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TRANSCRIPT
SNUFF OUT TOBACCO
Program Planners:
Kelly Rohan
Kylie Ruffner
Angela Strobel
Parkway North High School and Tobacco Free St. Louis
December 7, 2012
Table of Contents
Executive Summary……………………………………………………………………………………3-4
Team Biographies………………………………………………………………………………………...5
Literature Review……………………………………………………………………………………….6-9
Needs Assessment………………………………………………………………………………….10-13
Mission Statement, Goals, and Objectives……………………………………………………….14-15
Description of Project’s Theoretical Framework…………………………………………………16-18
Intervention (Activity/Lesson Plan)………………………………………………………………...19-23
Budget………………………………………………………………………………………………..24-27
Marketing Plan……………………………………………………...............................................28-29
Logic Model………………………………………………………......................................................30
Timeline………………………………………………………………………………………………31-32
Evaluation Results…………………………………………………………………………………..33-37
Discussion……………………………………………………………………………………………38-42
References…………………………………………………………………………………………...43-47
Appendix……………………………………………………………………………………………………………………………………………….48a. Pre/Post Testb. Photos of Implementationc. PowerPoints
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Executive Summary
Snuff Out Tobacco is a tobacco cessation and prevention program created
specifically for sophomore health students at Parkway North High School in St. Louis,
Missouri. Tobacco Free St. Louis approached the group in need of a program directed
towards a high school in the St. Louis area. Group member Kelly was an alumna of
Parkway North so she contacted the high school in order to set up the program and
development began.
We began the process with a review of current literature. Here it was found that
cigarette use, as suspected, was of greatest use within high schools across the country.
Through the needs assessment that was conducted, however, it was found that the
greatest tobacco threat within Parkway North was chewing tobacco. Because of this
finding, Snuff Out Tobacco emphasized chewing tobacco use.
We then established a set mission statement of providing students an unbiased
information of tobacco products and their dangers, with a goal of planning,
implementing the program with its focus on smokeless tobacco. Due to the very
personal reasons people use tobacco products, we decided to formulate the program
based around the Theory of Planned Behavior and its constructs of attitudes, norms,
and beliefs of personal control.
On implementation day, we had various activities prepared for the students
including a PowerPoint presentation, a cost of tobacco activity, contents of chewing
tobacco activity, and Pop Rocks candy and Big Red gum activities. The presentation
included information on the different types of tobacco products and the harmful effects
they cause. The cost of tobacco activity showed students the amount of money they
could save by not purchasing tobacco products and products such as an iPad, which
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they could buy instead. The contents activity let students pick items out of a box that
represented chemicals actually found in chewing tobacco. The Pop Rocks activity
allowed students to see how chemicals in chewing tobacco crosses the mucous
membrane of the gums, while the Big Red activity allowed students to feel a burning
sensation similar to that of actually using chewing tobacco.
At the conclusion of the program, we found that two of our six objectives were
met, including average cost of a pack of cigarettes and the financial burden of using
tobacco products. Objectives not met included the ability to identify the painful effects of
smokeless tobacco, that it is a myth that there is fiberglass in smokeless tobacco, the
contents of chewing tobacco, health consequences of use of smokeless tobacco,
though there was a statistically significant rise in correct answers on each objective from
Pre to Post-tests.
In the future, multiple changes could be made to fine-tune the program. A larger
classroom will help movement of presenters and help the students to stay focused.
Water to help make the transition between activities smoother would also be beneficial.
A guest presenter from Truth.org with the ability to actually show tobacco products
could also help the students retain the knowledge of the program.
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Project Planning Team Biographies
Angela Strobel is a senior Community Health Education student. She has been on the Academic Dean’s List for five semesters. She is also a member of the Delta Phi Epsilon sorority where she serves on the Leadership Team. After graduation, she plans on attending graduate school for counseling. She then plans to continue on and become a licensed sex therapist.
Kelly Rohan is a senior Community Health Education student. She is a member of the Alpha Phi Sorority on SIUE’s campus where she serves as the Director of Formal Recruitment. Kelly has been on the Academic Dean’s List for three semesters. Kelly plans to graduate in December 2013, where she then plans to travel for a semester before possibly attending graduate school or accepting a job within the health field.
