let’s talk tobacco€¦ · general guidelines remember: ... approaching the topic in a...

Let’s TalkTobacco

A Collaborative Preventative Project By

AND

MENTORING 101

Thanks to our partnership with Owensboro Health through the Owensboro Health Community Health Investments Grant Program, we are now ready to tackle an issue that has remained present among our youth for far too long. The Mentoring 101: Let’s Talk Tobacco handbook is designed specifically for Mentors like yourself to equip you with the necessary tools needed to have healthy conversations with your Mentee concerning tobacco.

My hope is this resource will leave you feeling comfortable and empowered when it comes to discussing the topic of tobacco use with your Mentee. The words you speak, the example you set, and the support you provide will go a long way in helping them to choose the right path.

I would also like to give special mention and thanks to The Governor’s Prevention Partnership for inspiring mentoring organizations across America through the success and availability of their programs.

I am excited to witness the impact this program will have on the youth we serve, their households, and our community. I hope you are too!

Warmest regards,

Berly Tillman SullivanExecutive DirectorMentorKids Kentucky

DEAR MENTORS,

Berly

INTRODUCTIONEarly adolescence is a time of crucial turning points in terms of healthy behaviors. Research has shown that early initiation of tobacco use at this stage of life can have lifelong health consequences. Despite decades-long efforts to eliminate smoking, far too many youth start using tobacco.

According to the Green River District Health Department, 4,500 youth in Kentucky become new smokers each year and 11.4 million packages of cigarettes are bought or smoked by youth each year in Kentucky. If these rates continue, 119,000 youth - alive today - will die from smoking related causes.

The healthy conversations handbook is designed to provide MentorKids Kentucky’s Mentors with information, conversation starters and resources to promote healthy, tobacco-free lifestyles for the youth we serve.

As a Mentor, you can have a significant influence on your Mentee’s attitudes and behaviors. If they do not start smoking before they leave high school, it is less likely they will take up the habit later in life.

GOALS FOR MENTORS USING THIS HANDBOOK ARE TO: • Better understand the health consequences of

tobacco use. • Better understand the reasons why youth start

using tobacco. • Gain skills and increase comfort level when

talking about tobacco use with Mentees. • Gain a better understanding of how to serve

as a role model for healthy behaviors.

1

MENTORING 101Let’s Talk Tobacco

CHARLIE & EDMUND MATCHED 7 YEARS

GENERAL GUIDELINESREMEMBER:• Always contact the MentorKids Kentucky Program Director if you have

concerns about your Mentee or if you are unsure of what to say or do.• Maintain confidentiality with your Mentee whenever possible to preserve

trust. • If you stop feeling like a Mentor and start feeling like an instructor, you’re

probably coming on too strong.• Keep it short, simple, and fun. Let your Mentee’s interest be your guide in

choosing how to use healthy conversations. • Do not devote entire or consecutive match meetings to the topic of

tobacco. Approaching the topic in a heavy-handed manner could turn the Mentee off or increase his/her interest in tobacco products.

• A 15-minute discussion, ever so often is sufficient. • Avoid setting a predictable pattern of bringing up the topic. Instead, wait

for the right moment.• Pay attention to the signals your mentee may be giving. Consider trying

again another day if the Mentee disengages.• Have smart responses prepared in case the conversation prompts the

Mentee to disclose having used tobacco products, expressed concerns about the tobacco use of others, or asks questions about tobacco products.

KEEP IT SHORT & SIMPLE.

A 15 MINUTE CHAT IS GREAT!

ASK FOR HELP IF YOU NEED IT.

2


KAMERYN MATCHED 1 YEAR

3

THE REASON YOUTH ARE TARGETED BY BIG TOBACCO

A 1969 research paper by Philip Morris recognizes the progression from trying cigarettes to becoming addicted, stating…

“to account for the fact that the beginning smoker will be all right with the unpleasantness we must invoke a psychosocial motive. Smoking a cigarette for the beginner is a symbolic act. The smoker is telling his world, this is the kind of person I am. Surely there are variants of this theme: I am no longer my mother’s child, I am tough, I am not a square.

Whatever the individual intent, the act of smoking remains a symbolic declaration of personal identity…As the force from that psychosocial symbolism subsides, the pharmacological effect takes over to sustain the habit.”


