related lung function.

facts facts you should know

15?Do you know anyone who has been diagnosed with

COPD? Do you know if they smoked cigarettes?

thinkthink

??thinkthinkabout it

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smoking smoking harms reproduction

Babies whose mothers

smoked during pregnancy

weigh less and have a

greater risk of infant

death and disease.

Babies whose mothers

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Smoking harms every phase of reproduction. Women who

smoke have more difficulty becoming pregnant and have

a higher risk of never becoming pregnant. Women who

smoke during pregnancy have a greater chance of complications,

premature birth, low birth weight infants, stillbirth, and infant

mortality.

Low birth weight is a leading cause of infant deaths. More than

300,000 babies die each year in the United States because of low

birth weight. Many of these deaths are linked to smoking. Even

though we now know the danger of smoking during pregnancy,

fewer than one out of four women quit smoking once they

become pregnant.

High Risk Pregnancy. Smoking makes it more difficult for women

to become pregnant. Once they are pregnant, women who smoke

have more complications. One complication is placenta previa, a

condition where the placenta (the organ that nourishes the baby)

grows too close to the opening of the womb. This condition

frequently requires delivery by caesarean section. Pregnant women

who smoke are also more likely to have placental abruption. In this

condition, the placenta separates from the wall of the womb earlier

than it should. This can lead to preterm delivery, stillbirth, and early

infant death. If you smoke while you are pregnant, you are also at a

17

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higher risk that your water will break before labor begins. All these

conditions make it more likely that, if you smoke, your baby will be

born too early.

Low Birth Weight Babies. Babies of mothers who smoked during

pregnancy have lower birth weights, often weighing less than 5.5

pounds. Low birth weight babies are at greater risk for childhood

and adult illnesses and even death. Babies of smokers have less

muscle mass and more fat than babies of nonsmokers. Nicotine

causes the blood vessels to constrict in the umbilical cord and womb.

This decreases the amount of oxygen to the unborn baby. This can

lead to low birth weight. It also reduces the amount of blood in the

baby’s system. Pregnant smokers actually eat more than pregnant

nonsmokers, yet their babies weigh less. If you quit smoking before

your third trimester (the last 3 months), your baby is more likely to

be close to normal weight.

Sudden Infant Death Syndrome. The death rate from sudden infant

death syndrome (SIDS) has fallen by more than half since the “Back

to Sleep” campaign began in the 1990s. This campaign reminds

parents that babies should lie on their backs while sleeping. Yet more

can be done. Babies exposed to secondhand smoke after birth have

double the risk of SIDS. Babies whose mothers smoke before and

after birth are three to four times more likely to die from SIDS.

Babies whose

mothers

smoke before

and after

birth are 3 to

4 times more

likely to die

from sudden

infant death

syndrome.

18

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facts facts you should know

19

Smoking causes lower fertility in women.

Babies of women who smoke are more likely to be born too early.

Smoking during pregnancy causes placenta previa and placental abruption. These conditions can cause a baby to be born too early and then be sick.

The nicotine in cigarette smoke reduces the amount of oxygen reaching the fetus.

Smoking causes reduced fetal growth and low birth weight.

Smoking by the mother can cause SIDS.

?If you were a woman who smokes, would you quit

smoking to help protect the life of your child?

thinkthink

??thinkthinkabout it

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smokingsmokingother effects of

Overall health

in smokers is

poorer than in

nonsmokers.

Overall health

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Smoking damages your health in many other ways. Smokers

are less healthy overall than nonsmokers. Smoking harms

your immune system and increases your risk of infections.

The toxic ingredients in cigarette smoke travel throughout your

body. For example, nicotine reaches your brain within 10 seconds

after you inhale smoke. It has been found in every organ of the body,

as well as in breast milk. If you smoke, your cells will not get the

amount of oxygen needed to work properly. This is because carbon

monoxide keeps red blood cells from carrying a full load of oxygen.

Carcinogens, or cancer-causing poisons, in tobacco smoke bind to

cells in your airways and throughout your body.