Kylie Ruffner is a senior Community Health Education student. She is a member of Eta Sigma Gamma, the health education honor society at SIUE. She holds a leadership position as a Cougar Guide, which aid new freshman in the high school to college transitioning process. Upon graduation, Kylie plans to attend graduate school for public health and then to pursue a career in disaster preparedness and relief.
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Literature Review
Tobacco is the leading cause of preventable deaths in the United States. It
accounts for one out of every five deaths that happen in the US as well (CDC, 2012).
The percentage of students who reported smoking cigarettes in the last month is 19.5%.
They also reported that the amount of student in high school who currently smoke
cigars is 14% and the amount of students to use smokeless tobacco is at 8.9%,
numbers higher than expected. Having a low socioeconomic status, increased
accessibility to tobacco, a low self-esteem, previous exposure from peers or family
members, and a history of aggressive behavior are just some of the risk factors
associated with tobacco use. The amount of tobacco use needs to be addressed, and
more cessation programs should be developed.
Each state receives a grade based on the tobacco regulation programs that are
developed. The FDA has earned an A on their efforts towards tobacco cessation. The
Cessation Coverage received a C grade, and in the Cigarette Tax and framework
convention on tobacco control received a D in both areas. In regards to state spending
on tobacco programs only two states received As and most of the other states received
an F because they do not always use all of their resources. Locally, Missouri has a
grade of its own based on the same grading scale as above. Missouri recently received
an F for their efforts. Missouri does not spend enough money on tobacco programs, and
is not taking all the proper precautions they should be like other states are. They still
allow smoking in public places like restaurants and bars. They also have the lowest
tobacco tax, at .17 cents whereas Illinois has a tobacco tax of $1. One thing that
Missouri has going for them is that their Medicaid plans include coverage for cessation
programs (American Lung Association, 2012). Because of this, the development of
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tobacco programs is not as successful as it could be. If there is increased effort and
funding, each state’s grade could be higher which would likely result in lower smoking
rates.
Adams found that tobacco prevention programs were not as successful as they
could be, thus a greater enforcement of tobacco policies was needed (2009). This may
be a better approach for certain schools, but this can definitely depend on the school
district, the students and the educators. According to Bailey’s study, the majority of
teenagers who smoke do so on weekends (2012). They also discovered that there was
an insignificant difference between different demographics and those who smoke. A
tobacco use cessation program would have to be dynamic and focus on all the
demographics available. However, Brown’s study demonstrated that a school program
could work if integrated with the student’s extracurricular activities (2002). Although
there was not any huge change for those who already smoke, results showed that the
eighth graders that participated in the study, who had not smoked yet, were less likely to
smoke before the end of their sophomore year. This evidence only demonstrates the
dire need for a successful program.
Smokeless tobacco is becoming more and more popular as well. High school
students are our target population and according to Nelson’s study, smokeless tobacco
use has increased with boy students in the twelfth grade (2006). It costs a little less than
cigarettes, does not smell up the house and the effect are transmitted more intensely
through the cuts it causes in your mouth. According to the CDC, smokeless tobacco is
not a safe alternative to cigarettes. 6.1% of students reported being current users of
smokeless tobacco (2011). According to Ebbert’s study, a pharmacological approach
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would be easiest in cessation efforts (2011). Trying the drug, Varenicline, a nicotine
replacer, proved to be the most effective way and those other nicotine replacers didn’t
prove to be as effective. Ebbert and his fellow researchers decided that adding
behavioral therapy would add to the success of the program. This is important to
discuss in a cessation education program, so that users know what options there are for
treatment.
Hookah use is a topic not discussed as widely as cigarettes or smokeless
tobacco. Jamil’s study found that 19% of adults surveyed smoke hookah (2010). 9% of
the 19% who have used hookah also have a history with cigarettes. This study also
found out that being under the age of 22 could contribute to hookah use. The
researchers think that more information about hookah is needed about hookah use,
because it is not a topic discussed as much as it should be. Hookah is dangerous and
according to the CDC, it is not a safe alternative to cigarettes and can still cause cancer
(2012). The charcoal used to heat up the tobacco emits carbon monoxide, metals and
carcinogens. There is still a danger to other people as well, because there is still second
hand smoke when smoking hookah. Hookah has also been known to cause lung,
bladder and oral cancer.