REASONS YOUTH USE TOBACCO PRODUCTS:

• The youth’s perception is that the use of tobacco products is normal.• Their peers or siblings use and approve of tobacco use. • Their legal guardian uses tobacco products.• The youth experiences a lack of support/involvement from their legal guardian.• They suffer from low self-image or self-esteem.• They simply lack skills to refuse offers of tobacco products.

WAYS PEER PRESSURE PLAY INTO TOBACCO USE:

• Peer role models can have a powerful influence on your Mentee, and they may not realize how susceptible they are to this influence.

• Youth believe that they are not easily influenced and that they make their own independent decisions; however, research shows that young people with friends who use tobacco products are more likely to use tobacco products themselves.

4


BILL & GARRISON MATCHED 4 YEARS

• Be aware that resisting peer pressure may not simply be a matter of the youth just “saying no”. Peer pressure does not always involve verbal offers or taunting. Rather, many youth simply observe peers (the ones they admire or identify with) engaging in a behavior, then reach their own conclusions about the desirability of that behavior.

THE CONSEQUENCES OF CIGARETTES:

• If the trend in early initiation of cigarette smoke continues, approximately 5 million youth, age 18 and under today, will die prematurely as adults because they began to smoke cigarettes during adolescence (Centers for Disease Control).

• If teens do not start smoking by the end of high school, it is much less likely they will ever smoke (CDC).

• The symptoms of serious nicotine addiction often occur weeks or even days after youth experimentation with smoking (Campaign for Tobacco Free Youth).

• More than a third of youth who try smoking a cigarette will become regular, daily smokers before they even leave high school (CTFK).

5


THE CONSEQUENCES OF SECONDHAND SMOKE:

• Youth who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances as smokers.

• Secondhand smoke contains more than 250 chemicals known to be toxic or carcinogenic (cancer causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia and hydrogen cyanide.

• On average, youth are exposed to more secondhand smoke than nonsmoking adults.

THE CONSEQUENCES OF E-CIGARETTES:

• E-cigarettes are currently the most popular tobacco product among youth.

• Youth who use e-cigarettes are 7 times more likely to use cigarettes in the future.

• Manufacturers do not have to report e-cigarette ingredients so users do not know what is actually in them.

EXAMPLES AND CONSEQUENCES OF SMOKELESS FORMS OF TOBACCO:

• Snuff is a small green tobacco that often comes in tins or pouches that look like tiny teabags. Users take a small amount and put it between their lower lip and gum.

• Chewing tobacco looks more like shredded or twisted tobacco leaves. Users take a small amount and put it between their cheek and gum. After letting it sit in their mouth for a while, they suck on it and spit out the extra saliva that builds up in their mouth. This process allows nicotine to be absorbed into their bloodstream.

• Both forms of smokeless tobacco can cause bad breath, stains on teeth, dental cavities, bleeding gums, sores in the mouth, cracked lips, gum disease, and oral, esophageal and pancreatic cancer.

6

ACT AS A FRIEND AND GUIDE.

You are not ultimately responsible for your Mentee’s decision to use tobacco products.

TAKE TOBACCO USE AND THE POTENTIAL FOR NICOTINE ADDICTION SERIOUSLY.Nicotine is one of the most addictive drugs and there is no “safe” experimentation. Youth who use tobacco products are more likely to experiment with other substances, and research shows they are more likely to go on to use other drugs.

CONNECT HEALTHY CONVERSATIONS TO WHAT YOUR MENTEE IS LEARNING IN SCHOOL.Most elementary schools celebrate red ribbon week and middle school students have either learned or are learning about the dangers of smoking and smokeless tobacco. Ask your Mentee what they have learned and what they think about it.

THE DO’S & DON’TS OF HEALTHY CONVERSATIONS

DO


7

PRACTICE AND REINFORCE TOLERANCE AND KINDNESS.For example, if your Mentee sees someone smoking and makes a critical comment, talk about how hard it must be for the smoker to quit even though they are most likely aware of others disapproval of their smoking.