Smoking harms your whole body. It increases your risk of fractures,

dental diseases, sexual problems, eye diseases, and peptic ulcers.

If you smoke, your illnesses last longer and you are more likely to

be absent from work. In a study of U.S. military personnel, those

who smoked were hospitalized 28 percent to 55 percent longer

than nonsmokers. And the more cigarettes they smoked, the longer

their hospitalization. Smokers also use more medical services than

nonsmokers.

21

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Among people younger than 65 enrolled in a health maintenance

organization, or HMO, health care costs for smokers were 25

percent higher than for nonsmokers.

22

smokingsmokingalso increases your risk of...

gum disease and tooth loss (half of all cases)

cataracts

respiratory infections

peptic ulcers

hipfractures

sexual and reproductive

problems

being hospitalized(by up to 55%)

complications aftersurgery

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facts facts you should know

23

Smokers are less healthy than nonsmokers.

Smokers are more likely to be absent from work than nonsmokers.

Smokers use medical care services more often than nonsmokers.

After surgery, smokers have more problems with wound healing and more respiratory complications.

For women, smoking causes your bones to lose density after menopause.

Smoking increases your risk of hip fractures.

Smoking causes half of all cases of adult periodontitis, a serious gum infection that can cause pain and tooth loss.

For men, smoking may cause sexual problems.

Smoking increases your risk for cataracts, a leading cause of blindness in the United States and worldwide. Smokers are two to three times more likely to develop cataracts than nonsmokers.

Smoking causes peptic ulcers in smokers with Helicobacter pylori infections. Compared with nonsmokers, smokers with this infection are more likely to develop ulcers and to have complications of an ulcer. In severe cases, this condition can lead to death.

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smoking smoking benefits of not

From 1995 to 1999, smoking

caused about 440,000

people to die early each year

in the United States,

or one in every

five deaths.

From 1995 to 1999, smoking

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Cigarette smoking is the leading cause of preventable

disease and death in the United States. It is also costly

to our nation.

Cigarette smoking has caused an estimated 12 million deaths since

the fi rst Surgeon General’s report on smoking in 1964. These include

4.1 million deaths from cancer

5.5 million deaths from cardiovascular (heart and blood vessel) diseases

1.1 million deaths from respiratory diseases, and

94,000 fetal and infant deaths.

From 1995 to 1999, smoking caused about 440,000 people to die early

each year in the United States. That was one in every fi ve deaths. Adults

who smoke die an average of 13 to 14 years early.

The U.S. Public Health Service has set goals to reduce smoking in our

country by the year 2010. The fi rst goal is to cut smoking rates among

25

The economic burden of cigarette use is enormous. From 1995

to 1999, smoking-related costs totaled $157.7 billion each

year. This fi gure includes more than $75 billion in direct medical

costs for adults (ambulatory care, hospital care, prescription drugs,

nursing homes, and other care), about $82 billion in indirect costs

from lost productivity, and $366 million for neonatal care. This

equals an estimated $3,000 per smoker per year.

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high school aged youth from 22 percent to 16 percent. Among adults,

the goal is to reduce smoking from 23 percent to 12 percent.

If these goals are met, about 7.1 million early deaths will be

prevented after 2010. Although adult and youth smoking rates have

gone down in recent years, the diseases caused by smoking will

continue for many years.

26

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GOALCut youth smoking from

22% to 16%

GOALCut adult smoking from

23% to 12%

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facts facts you should know

27

More than 12 million deaths have been caused by smoking since the fi rst published Surgeon General’s report on smoking in 1964.

Cigarette smoking has caused about 440,000 early deaths each year from 1995 to 1999, or more than 1,200 people every day.

One half of all lifetime smokers will die early because of their decisions to smoke.

The economic costs of smoking in the United States each year from 1995 to 1999 were $157.7 billion.

Meeting our national health goals for reducing smoking will prevent 7.1 million early deaths after 2010.

Adults who smoke lose an average of 13 to 14 years of their lives.

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Compared to smokers, your…

Stroke risk is reduced to that of a person who never smoked after 5 to 15 years of not smoking.