Secondhand smoke is very dangerous as well, but many have not heard about
the dangers of third hand smoke. With so many students who have family members
who smoke, this is a big concern for their health by just being at home. According to
Protano, third hand smoke is the chemicals, pollutants, and carcinogens that stay in the
fibers of our clothing, carpet, upholstery, hair, etc. The study that Protano conducted
concluded that third hand smoke is just as dangerous as second hand smoke (2008).
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The subject of third hand smoke is not a commonly discussed topic in the schools or
media. Since secondhand and thirdhand smoke affects those who don’t smoke as well,
it is possible that if students find out about the dangers of second and third hand smoke,
they may be more likely to discuss the smoking habits of their family members at home
and how it affects them.
Tobacco in all its forms is dangerous. Cigarettes seem to be the only form of
tobacco discussed, so it is important to discuss smokeless tobacco, second hand, third
hand smoke as well as hookah. According to the CDC, nicotine dependence is the most
common kind of dependence in the United States (2011).
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Needs Assessment
Tobacco use is one that affects all populations across the nation. From cigarettes
to chewing tobacco and even hookah, tobacco use raises health concerns across the
board. These issues include, but are not limited to, various cancers, dependence on
nicotine, and reproductive issues such as heightened risk of preeclampsia (Center for
Disease Control and Prevention, 2011). Within high schools across the United States,
19.5% of students have smoked at least one cigarette within the past month (Center for
Disease Control and Prevention, 2012). The CDC has also stated that 14% of high
school students were current cigar smokers, while 8.9% currently use smokeless
tobacco (2012).
Our needs assessment was performed at Parkway North High School in St.
Louis, Missouri. Parkway North is a large public school in the suburbs of St. Louis with a
student enrollment of 1,440 (Parkway North High School, 2012). We distributed
questionnaires to a sophomore health class of 21 male and female students. The
questionnaire included questions such as have they ever used or currently use a
tobacco product, what kind, if family members use tobacco products, the price of them,
and the content in tobacco products.
After reading the questionnaires, we found that only one student admitted to
using tobacco. When asked what kind of tobacco product that student had used, he
replied “weed.” This implies that some of the students had not been properly educated
on the different types of tobacco products on the market, let alone illicit drugs. In reply to
the question of whether the students had immediate family members who smoked,
seven students replied that they did. Of these seven, six of these students had family
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members that smoked within their homes, exposing them to smoke on a daily basis. In
response to the question of what diseases do the students believe that use of tobacco
products cause, five students left the question completely blank, while fourteen students
listed some form of a cancer. Other additional responses included stroke,
cardiovascular disease, respiratory disease, and “oral problems.”
Parkway North High School does not participate in typically popular tobacco
prevention programs, such as Red Ribbon Week; however, the school partners with
Preferred Family Healthcare, an organization that provides substance abuse and mental
health treatments, to help educate students on health issues. Through Preferred Family
Healthcare, the students are taught additional information on tobacco use as well as
other health topics heavily affecting teens.
In addition to Preferred Family Healthcare, Parkway North has two recovering
illicit addicts come as guest speakers to talk to the health classes. Mrs. Chambers, one
of three health teachers, feels that the students learn the most from hearing the addicts’
stories because it is more personal and real. She believes that even though their stories
can be scary, the students tend to get more out of hearing their experiences than
through a lecture. The guest speakers’ life events tend to “shoot the students straight”
and their honesty is most meaningful.
After the questionnaires were completed, we discussed with Mrs. Chambers and
the assistant principal, Dr. Calcaterra, about the current tobacco use and perceptions
throughout the high school. Parkway North is a tobacco-free campus with a fifty dollar
citation for being caught with tobacco on campus. They both agreed that cigarettes are
number three on the list of concerns, behind alcohol and marijuana use. Cigarette use
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has slowly diminished, and the students who continue to smoke are set in their ways
and are typically senior students. Mrs. Chambers and Dr. Calcaterra feel that cigarette
smoking is a greater issue in the middle schools versus in students of Parkway North
High School. They believe that the reason for this is because it that it is beginning to be
seen as an unattractive habit or that it is not a strong enough drug. On the other hand,
the reason some students do smoke is because of the easy access of cigarettes from
parents or other family members that smoke. There is a lack of peer pressure to use
cigarettes because the pressure is focused on the “harder” drugs like alcohol and
marijuana. When we discussed the other forms of tobacco, such as hookahs, cigars,
and smokeless tobacco, they were unsure of where the students stood, so we talked
with a senior female student.