BE HONEST WITH YOUR MENTEE IF YOU ARE ONE OF THE FOLLOWING:

• A CURRENT SMOKER: tell your Mentee how hard it is to quit. Talk about how much you regret having ever started. Talk about how cigarettes have affected, or are affecting your health. Talk about how much cigarettes are costing you each year, and the things you wish you could spend that money on instead.

• A FORMER SMOKER: talk about how hard it was to quit and how many times you had to try before you were finally successful.

• A LIFELONG NON-SMOKER: talk about why you never started. Talk about the pressures you may have felt from friends and/or tobacco advertising and why you resisted that pressure. Talk about how glad you are now about your decision.


8

DON’T ASK YOUR MENTEE IF THEY SMOKE.

Let your mentee make a disclosure if they choose and have your smart response ready in case this happens.

DON’T ASSUME THAT YOU HAVE NO INFLUENCE OVER YOUR MENTEES DECISION TO USE TOBACCO.

A caring adult is a very important factor in a youth’s decision about whether or not to use tobacco. A Mentor can help prevent tobacco use simply by being a consistent presence in the Mentee’s life, whether they ever discuss specific tobacco products directly with their Mentee.

DON’T ASSUME YOUR MENTEE UNDERSTANDS HOW EASY IT IS TO BECOME ADDICTED TO TOBACCO.

While schools teach about the dangers of tobacco use, many youth still do not really believe that they could become addicted. They may convince themselves they will only “use socially” and will know when to stop before becoming addicted.

DON’T


KANNON MATCHED 1 YEAR

9

DON’T PASS JUDGMENT IF YOUR MENTEE MENTIONS HAVING SMOKED. Instead, express your own views and values about avoiding tobacco use and serve as a positive, supportive role model. Be careful not to preach. If you are unsure of what to do, reach out to the MentorKids Kentucky Program Director and jointly determine the best course of action.

DON’T ASK ABOUT YOUR MENTEES HOUSEHOLD MEMBERS EVEN IF YOU KNOW THEY USE TOBACCO.

If your Mentee chooses to talk about their household’s tobacco use, just listen and help them better understand their own feelings about it. You can also ask whether your Mentee would like to do anything differently in their own life. It is extremely important to remain sensitive to your Mentee’s household practices and history during this process.

DON’T URGE YOUR MENTEE TO TRY TO CHANGE THE MINDS OF HOUSEHOLD MEMBERS AND FRIENDS WHO USE TOBACCO PRODUCTS.

Just as you should refrain from judging your Mentee regarding their tobacco use, don’t take sides against your Mentee’s legal guardian. It is important to support the legal guardian(s) even if you don’t agree with their choices. Also, be mindful not to criticize your Mentee’s friends. It will only cause them to tune you out. Leave the door open for your Mentee to talk to you if they are worried about friends and family.


ENTRY POINTS FOR DISCUSSION OF TOBACCO USE

Keep smart responses handy in case the Mentee mentions the topic of tobacco use, discloses having used tobacco products, expresses concerns about others tobacco use, or asks questions about tobacco.

A SMART RESPONSE DOES THE FOLLOWING:• Avoids blaming or judging the Mentee.• Avoids overreaction.• Maintains appropriate boundaries (i.e., the Mentor is not a parent, physician,

therapist, or peer). • Invites the Mentee to share their perspective on the issue. • Reflects (repeats) expressed opinions and emotions to help validate their

Mentee’s feelings and encourage further discussion of those feelings.• Opens the discussion of options and choices. • Encourages a problem-solving alliance between Mentor and Mentee. • Offers information or advice only if wanted.

Here is an example of a Smart Response...The Mentee says:

“My friends are always smoking around me”.

1010


POSSIBLE SMART RESPONSES: • I’m here to listen if you want to talk about that. • I’m glad you trusted me enough to tell me. Do you feel like talking about it? • What kind of situation does that put you in? • How do you feel when your friends do that? • Why do you think your friends do that? • How would you feel about telling your legal guardian about that? • That was a situation I experienced when I was your age. Can I tell you about

how I handled it and what I learned from it?

RESPONSES TO AVOID:• I can’t believe your friends would do that! • You should tell on your friends. • Don’t they know that cigarettes will kill them?• I’m going to tell your legal guardian. • You must tell your legal guardian. • That’s terrible! • I’m very disappointed in you. • Promise me you’ll never do that again. • You should really follow my advice about this.