Cancers of the mouth, throat, and esophagus risks are halved 5 years after quitting.

Cancer of the larynx risk is reduced after quitting.

Coronary heart disease risk is cut by half 1 year after quitting and is nearly the same as someone who never smoked 15 years after quitting.

Chronic obstructive pulmonary disease risk of death is reduced after you quit.

Lung cancer risk drops by as much as half 10 years after quitting.

Ulcer risk drops after quitting.

Bladder cancer risk is halved a few years after quitting.

Peripheral artery disease goes down after quitting.

Cervical cancer risk is reduced a few years after quitting.

Low birthweight baby risk drops to normal if you quit before pregnancy or during your fi rst trimester.

the benefitsthe benefitsof quitting

28

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quittingquittingisn’t easy

Most ex-smokers try to quit several times before succeeding. About one-third of smokers who quit for a year may start again. However, the longer you stay quit, the less likely you are to start smoking again.

According to polls, nearly three out of four smokers say that they would like to quit.

Only 19 percent of people who smoke have never tried to quit.

Each year, about 15 million smokers quit for at least a day, but fewer than 5 percent of them are able to stay tobacco-free for 3 to 12 months.

Remember, smokers often try to quit more than once before they succeed.

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Within 20 minutes after you smoke that last cigarette, your body begins a series of changes that continue for years.

20 Minutes After QuittingYour heart rate drops.

12 Hours After QuittingCarbon monoxide level in your blood drops to normal.

2 Weeks to 3 Months After QuittingYour heart attack risk begins to drop.Your lung function begins to improve.

1 to 9 Months After QuittingYour coughing and shortness of breath decrease.

1 Year After QuittingYour added risk of coronary heart disease is half that of a smoker’s.

5 Years After QuittingYour stroke risk is reduced to that of a nonsmoker’s 5-15 years after quitting.

10 Years After QuittingYour lung cancer death rate is about half that of a smoker’s.Your risk of cancers of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases.

15 Years After QuittingYour risk of coronary heart disease is back to that of a nonsmoker’s.

withinwithin20 minutes of quitting...

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31

quitquittips

basicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicbasicstrategies

aboutaboutweight gain

Nibble on low-calorie snacks like carrot sticks, celery, and apples.

Chew gum.

Stretch out your meals. Eat slowly and pause between bites.

After dinner, instead of a cigarette, suck on a hard candy or sip your favorite beverage.

Take a deep breath and exhale slowly. Remember, the desire to smoke will pass.

See your doctor, call a telephone quitline, or join a group program to learn new skills and behaviors to deal with situations where you want to smoke.

Get ready and set a quit date.

Get support and encouragement from family and friends.

Get medication and use it correctly.

Be prepared for relapse or diffi cult situations.

Nearly 80 percent of those who quit smoking gain weight. But 56 percent of people who continue to smoke gain weight, too.

The average weight gain after quitting smoking is just 5 pounds.

The bottom line: The health benefi ts of quitting far exceed any risks from the average weight gain that may follow quitting.

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helpfulhelpfulhelpfulhelpfulhints

To limit weight gain after you quit smoking, eat

a well-balanced diet and avoid extra calories in

sugary and fatty foods. If you crave sweets, eat

small pieces of fruit. Have low-calorie snacks on

hand for nibbling. Drink 6 to 8 glasses of water

each day. Build exercise into your life by walking

30 minutes per day, or choose another exercise

like running, swimming, cycling, or gardening.

Talk to your doctor about an exercise program

that is right for you.

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acknowledgmentsProject Leads and WritersSarah Gregory, Health Communications Specialist, Centers for Disease Control and PreventionPete Xiques, Science Applications International Corporation

Graphic DesignC. Mark Van Hook, Denton Lesslie, Science Applications International Corporation

Editorial AssistanceVickie Reddick, Science Applications International Corporation

A special thank you to Surgeon General Dr. Richard Carmona for his commitment to health literacy and his commissioning of this public document.