The student knew a lot of her classmates and agreed that cigarettes were not as
much of a problem, but alcohol and marijuana use were. She felt like a few groups of
students owned hookahs and used them, but not a significant percentage. When asked
about smokeless tobacco, the student’s eyes lit up. She stated that a large majority of
the male student population, especially the athletes, used smokeless tobacco or
“dipped”. We came to the conclusion that this type of tobacco was most commonly used
for numerous reasons. Chew cuts the gums and inside of the lip, so the nicotine is
quickly absorbed into your system and provides a longer high than the other forms of
tobacco. There are also many different types or flavors, so there is a wider variety.
Smokeless tobacco is cheaper than cigarettes as proven by our stop at a local gas
station. Lastly, chew is easy to hide and doesn’t smell. Students can put it in their
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mouths without being caught, whereas cigarette or hookah smoking is obvious. The
container can also be easily hidden in pockets or lockers.
As seen from the data, a more comprehensive program on tobacco use is
needed in this community. The lack of knowledge within the classroom is proof enough
that a more thorough understanding of what different tobacco products are and their
individual health risks is needed. While it is good that the school partners with another
organization within their community, this program can be used as a more in-depth,
supplementary source of information where the school classes and Preferred Family
Healthcare information might lack. This program will give students a “real life”
understanding of tobacco and its use and dangers in the students’ world.
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Mission Statement, Goal and Objectives
The Mission Statement:
The mission of this program is to provide unbiased information about tobacco products
and their dangers to high school students.
Goal:
1. To plan, implement, and evaluate a tobacco prevention and cessation program with a
focus on preventing smokeless tobacco use
Objectives:
Objective 1.1
90% of students will be able to identify the average cost of a pack of cigarettes.
Objective 1.2
All students in attendance will be able to identify the painful effects of chewing tobacco.
Objective 1.3
All students will be able to identify that fiberglass in chewing tobacco is a myth and it
does not cut the gums.
Objective 1.4
86% of the students in attendance will be able to identify the contents of chewing
tobacco.
Objective 1.5
100% of the students in attendance will be able to acknowledge that using tobacco
products is a financial burden.
Objective 1.6
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86% of the students in attendance will be able to identify the health consequences of
using tobacco products.
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Theoretical Framework
For our tobacco education program, we targeted 21 sophomore high school
students from Parkway North High School. Our goal is to prevent all students from
trying tobacco products. According to the CDC, 19.5% of high school students have
smoked tobacco and 8.9% have used smokeless tobacco within the last month (2012).
After our needs assessment, we discovered that the use of cigarettes is less
common than use of smokeless tobacco in this particular high school. Reasons for this
could be that chewing tobacco is smokeless, thus more convenient to use and hide. It is
also easy to access, as many younger students are friends with older students who may
legally purchase the tobacco products. Smokeless tobacco can be a huge part of
athletic tradition for a lot of sports in high school as well. Other reasons that high school
students may use tobacco products include socioeconomic status, lack of self esteem,
the mass media, peer and parental exposure and the idea that tobacco use is normal
(CDC, 2012). We felt that the theory of planned behavior best fit our program because
of the individual decision making process when using tobacco products. (See graphic
below.)
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Behavioral Beliefs
Evaluation of Consequences
Normative Beliefs
Motivation to Comply
ControlBeliefs
Perceived Power of Circumstances
Attitude Toward Behavior
Subjective Norm
Perceived Behavioral
Control
Intention Behavior
The Theory of Planned Behavior explains that health behaviors are influenced by
attitudes, norms, and the sense of personal control. The high school atmosphere
seemed to support “dipping” because more students do so than we expected, especially
within the male population. According to Eaves, chewing tobacco is a social norm and is
even superstitious for baseball players to do (2011). For those students who have
parents who use tobacco, they may also think it is a regular thing to do and could be
more likely to pick up the habit themselves.
We believe that the attitude of the students is not beneficial to their health. We
feel that teens may not fully understand that the negative side effects of tobacco that
could affect them. They may think that they are too young to die from tobacco and will
keep using it. It is imperative to educate the teens from Parkway North about how
serious and common tobacco side effects are, especially for their age group.