WHAT WOULD YOUR “SMART RESPONSE” BE IF YOUR MENTEE MADE THE FOLLOWING STATEMENT? THINK ABOUT IT.• I’ve tried tobacco products, but I’m not going to do it again.• I use tobacco products and I do not plan to quit.• I’ve tried chew and/or e-cigs before.• I wish I could quit using tobacco products.• Most of my friends use tobacco products.• Cigarettes are nasty.• I hate that [insert name here] uses tobacco products.• If my legal guardian uses tobacco products, then why shouldn’t I?• You [the Mentor] use tobacco products, don’t you?

11


11

Another technique the Mentor can use to approach the subject of tobacco use with their Mentee after being matched for 6 months or more is called “cracking the door”. It allows the Mentor to offer a gentle nudge if their Mentee has never brought up the subject of tobacco.

THERE ARE TWO WAYS TO COMFORTABLY AND NATURALLY CRACK THE DOOR TO DISCUSSING TOBACCO: • Commenting on the surrounding environment in which you find yourselves

during your match meeting. • Steering the “small talk” that you have at the beginning of your match

meeting.

EXAMPLES OF COMMENTING ON SURROUNDING ENVIRONMENT: A Mentor and Mentee share a love of basketball. The next time they meet the Mentor brings a sports magazine featuring UK Basketball that happens to contain a tobacco advertisement. This “cracks the door” for the Mentor to say, “I can’t believe they still put tobacco ads in magazines. What do you think about that?”

1212


KATHERINE (JUNIOR ED)

Another example could be, the Mentor is walking through a neighborhood with their Mentee and they happen to walk by a store that advertises cigarettes in the window. To “crack the door” the Mentor might say, “What do you think about that cigarette ad in the window?”

OTHER EXAMPLES OF ENVIRONMENTAL CUES THAT COULD SERVE AS OPPORTUNITIES TO “CRACK THE DOOR” ARE: • You see a group of teenagers hanging out and using tobacco products.• You see someone wearing clothing that advertises tobacco products.• You are watching a baseball game and see the players chewing

smokeless tobacco. • You see a “No Smoking” sign in a restaurant or other public place. • You see an actor smoking in a movie.

13


TALA MATCHED 5 YEARS

SAMPLES OF SMART RESPONSES

Tobacco Conversation #1 YOUTH IN EARLY STAGES OF TOBACCO EXPERIMENTATION.

Todd (Mentor) and Jacob (Mentee) have been matched for 6 months. Todd is a former smoker who quit 10 years ago. Todd has seen Jacob’s mom smoking cigarettes when he comes to pick Jacob up and has never talked about tobacco products with him. One day as Todd and Jacob are filling up Todd’s gas tank, Todd decides to ‘crack the door’ by pointing out the cigarette poster in the window of the gas station.

Mentor: Can you believe that just one pack of cigarettes costs $5.72?Mentee: Yeah, my mom is always complaining about that.Mentor: Imagine how much it would cost a year if a person smoked a pack every day.Mentee: Do you smoke?Mentor: I used to, but I quit about 10 years ago.Mentee: How old were you when you started?Mentor: I started when I was 15 and regretted it for the next 20 years.Mentee: This one kid in my neighborhood is always trying to get me to smoke.Mentor: What do you tell him? Mentee: One time, I did try it and I coughed a lot. It was kind of nasty. Mentor: Did you regret trying it?Mentee: Yes, I felt bad about it.

MENTORING 101

14

Let’s Talk Tobacco

Mentor: Next time you are around that kid, don’t be afraid to just say no. Mentee: I know. I’m not going to smoke again or anything.

A few visits later, Todd and Jacob are at the library checking out some books Jacob needs to write a report for school. After Jacob has checked out his books, he and Todd sit down at a study table to work on an outline for the report. Todd notices that Jacob seems distracted by something and says:

Mentor: Is everything ok? You seem like something is on your mind.Mentee: Yeah. I guess so.Mentor: Would you like to talk about? I find it helps me to talk things out.Mentee: Well, I have been thinking about my mom smoking. I really wish she would quit and she says she wants to but I don’t know why she doesn’t.Mentor: It’s hard to do. It took me a while to fianlly quit for good. But your Mom doesn’t have to do it alone.Mentee: Really?Mentor: Let’s call MentorKids Kentucky. I bet they can give us some good advice.Mentee: Okay. That sounds good.