Additional thanks to the many people who provided expert advice and suggestions: Dr. Jonathan Samet, Senior Scientifi c Editor of the 2004 Surgeon General’s Report and Professor and Chairman, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University; Dr. Allan Noonan, Senior Advisor, Offi ce of the Surgeon General, DHHS; Craig Stevens, Director of Communications, Offi ce of the Surgeon General, DHHS; Jennifer Cabe, Speechwriter, Offi ce of Public Health and Science, DHHS; Campbell Gardett, Director, News Division, Offi ce of the Secretary, DHHS; Leslie Norman, Managing Editor of the 2004 Surgeon General’s Report, CDC; Peggy Williams, Writer-Editor, Constella Health Sciences; Lynn Hughley, Lead Graphics Specialist, Northrop Grumman Corporation; the CDC Health Literacy Workgroup, co-chaired by Suzi Gates and Dr. P. Lynne Stockton, CDC, Kelly Holton, Lockheed Martin Corporation; Dr. Ruth Parker, Associate Professor of Medicine, Emory University School of Medicine; Dr. Julie Gazmararian, Research Associate Professor, Rollins School of Public Health, Emory University; and the scientifi c and communications staff of the Offi ce on Smoking and Health, CDC.

For more information on smoking and your health, or for advice on how to quit smoking, talk to your doctor.

More facts and advice are available from CDC’s Offi ce on Smoking and Health or on the Web at:

Offi ce on Smoking and HealthMail Stop K-504770 Buford Highway, NEAtlanta, GA 30341-3717770-488-5705, press 3

To fi nd out if your state has a telephone quitline, or to talk to a trained counselor from the National Cancer Institute, call

1-877-44U-QUITor visit the Web at

www.smokefree.gov

www.cdc.gov/tobaccoor

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SmokingSmokingSmokingcancer, death, and you

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Tobacco Resources for Parents ParentLinkRI.org http://www.parentlinkri.org/This site has tips for parents on talking to their teens and preteens, including “Let’s Talk About… Helping your child say ‘No’ to Tobacco” (http://www.parentlinkri.org/links/DisplayTip18.htm) Smoke-free Homes http://www.epa.gov/smokefree/The Environmental Protection Agency has information and resources for families in English and in Spanish about secondhand smoke, particularly in cars and homes, including:

• A brochure (http://www.epa.gov/smokefree/pdfs/trifold_brochure.pdf) • The Smoke-Free Home Pledge (http://www.epa.gov/smokefree/pledge/index.html)

Not in Mama’s Kitchen http://www.notinmamaskitchen.org/The African American Tobacco Education Network sponsors Not in Mama’s Kitchen, a campaign to encourage mothers and other women not to smoke in their home or car. Got a Minute? Give It To Your Kid. http://www.cdc.gov/tobacco/educational_materials/parenting/gotaminbrochure.htmThis brochure, public service announcement, and 10 Tips are designed to help parents keep their kids from using tobacco. Keep Kids from Smoking http://www.keepkidsfromsmoking.com/This a national website with tips and advice for parents to help them keep their kids from smoking. 2004 Surgeon General’s Report: Health Consequences of Smoking: What it Means to You http://www.cdc.gov/tobacco/sgr/sgr_2004/consumerpiece/index.htmThe Surgeon General’s Report is nearly 1,000 pages long and is written for a scientific audience. However, the Surgeon General asked that this booklet be created. This booklet explains what the report says and what it means to people. Secondhand Smoke: What It Means To You http://www.surgeongeneral.gov/library/secondhandsmoke/secondhandsmoke.pdfThis booklet explains the Surgeon General’s 2006 Report on Secondhand Smoke and how individuals can take action to improve their health. KidsHealth http://www.kidshealth.org/This site has health information on a variety of topics, including:

o Kids and Smoking - http://www.kidshealth.org/parent/positive/talk/smoking.html o Smoking (for teens) - http://kidshealth.org/teen/drug_alcohol/tobacco/smoking.html

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o Smokeless Tobacco (for teens) - http://kidshealth.org/teen/drug_alcohol/tobacco/smokeless.html

o Smoking Stinks (for kids) - http://www.kidshealth.org/kid/watch/house/smoking.html CDC’s Office on Smoking and Health This site has one page information sheets geared toward youth, parents and coaches on tobacco. These resources have great information and can be used as part of a school community’s education efforts on tobacco.