Having the feeling of being in control of your own actions is very important. It is
especially important when all of the pressure that peers, parents, or the media may put
on teens to “fit in”, which can influence them to use tobacco products. This could cause
teens to feel a lack of control over their own life. Explaining the amount of control that
teens have over their own actions will be beneficial to our program.
The Theory of Planned Behavior is the best theory to use for our tobacco
education program due to the intrapersonal nature of tobacco use. By the end of this
program and with help of this theory, the students will be less likely to use tobacco
because they will have a better attitude towards quitting, and a stronger sense of
personal control. The attitudes, perceived norms, and sense of personal control are
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factors that influence tobacco use and with the use of this theory, we believe our
program will be successful.
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Interventions
Activity Objective Intervention Theory and Attitude Change
Email to Parents Inform the parents of the 21 sophomore health students at Parkway North High School on the importance of tobacco prevention and how they, as parents, can help prevent use in their children.
The email will inform the parents of Proposition B and encourage them to vote yes.
This will target the student’s normative beliefs. By sending an email containing helpful tips on how to prevent tobacco use in their children, the students will see that parents may express to their children that they do not approve of the behavior.
Lecture By the end of Snuff Out Tobacco, 86% of the sophomore health students will be able to identify the health consequences of using tobacco products.
The lecture will be on November 8th, last 10 minutes, and make sure the students are ready to learn and participate in the other activities. We will need a PowerPoint, computer, and projector to perform this lecture.
This will change the attitude of the behavior. By showing the long-term and short-term harmful effects of tobacco, and teaching about the different types and consequences, the students will be encouraged not to use tobacco products.
Different Cost of Tobacco Products
By the end of Snuff Out Tobacco, 100% of the sophomore health students will be able to correctly indicate the cost of using tobacco products.
The activity will take 10 minutes and will make the subject of tobacco and its costs relevant to the students. We will use social math to help us meet this objective by relating the tobacco costs to items and purchases that the students would be
This activity will affect their behavioral belief. We will be giving the students all of the knowledge needed to make the wise decision not to use tobacco products, because they will see that spending their money on
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interested in, like UGG boots, Halo 4, and an iPad.
tobacco products will affect their financial obligations.
Chewing Tobacco Content Demonstration
By the end of Snuff Out Tobacco, 86% of the sophomore health students will be able to identify one ingredient contained in chewing tobacco.
The demonstration will be on November 8th. The demonstration will take 15 minutes and will get the students active in the learning process. We will need examples or props to represent the following contents of chewing tobacco: polonium 210, N-nitrosamines (latex gloves), formaldehyde, nicotine (Raid), cadmium (batteries), cyanide (Raid), arsenic, benzene (toy car/gasoline), lead (pencil), ammonia (toilet bowl cleaner).
This activity will change their attitude toward the behavior of using tobacco products. By demonstrating the harmful contents, the students will be persuaded and informed into not using them.
Pop Rocks Activity
By the end of Snuff Out Tobacco, all students will be able to identify that nicotine enters the gums through absorption.
The activity will be done on November 8th. It will take 5 minutes and appeals to the student’s senses. Each student in attendance will receive a Dixie cup with a bag of Pop Rocks inside. They will insert them in between their lower lip and gums to give them the chewing tobacco sensation, as well as to demonstrate how the tobacco enters the
This activity will affect their attitude toward the behavior. The pop rocks will be inserted in the space between their lip and gums to demonstrate how the nicotine in chewing tobacco enters the gums via absorption.
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mucus membrane.
Big Red Gum Activity
By the end of Snuff Out Tobacco, all students will be able to identify the painful effects of chewing tobacco.
The activity will be done on November 8th
and will take 5 minutes and appeal to the student’s senses. Along with the Pop Rocks and Dixie cups, the students will receive a piece of Big Red gum. They will be instructed to insert the gum in between their lower lip and gums, where the Pop Rocks were inserted, to demonstrate the burning sensation chewing tobacco gives the user.
This, too, will affect their attitude toward the behavior. The chewing gum gives the effect that it is painful, by burning the inside of the lip and gums.
Intervention Plan
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Introduction-
Hi! My name is Kelly Rohan, Angela Strobel, and Kylie Ruffner. We are senior students at Southern
Illinois University Edwardsville. We are here to talk to you guys about tobacco products, with a focus on
smokeless tobacco based upon what we learned at our last visit. We would like to hand out this Pre-Test
before the program to get an understanding of your prior knowledge. This will not count toward your
grade. We ask that you please place one of the stickers on the top right corner of your sheet.
