Do Not Smoke Educational Campaign: Collaboration with a School District to Prevent Teen Smoking

Monday, 9 November 2015

Lisa Otto, MSN, BSN, RN, CMSRN
Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA

Background: Smoking is a significant problem in the United States with health, societal, and financial cost. An estimated 42.1 million adults (18.1 percent) in the United States actively smoke cigarettes (Agaku, King, Dube, & Centers for Disease Control and Prevention (CDC), 2014; CDC, 2012). The purpose of this presentation is to demonstrate how the clinical project, the do not smoke program, has significant implications to enhance clinical, patient and educational outcomes. The transformative program is designed to prevent and promote change in teen smoking behavior through early educational activities. According to the CDC (2007) tobacco use among men and women is the single most preventable cause of death. Smoking causes cancer, lung disease, and cardiovascular disease. Exposure to tobacco smoke, including the total number of cigarettes smoked over the lifetime, smoking onset age, content of tar and nicotine, as well as smoking cigarettes that are unfiltered, directly relates to the development of lung cancer (Lewis, 2014). Active smoking causes 80 percent of lung cancers deaths (CDC, 2012). In the United States, lung cancer is the leading cause of death in both men and women with health care expenditures of $289 billion (Jemal, et al., 2008).

Most smokers begin smoking during teenage years; therefore, prevention of teen smoking may be the most significant intervention in reducing incidence of lung cancer (Lewis, 2014). According to the Centers for Disease Control (CDC) (2006), 11.7 percent of middle school students reported using tobacco products, and 8.4 % used cigarettes. Daily, 3,900 youth younger than 18 years of age try cigarettes for the first time, and greater than 950 youth become new, regular smokers. According to Sargent et al (2005), movies that show smoking are a risk factor for youth smoking initiation. Exposure to marketing and media that promotes tobacco increases youth chances 2.2 times for starting tobacco use (Wellman, Sugarman, DiFranza, & Winickoff, 2006). Multiple approaches are in progress to prevent teenage smoking. Researchers are exploring the links between 1) a conduct problem and smoking, 2) advertising and smoking, and 3) policy implementation at the state and federal level such as higher cigarette prices, enforcement of minor in possession laws, and limiting advertisement on smoking. The development and implementation of an educational do not smoke program at the middle school level aims to prevent initiation of smoking. The educational program teaches youth about the negative physiologic and health consequences of smoking and discusses topics of interest to the youth that relate to smoking. These youth topics of interest include the effects of smoking on personal sport performance and smoking as seen in commercials, television shows, and movies. The program targets middle school age students to enhance their knowledge of negative health effects of smoking, and shape smoking beliefs.

Implementation: The do not smoke program purpose is to prevent youth smoking through education in a middle school environment. The science curriculum in the local middle school includes structure and function of the respiratory system. The do not smoke presentation is designed to correlate with the respiratory unit of study, and build on the middle school student’s previously learned knowledge about respiratory physiology. The learning objectives of the do not smoke educational program include: 1) Effect of smoking on diffusion and oxygenation, 2) Cell mutation and development of cancer in structures of the respiratory system, 3) Excess mucous production and frequent infections, 4) Strain on the heart and development of heart disease, 5) Yellow teeth color, 6) Smelly clothes, 6) Impact on daily activities and sports, and 7) media influence on smoking. In order to promote student interest and study of the effects of smoking on the human body, the middle school respiratory unit exam includes questions from the do not smoke program. The educational program incorporates images of excess mucous, bronchitis, lung infection, over distended alveoli, emphysema, lung cancer, and heart disease in the presentation to promote middle school student’s comprehension and perception of real negative health consequences of smoking. The do not smoke program aims to reach large numbers of middle school students through smaller educational groups. The science classes in each period are grouped in the library for the do not smoke program. Smaller groups of 50 to 60 students promote learning activities, questions, and discussion. Some group activities include filling balloons with whip cream demonstrating mucous accumulation, infection, and pneumonia. Inflating paper bags and gathering the bags to form a barrel exhibiting over distended alveoli and the development of barrel chest.

Evaluation: Approximately 300 middle school students attended the do not smoke program in 2014. The middle school students responded and interacted positively during the educational program. Questions about smoking and oxygenation, performance in sports and activities, as well as teeth color changes, and smelly clothes occurred. The students identified many misperceptions of smoking such as smoking makes you skinny and smoking being cool. The middle school student’s discussions centered on media literacy, smoking in movies, commercials about effects of smoking, cigars, e-cigarettes, second hand smoke, and smoking candy (crushing candies and inhaling the dust). The Student’s demonstrated interest in knowing how long the effects of smoking last once someone stops smoking and smoking cessation resources. The middle school teachers expanded the core respiratory system curriculum to introduce the negative health effects of smoking.

Future plans: The do not smoke program clearly identified the value in following the smoking habits of middle school students that attended the educational program as compared to students without the education. Future studies will assess youth perception of smoking on health and wellbeing pre and post participation in the do not smoke program. Targeting the teaching strategies in the do not smoke program more specifically toward media literacy and gender themes, may reduce smoking risk (Mays, et al., 2014). Expanding the do not smoke campaign to other schools will increase the number of students exposed to the educational program and may further reduce the initiation of teen smoking and promote smoking prevention.