o Youth - http://www.cdc.gov/tobacco/educational_materials/yuthfax1.htm o Parents - http://www.cdc.gov/tobacco/educational_materials/yuthfax1.htm#Parents o Coaches - http://www.cdc.gov/tobacco/educational_materials/yuthfax1.htm#Coaches

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New Law Mandates Health Insurance Coverage To Help Smokers Quit In Rhode Island Beginning January 1, 2007, smokers in Rhode Island who want to quit are now entitled to get some help from their health insurers. Under a new law passed by the General Assembly last year, all Rhode Island health insurance providers are required to cover an annual total of 8 ½ hours of smoking cessation counseling, as well as over the counter or prescription nicotine-replacement therapy for each subscriber. The legislation established Rhode Island General Law §27-18-66, which applies to any insurer who provides medical coverage for physician’s office visits, or provides major medical or comprehensive medical coverage. If a subscriber’s plan does not include prescription drug coverage, their insurer would be exempt from providing nicotine-replacement therapy. Research shows that individuals who use counseling and/or nicotine-replacement therapy are twice as likely to succeed in quitting smoking than those who do not.

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Quitting tobacco is a process. Where are you right now?

1. “I don’t want to quit.” “I’m not considering quitting.” “I am not interested in quitting.” "I don't think I need to quit."

2. “I am thinking about quitting.” “I’m considering it.” “I’m leaning towards quitting.” 3.

“I am preparing to quit soon.” “I am ready to work on quitting.” “I am learning about ways to quit.” “I am making a quit plan.”

4. "I'm taking specific steps toward quitting." "I'm in the process of quitting." "I have made specific changes in my life to help me quit." "I have quit recently."

5. “I have been t free for

obacco more than

m 6 months.” “I feel free fro tobacco.”

If you try to quit but are not successful, you can re-enter this process and work through the stages again. Quitting tobacco is a process that takes practice and often takes several tries to be successful.

Stage of Change tool

Clare Lemke, BSN, Livingston HealthCare

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How important is smoking (or chew tobacco) in your life?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

What are the GOOD THINGS about using tobacco? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

What are some NOT SO GOOD things about using tobacco? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

TOOL FOR STAGE 1

Clare Lemke, BSN, Livingston HealthCare

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How IMPORTANT is it for you to quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

If you were to quit, what would be some reasons? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

What is standing in your way from making a quit attempt at this time? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

How CONFIDENT are you that you can quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

TOOL FOR STAGE 2

Clare Lemke, BSN, Livingston HealthCare

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How IMPORTANT is it for you to quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

What POSITIVE STEPS have you already taken? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

What PROBLEMS do you think you will have? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

How CONFIDENT are you that you can quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

TOOL FOR STAGE 3

Clare Lemke, BSN, Livingston HealthCare

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How IMPORTANT is it for you to quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

What HAS BEEN WORKING? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

What HAS BEEN A PROBLEM for you? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

How CONFIDENT are you that you can quit and stay quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

TOOL FOR STAGE 4

Clare Lemke, BSN, Livingston HealthCare

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How IMPORTANT is it for you to stay quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

What will HELP YOU stay quit? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

What will MAKE IT DIFFICULT for you to stay quit? _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________

How CONFIDENT are you that you can stay quit?

_________________________________________________ 1 2 3 4 5 6 7 8 9 10

not important somewhat important very important

TOOL FOR STAGE 5

Clare Lemke, BSN, Livingston HealthCare

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Tobacco Cessation Resources and Links Blue Cross Blue Shield Neighborhood Health Plan of Rhode Island United Healthcare Rhode Island law requires health insurance providers to provide up to 8 ½ hours of smoking cessation counseling, as well as over the counter or prescription nicotine-replacement. Contact your health insurance provider or your doctor. TrytoStop.org http://www.trytostop.org/This site from the Rhode Island Department of Health and the Massachusetts Department of Public Health has a Quit Wizard, Expert Advice, a Community Section, Resources and Tools to help smokers quit. Try-To-Stop Resource Center M-Th 9-7, F 9-5