To start off, we would like to show you guys a little presentation we put together on the types of
tobacco products, health effects from use, and average costs.
-PowerPoint
Types of Tobacco products
Hookah
Cigars
Cigarettes
Smokeless tobacco
Hat Box Activity (Kylie)- Hatbox Chewing Tobacco Demonstration (Go to each table and allow them to
draw an item from the box. Return to front of room. Ask tables one by one which items they drew from
the table. Discuss what chemical is in each and feelings as we move around the room.)
-Contents:
N-nitrosamines- latex gloves
Nicotine and Cyanide- raid
Cadmium- batteries
Benzene- toy car/gasoline
Lead- pencil
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Ammonia- toilet bowl cleaner
Were you surprised by any of the contents?
Health Effects
PopRocks Activity (Angela)--Next, we would like to teach you all about some contents that you may not
know reside within chewing tobacco.Now we are going to enjoy some candy. Each of you will receive
Pop Rocks and a piece of Big Red gum, along with a cup. Do not eat either one yet! Open your bag of
Pop Rocks, take a pinch, and insert them between your lower lip and gums. If you feel the need to
swallow any of the spit your mouth is producing, we ask that you spit it into your cup. This represents
the action that chewing tobacco users must do to expel the juices created with the dip. The dissolving of
the Pop Rocks themselves represents the mode of action in which the chemicals enter the body through
the membrane of the gums.
Tell us how that felt. Questions or comments?
Take the piece of Big Red gum and chew it a little bit, just so the gum becomes soft. Move the gum to
the same area of your mouth as you placed the Pop Rocks. Does it burn or tingle? This sensation is
similar to how it feels when you use smokeless tobacco. Over time, this represents the damage and pain
caused by the use of smokeless tobacco.
Again, what did you think about that activity? Questions or comments?
Cost of Tobacco
Do you questions or comments about anything you learned or were surprised about?
Thank you for your participation and cooperation. We ask that you complete this post-test. You will not
receive a grade for doing so, we just want to see what you have learned.
Quitline- 1-800-784-8669 (Posted on board.)
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Budget
Revenue and Support CostContribution from sponsors $0.00Donations $212.68 Angela $70.89 Kelly $70.89 Kylie $70.89Grants $0.00Participant fee $0.00Sale of curriculum $0.00 Total Income
ExpendituresDirect Cost Personnel Salary and Wages $0.00 Fringe Benefits $0.00 Consultants $0.00 Supplies Instructional materialsEvaluation Tools $4.20 IncentivesMeeting Cost $0.00Equipment $0.00TravelPostage $0.00Advertising $0.00Space $0.00Subcontracts $0.00Indirect Costs $0.00 Total of indirect costs $0.00Total Cost $212.68
Materials List
Instructional Materials
Big Red Gum- $3.00
Pop Rocks candy- $12.00
Hat Box (Gift)- $1.00
Latex Gloves- $0.20
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Dixie Cups - $2.46
Batteries- $2.50
Insecticide (Raid)- $4.84
Toy Car (Gift)- $0.50
Toilet Bowl Cleaner- $1.97
Pencil- $0.20
Paint- $5.98
Paintbrush- $2.98
Evaluation Tools
Paper- pre/post-tests- $4.20
Ink- $19.97
Travel Costs
Fuel- $110.88
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Budget Narrative
For our budget, there were many items that we needed. For our transportation
needs in order to get to and from Edwardsville, Illinois to St. Louis, Missouri where our
project is located, we needed to allocate funds for fuel. We also had to obtain paper and
ink for printing purposes. For our final product, we bound together our work at an office
supply store.
The materials needed for our hat box demonstration were the hat box, batteries,
insecticide, toy car, latex gloves, a pencil and toilet bowl cleaner. The hat box was
decorated by the group members to look like a chewing tobacco container, and the
materials described were placed inside. The demonstration illustrated all the different
chemicals and materials that are absorbed when somebody uses chewing tobacco.
Latex represented the N-Nitrosamines, the insecticide represents the nicotine, the toy
care represents the Benzene in gasoline, the batteries represent the cadmium, the toilet
bowl cleaner represents ammonia, and the pencil represents the lead that is all in
chewing tobacco.