MENTORING 101

15

Let’s Talk Tobacco

Tobacco Conversation #2 YOUTH CONCERNED ABOUT FAMILY MEMBERS WHO USE TOBACCO.

Emilie (Mentor) and Ana (Mentee) have been matched for almost two years. Ana is 13 years old and is in eighth grade. When they meet on Saturday morning, Ana tells Emilie about her latest school project. When Emilie hears about the project, she uses the opportunity to ‘crack the door’ regarding tobacco products. Emilie is conscious of the fact that Ana’s family members smoke cigarettes, as well as e-cigarettes, and they have no apparent plans to quit. Emilie is therefore careful to communicate respect for the family’s viewpoints and values.

Mentor: How’s school been going?Mentee: I have so much work! We have to do this project for science class where we pick a health problem and describe how it affects kids and teenagers. I have no idea what I should write about. Mentor: Wow, we never got to choose our topics when I was in school. What are the other kids writing about?Mentee: My friend is writing about kids getting cancer. Someone else is writing about AIDS. Some of the boys who are into sports are going to write about steroids. Mentor: Those sound like great projects. Hey, do you know what causes a lot of health problems, more than both alcohol and drugs?Mentee: I don’t know…what? Mentor: Tobacco use. People smoking cigarettes, e-cigs, and using chewing tobacco. Mentee: All that stuff is gross.Mentor: I agree, tobacco can cause cancer and many other health problems. Plus, it is addictive. Once someone starts it is very difficult to stop...When do you think those who are addicted probably started?Mentee: When they were teenagers, right?

1216


Mentor: Yes. When I was in college, I wrote a paper on how tobacco companies market cigarettes to young people, to make smoking seem cool.Mentee: I should do my project on smoking!Mentor: Would you like me to help you with that? Mentee: Yes, but you know my dad smokes. He gets mad if people tell him he should quit. He says, “Stay out of my business!”Mentor: Would your dad be mad if you did your school project on smoking? Mentee: I guess not.Mentor: I think a lot of people feel it’s their right to smoke, and they do not want others to tell them what they can and can’t do. Maybe sometime in the future he might change his mind, but it sounds like now is not the right time. Mentee: Yeah. Mentor: After we have lunch, do you want to stop by the library and see what we can find online to help you with your project? I know some great websites with info about tobacco advertising. Mentee: Can we do it now? Mentor: Absolutely!

17


Tobacco Conversation #3MENTEE CURRENTLY USES TOBACCO PRODUCTS.

Jack (Mentor) and Justin (Mentee, age 14) have been matched for eight months. Although they’ve never really had a “serious” talk about risky behaviors, Jack has sometimes thought that he smelled cigarette smoke on Justin. He assumed the smell of cigarettes could be coming from someone smoking in Justin’s household, but he’s not sure. One chilly Saturday, they arrive at their favorite local restaurant for lunch. As they walk into the restaurant, they pass two employees having a smoke outside of the kitchen’s back door. Jack decides to take advantage of the environmental cues to “crack the door” for a conversation on smoking.

Mentor: You ever notice how everyone has to smoke outside now, even when it’s cold?Mentee: Yeah, no place lets you smoke inside. They should have a break room where they can smoke. Mentor: How do you think people who don’t smoke would feel about that? Mentee: If you keep it in one room, I don’t think they would care. Mentor: Maybe not.Mentee: My mom and grandma smoke all the time in the house. I guess I’m just used to it. Mentor: Both of my parents smoked in the house when I was growing up. I think that’s why I never started smoking myself. Mentee: (Laughs) I guess it’s too late for me, then!Mentor: Hey, it is never too late. I’m glad you told me. Do you want to talk about it?Mentee: (shrugs) I didn’t plan it; it just happened. A bunch of my friends, my family…they all smoke. It was like I didn’t have a choice. I just did it one day, and then before I knew it… Mentor: Now it’s every day? Mentee: Yeah, pretty much.