English 1-800-TRY-TO-STOP (800-879-8678) Spanish at 1-800-8-DEJALO (800-833-5256) TTY at 1-800-TDD-1477 (800-833-1477)

Quit Tips Line 24 hours a day 1-800-9-GETATIP (1-800-943-8284)

Smokefree.gov http://www.smokefree.gov/This site from National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society is intended to help people quit smoking. Different people need different resources as they try to quit. The information and professional assistance available on this Web site can help to support both a person’s immediate and long-term needs as they become, and remain, a nonsmoker. QuitNet.com http://www.quitnet.com/QuitNet is dedicated to providing comprehensive resources and support for people trying to give up smoking. Children Helping And Motivating Parents to Stop Smoking (CHAMPSS) http://www.champss.com/This is a site for children and teens who want to help a parent or guardian quit smoking. Freshstart (from the American Cancer Society) http://www.cancer.org/ Start your own cessation group at your place of work. To implement the Freshstart program within your organization, a member of your staff needs to complete or attend a free Freshstart Facilitator training. Upon completion of the training process, that staff member is responsible for promoting and leading employees through each group. For info call 1-800-ACS-2345 or contact the local office at 401-722-8480

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NOT On Tobacco (from the American Lung Association) http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39867N-O-T is a school-based voluntary program designed to help high school students:

• stop smoking, • reduce the number of cigarettes smoked, • increase healthy lifestyle behaviors, and • improve life management skills.

Helping Young Smokers Quit www.helpingyoungsmokersquit.orgThis site provides information and resources on tobacco (youth cessation include). Youth Tobacco Cessation Collaborative (YTCC) www.youthtobaccocessation.orgYTCC was formed to address the gap in knowledge about what cessation strategies are most effective in assisting youth to quit smoking. Collaborative members represent major organizations that fund research, program, and policy initiatives related to controlling youth tobacco use. The National Partnership to Help Pregnant Smokers Quit www.helppregnantsmokersquit.orgThis is a quitline & information resource for pregnant women sponsored by the Legacy Foundation and the American Cancer Society. Smoke-Free Families www.smokefreefamilies.orgSmoke-Free Families is a national program supported by The Robert Wood Johnson Foundation working to discover the best ways to help pregnant smokers quit, and spread the word about effective, evidence-based treatments.

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Tobacco Resources and Links thrive – Rhode Island’s Coordinated School Health Program – Tobacco Issue page http://www.thriveri.org/issues/tobacco.htmlProvides comprehensive Rhode Island and national information, tools, resources and links related to school tobacco issues.

Teacher Resources Rhode Island Health Education Framework and the Comprehensive Health Instructional Outcomes http://www.thriveri.org/documents/RI_HE_Framework.pdf http://www.thriveri.org/documents/RI_CHI_Outcomes.pdf Tobacco is covered under the “Substance Use and Abuse Prevention” and the “Disease Prevention and Control” health content areas in the Rhode Island Health Education Framework and the Comprehensive Health Instructional Outcomes. RIEAP Student Assistance Services - Tobacco Prevention and Control Project http://www.risas.org/poc/view_doc.php?type=doc&id=3978RIEAP helps schools select an evidence-based tobacco prevention curriculum, particularly at the middle school level. They can also help set up trainings in those curricula for health teachers and student assistance counselors. Every fall, they also host Vic DeNoble, a tobacco industry whistleblower, who makes dynamic tobacco presentations in schools. American Lung Association of Rhode Island (ALA-RI) http://www.lungusa2.org/rhodeisland/index.html

• ALA-RI maintains the Rhode Island Tobacco Resource Control Resource Center at 298 West Exchange Street in Providence. The Center is open to anyone concerned about tobacco. Materials such as pamphlets, bookmarks, signs, posters are available. There is also a resource library and a lending library with CD-ROM’s, exhibit boards and other audiovisuals for loan. Call ahead at 401-421-6487.