Another activity we did included Pop Rock candies and Big Red chewing gum.
The Pop Rock candies demonstrated how chewing tobacco can enter the bloodstream
through the mucous membrane, and the Big Red gum demonstrated the burning feeling
people get when using chewing tobacco.
In order to pay for all the materials listed, funds were privately and equally
donated by all members of the group. This was completed by purchases by individual
members of the group, then reimbursement of funds by the other group members. We
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believe that the activities will be worth the expense, and that it will have a positive
impact on the 21 sophomore health students at Parkway North High school in St. Louis
Missouri.
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Marketing Plan
Product Preventing and ceasing current tobacco use for 21 sophomore students at Parkway North high school.
Price There is no financial price to the participants of the Snuff Out Tobacco Program, but there is still a price. The price is divided into two different areas, those quitting tobacco use and those that we are trying show how to abstain from tobacco use. The nicotine withdrawals, the loss of tobacco and nicotine as a stimulant are the prices of ceasing tobacco use. There is a social price for those trying to abstain, the possibility of not fitting in with peers that use tobacco. There is also the price of not having tobacco as a study aid, less energy, and the lack of focus.
Place Parkway North High School sophomore health class, during class time at 1 o’clock in the afternoon on October 31st, 2012. As this is the student's’ regular class time, there will be no inconvenience in their schedule. This class was chosen because group member Kelly had contacts as an alumnae at Parkway North and this was the class time available for implementation.
Promotion The purpose of the program is to provide information to the students on how to abstain from or cease tobacco use. Communication strategies include email and the Snuff Out Tobacco in-class program. To do this we must override the competitor’s messages. In the school, these competitors include students who currently use, older students with access to tobacco products, and the tobacco use culture in athletics. Outside of the school these competitors include the stores selling these products, the tobacco companies themselves, and media that may portray tobacco use in a positive light.
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Recruitment Plan- Our group was able to recruit participants by having contact
with Kelly Rohan’s former high school and the health department. The school allowed
us to implement the intervention program in one of the sophomore health classes. As
this is only available to the one sophomore health class, the program itself will not be
advertised in the school. Snuff Out Tobacco took place at 1pm on November 8, 2012, a
day in which it is very likely for all students to be present in the classroom. In the future,
this can be replicated by the high school health department or by request of teachers in
the classroom. To do so, either the school health department would need to contact
teachers in order for someone to come in and implement the program or have the
teacher do so him/herself or the `teacher could implement the program in their
classroom as part of their classroom experience.
During our time with the students we provided many motivational factors. Our
lecture showed the students the dangers and results of using tobacco products to
motivate them to stop, or to never start. The activities reinforced the effects of using
tobacco by physically demonstrating to the students. A reinforcement of participation in
the program included getting to keep the candy after the Pop Rocks activity was
completed. No physical barriers of the program existed, but unwillingness to participate
occurred in some circumstances. The email to the students’ parents also helped reach
the priority population by taking the topic outside of the classroom and into the home
where many feel most comfortable.
30
31
32
Resource Personnel:Kelly Rohan,Kylie Ruffner,
Angela Strobel, Jared Opsal,
Jody Chambers, Dr. Calcatera,
Travis Becherer
Funding by the Group
Equipment, Supplies, and Educational
Materials: paper, ink, fuel, Pop
Rocks, Big Red gum, Dixie cups,
hat box, Raid, batteries, latex gloves, pencils,
PowerPoint
Space: Parkway North High
School health class
Inputs Outputs
Short-Term
Outcomes
Mid-Term
Outcomes
Long-Term
Outcomes
Refusal to Experiment
Those who use tobacco products
will stop
Those who don’t use tobacco
products will not begin
Parents support Proposition B
Students will pass on the
information to discourage
friends and family to stop using
tobacco products, or to never begin
Educate students about the dangers of
tobacco products
Educate students about
the cost of using tobacco
products
Physically demonstrate the effects of using tobacco
products
Change in knowledge of
tobacco products and
health outcomes
Change perception of
the cost of tobacco
Change in perceptions of
tobacco products
Decrease in mouth and lung
cancer, emphysema,
and cardiovascular
disease
Increase in spending money
Increase in lung capacity, and
oral and dental health
Snuff Out Tobacco Logic Model
33
Results
Snuff Out Tobacco was directed to a health class consisting of 21 sophomore
students, at Parkway North High School in St. Louis, Missouri on November 8th, 2012.