18


Mentor: That’s how it happens for a lot of people. Ever thought about what might happen in the future? Mentee: I don’t know. Mentor: There are some resources out there to help you if you want to stop smoking. Is it okay if I check in with you again sometime?Mentee: I guess. Mentor: And you know if you want to talk about anything at all, I’m always here to listen, right? Mentee: Yeah

Two visits later, while hanging out at Jack’s home, Justin is playing a video game. Prior to their meeting, Jack bookmarked the Foundation for a Healthy Kentucky’s website about tobacco use and prevention on his phone. He also made a few phone calls, identified an adolescent smoking cessation program in Justin’s neighborhood, and wrote down the name and phone number on a sticky note.

Mentor: Hey, Justin!Mentee: Yeah? Mentor: Check out this website I found. Mentee: What is it? Mentor: Remember when we were talking about how people can get help to stop smoking?Mentee: Yeah.Mentor: (Brings up website) There’s good info here…you might want to check it out. Mentee: (Laughs and shakes his head) Don’t know if I can do all that. Mentor: Hey, it’s there if you need it, OK? I’ll text you the link! Mentee: OK.

Based on Justin’s response, Jack decides to save the sticky note for another time.

19


SUGGESTIONS FOR MENTEES INTERESTED IN QUITTING OR HELPING OTHERS

Your Mentee may already use tobacco products, or they may be concerned about a friend who is a smoker. This section is designed to help them learn more about how to quit smoking and to identify sources of help and quitting.

If you were a former smoker, it will be valuable for you to share how you finally managed to give up smoking. Even if you are currently a smoker, you can still be helpful to your Mentee.

SUGGESTIONS:• Be alert for a natural opportunity to bring up this topic. It may come out of

one of the other conversations or activities you and your Mentee have done, or your Mentee may ask about it.

• If your Mentee is concerned about someone else’s smoking or is just curious about quitting smoking, ask them why they think people don’t just stop smoking when they feel like it.

• Suggest making a list of all the reasons why they would find it hard to stop such as their body’s addiction to nicotine, worries about gaining weight, prior failed attempts, they would miss it at parties, etc.

• Talk about how most people need help to quit smoking and that help is available. Tell your Mentee that you will help them find out more about this help and suggest you talk more about it at your next meeting.

• Encourage your Mentee and any actions they plan to take to quit.• Tell your Mentee they can contact you anytime if they need more

information or encouragement before your next meeting.• Please refer to the next page for additional resources on this topic.

20


THE GOVERNOR’S PREVENTION PARTNERSHIPThe Governor’s Prevention Partnership equips, empowers, & connects organizations, communities and families to prevent substance abuse, underage drinking and violence among youth and promotes positive outcomes for all young people. www.preventionworksct.org

FOUNDATION FOR A HEALTHY KENTUCKY This foundation works to address the unmet health needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity. www.healthy-ky.org

AMERICAN CANCER SOCIETYThe child and teen section of the website has useful information about the extent of youth smoking as well as information about other types of cigarettes/smoking such as clove cigarettes, hookah pipes, and flavored cigarettes (bidis). There are also helpful hints on how to help a teen stop smoking. www.cancer.org

TRUTH INITIATIVETruth Initiative is America’s largest non-profit public health organization dedicated to making tobacco use a thing of the past. This non-profit organization, formerly known as the American Legacy Foundation spreads the truth about tobacco through education, tobacco-control research and policy studies, community activism and engagement, and innovation in tobacco dependence treatment. www.truthinitiative.org CAMPAIGN FOR TOBACCO FREE KIDS A leader in the fight to reduce tobacco use and its devastating consequences in the United States and around the world. By changing public attitudes and public policies on tobacco, we strive to prevent youth from smoking, help smokers quit and protect everyone from secondhand smoke. www.tobaccofreekids.org

CENTER FOR DISEASE CONTROL, YOUTH TOBACCO PREVENTION PROJECTMost of the materials on the CDC website can be downloaded and reproduced without cost; many materials and videos an also be ordered on the site.www.cdc.gov

ADDITIONAL RESOURCES FOR TOBACCO PREVENTION

21



NOTES___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AND

A Collaborative Preventative Project By

AND

let’s talk tobacco€¦ · general guidelines remember: ... approaching the topic in a...

Documents