• ALA-RI offers youth tobacco prevention programs, including Teens Against Tobacco Use (TATU).

• They offer alternative to suspension programs and youth tobacco cessation programs, including Not On Tobacco (NOT) http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39867

• And they hosts the RI Tobacco Control Network http://www.ritobaccocontrolnet.com/

American Cancer Society (ACS) - Southern New England Region http://www.cancer.org/docroot/COM/COM_0.asp?sitearea=COM

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• 1-800-ACS-2345 provides information and resources 24-hours a day seven days a week. • ACS has youth tobacco prevention resources and programs, including the Power of

Choice. The Power of Choice training is designed to provide some of the tools to our youth and to give them the confidence to bring the youth perspective to the challenging world of tobacco control. One of the successful approaches to partnering with youth in tobacco control and other "choice" decisions is youth empowerment. There is also a Power of Choice Tool Kit based on the best information available from people who have worked in community based tobacco control and with young people.

• ACS also hosts the Great American Smokeout the third Thursday in November. For info call 1-800-ACS-2345, contact the local office at 401-722-8480 or visit http://www.cancer.org/docroot/PED/ped_10_4.asp

• ACS also provides Freshstart trainings for workplaces that want to start a cessation group.

CDC Youth Tobacco Educational Materials CDC provides a variety of resources for teachers, including:

• Tobacco Information and Prevention Source (TIPS) • Resources for Teachers • You(th) & Tobacco Educational Materials • Educational Materials

SAMHSA Model Programs http://modelprograms.samhsa.gov/template_cf.cfm?page=model_listThe Substance Abuse and Mental Health Services Administration / Center for Substance Abuse Prevention maintains a list of evidence-based prevention programs and curricula on tobacco (as well as other drugs and topics). Model programs include (among others):

• Lifeskills Training - http://www.lifeskillstraining.com/ • Project Northland - http://www.hazelden.org/ (search for “Project Northland”) • Project Towards No Tobacco (TNT) - http://pub.etr.org/ (search for “Towards No

Tobacco”) Kick Butts Day (KBD) http://kickbuttsday.org/ KBD is the Campaign for Tobacco Free Kids' annual celebration of youth advocacy, leadership and activism. KBD is a day to stand out, speak up and seize control in the fight against tobacco. The next Kick Butts Day is Wednesday, March 28, 2007. TarWars http://www.tarwars.org/ TarWars is a tobacco-free education program for kids from the American Academy of Family Physicians. Contact Catherine Norton at the Rhode Island Medical Society at 401-528-3286 or [email protected]. thrive e-Academy - Preventing Youth Tobacco Use: Promising Curricula & Other Strategieshttp://www.thriveri.org/documents/tobacco_flyer.pdf

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The thrive e-Academy has a 6-week online professional development program on Tobacco for RI teachers of health that is offered several times per year. Basic Skills for Working with Smokers http://www.umassmed.edu/uploadedFiles/TTS_promo_flyer.doc UMass Boston offers a self-paced online course designed as an introduction to the basic concepts needed by professionals who are working with tobacco users. CEUs are available for RNs, CHES, and others.

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Tools for School Administrators School Health Index (SHI) http://apps.nccd.cdc.gov/shi/default.aspx The SHI is a self-assessment and planning tool that schools can use to improve their health and safety policies and programs. It can be done on paper or online and can also be customized to assess only specific topics, including Tobacco. Guidelines for School Health Programs to Prevent Tobacco Use and Addiction http://www.cdc.gov/HealthyYouth/tobacco/guidelines/index.htm These CDC Guidelines identify strategies most likely to be effective in preventing tobacco use and addiction among young people. Fit Healthy and Ready to Learn http://www.nasbe.org/HealthySchools/fithealthy.htmlThis document was developed by the National Association of State Boards of Education (NASBE) with CDC support. This practical guide helps schools and local school districts establish strong policies on tobacco and other health issues in the context of a coordinated school health program. RIEAP Student Assistance Services - Tobacco Prevention and Control Project http://www.risas.org/poc/view_doc.php?type=doc&id=3978 In addition to resources for teachers, RIEAP helps make tobacco cessation programs available for schools, including the Not On Tobacco Program and Success in Stages/Your Decisions Count (http://www.successinstages.com/), a confidential, interactive computer program that helps high school students stay or become tobacco-free.

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Rhode Island Tobacco Resources Rhode Island Tobacco Control Program http://www.health.ri.gov/disease/tobacco/index.php The Department of Health offers information, resources, data, tips, links and more. American Cancer Society (ACS) - Southern New England Region http://www.cancer.org/docroot/COM/COM_0.asp?sitearea=COM,1-800-ACS-2345, or 401-722-8480 ACS provides information and resources 24-hours a day seven days a week. American Heart Association – Providence Branchhttp://www.americanheart.org/presenter.jhtml?identifier=1200247&division=NEA072 or 401-330-1700 The Heart Association has information and resources to fight heart disease and stroke, including information on tobacco. American Lung Association of Rhode Island (ALA-RI) http://www.lungusa2.org/rhodeisland/index.html or 401-421-6487 ALA provides a variety of information, resources and tools to prevent tobacco use.

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National Tobacco Resources Surgeon General

• The Health Consequences of Smoking: A Report of the Surgeon General http://www.surgeongeneral.gov/library/smokingconsequences/

• The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General http://www.surgeongeneral.gov/library/secondhandsmoke/

Centers for Disease Control & Prevention (CDC)

• Division of Adolescent and School Health http://www.cdc.gov/healthyyouth/tobacco/index.htm

• Tobacco Information and Prevention Source (TIPS) http://www.cdc.gov/nccdphp/dnpa/nutrition/index.htm

• Health Topic Tobacco http://www.cdc.gov/doc.do/id/0900f3ec802346d8

• 2004 Surgeon General’s Report: Health Consequences of Smoking: What it Means to You http://www.cdc.gov/tobacco/sgr/sgr_2004/consumerpiece/index.htm

Campaign for Tobacco Free Kids http://www.tobaccofreekids.org/ This site provides policy information, data and reports nationwide and from each state on efforts to prevent tobacco use among children. Join Together Online http://www.jointogether.org/ This site provides current research and news on alcohol, tobacco, and other drugs. The Truth campaign http://www.thetruth.com/This youth-oriented, mulitmedia public awareness campaign has been credited with decreasing tobacco use among youth. World Health Organization http://www.who.int/tobacco/en/This site presents international tobacco information. American Legacy Foundation www.americanlegacy.orgDedicated to building a world where young people reject tobacco and anyone can quit. National Latino Council on Alcohol and Tobacco Prevention www.nlcatp.org Their mission is to prevent or eliminate tobacco use and reduce alcohol abuse in the Latino community, through research, programs, and policy analysis.

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Tobacco-Related Statutes and Regulations RIGL Chapter 23-20.9 - Smoking Restrictions in Schools Act http://www.rilin.state.ri.us/Statutes/TITLE23/23-20.9/INDEX.HTM RIGL §11-9-13 – Sale of tobacco to minors http://www.rilin.state.ri.us/statutes/title11/11-9/11-9-13.HTM RIGL §11-9-14 – Use of tobacco by minors http://www.rilin.state.ri.us/statutes/title11/11-9/11-9-14.HTM RIGL §27-18-66 – Accident and sickness insurance – Tobacco cessation programs http://www.rilin.state.ri.us/Statutes/TITLE27/27-18/27-18-66.HTM RIGL Chapter 23-20.10 - Public Health and Workplace Safety Act http://www.rilin.state.ri.us/Statutes/TITLE23/23-20.10/INDEX.HTM Rules and Regulations for Smoke-free Public Places and Workplaces http://www.rules.state.ri.us/rules/released/pdf/DOH/DOH_3258.pdf Rules and Regulations for School Health Program http://www.thriveri.org/documents/Rules_Regs_School_Health.pdf RIPL Chapter 05-074/05-076 – District wellness subcommittees, policies, and plans http://www.rilin.state.ri.us/PublicLaws/law05/law05076.htm