We prepared for 21 students, but there were only 18 students in attendance and all 18
participated in the program. The program began with a short introduction, followed by a
pre-test to be compared to a post-test given upon completion. After the pre-test, we
began with a lecture explaining the different types of tobacco products to give the
students an overview. We then facilitated the smokeless tobacco contents activity to
show the harmful ingredients in smokeless tobacco before talking about the health
effects within the lecture. Following the health effects, we discussed the cost of using
tobacco products through the lecture and by doing social math with items that the
students relate to. We continued on with our Pop Rocks and Big Red gum activities to
show the students the how the chemicals move across the gums and the painful effects
tobacco products can cause. The students were curious and inquisitive, so we had
discussions to wrap up Snuff Out Tobacco, followed by the post-test.
Objective Measures/Instruments ResultsBy the end of the program, 90% of the students will be able to identify the average cost of a pack of cigarettes.
What is the average cost of a pack of cigarettes?
a. $1.75 b. $4.50 c. $3.50 d. $2.75
Objective met: 100%Before the program only 39% of students were able to identify the average cost of a pack of cigarettes as being $4.50. Afterwards, 100% of the students correctly identified that the average price of a pack of cigarettes is $4.50.
By the end of the program, all students in attendance will be able to identify the painful effects of chewing tobacco.
Is chewing tobacco painful? strongly disagree
disagreeneutral
Objective not met: 78%According to the pre-tests, 56% of students identified that chewing tobacco is painful. The post-tests
34
agreestrongly agree
showed that Snuff Out Tobacco made 78% of students agree or strongly agree that chewing tobacco is painful.
By the end of the program, all students will be able to identify that fiberglass in chewing tobacco is a myth and it does not cut the gums.
Chewing tobacco cuts the gums.
True or False
Objective not met: 67%Prior to Snuff Out Tobacco 28% of students thought that chewing tobacco cuts the gums. Upon completion, 67% of the students identified the answer to be false that in fact chewing tobacco does not cut the gums.
By the end of the program, 86% of the students in attendance will be able to identify the contents of chewing tobacco.
Which of these items is found in chewing tobacco?
a. Lead b. Pop Rocks
c. Bleach d. Dirt
Objective not met: 78%The pre-tests showed that 44% of the students were able to identify at least one of the contents in chewing tobacco. The post-test proved that upon completion of the program 78% of students could recognize the contents of chewing tobacco.
By the end of the program, 100% of the students in attendance will be able to acknowledge that using tobacco products is a financial burden.
You can save about _______ yearly by not using chewing tobacco.
a. $500b. $785c. $985
d. $1,095
Objective met: 100%The pre-test showed that 28% of students could correctly identify the financial burden using tobacco products create. The post-test proved that after Snuff Out Tobacco 100% of the students could identify the financial burden of tobacco products.
By the end of the program, 86% of the students in attendance will be able to identify the health consequences of using tobacco products.
Which of the following is NOT a health consequence of using smokeless tobacco
products? a. Cardiovascular
disease b. Mouth cancer
c. Foul smelling breath
Objective not met: 83%According to the pre-test, 39% of the students were able to identify what the health consequences of using smokeless tobacco are. The post-test showed that after the program 83% of the students could
35
d. Weight gain correctly identify the health consequences of smokeless tobacco products.
While the program clearly showed knowledge gains, only two of the six
objectives were achieved. All students were able to identify the average cost of a pack
of cigarettes and all students were able to acknowledge that using tobacco products is a
financial burden. The first objective of identifying the average cost of a pack of
cigarettes took a leap from 39% of students correctly answering, to 100% upon
completion of Snuff Out Tobacco. We projected that 90% of the students would be able
to accurately do so. The fifth objective was also met when all of the students were able
36
Averag
e Cost
Painful E
ffects
Cuts Gums?
Conten
ts of
Chewing To
bacco
Finan
cial B
urden
Health
Conseq
uences
0
5
10
15
20
25
Pre and Post Test Results
Pre-TestPost-Test
Questions
Num
ber
of C
orre
ct A
nsw
ers
to correctly identify that using tobacco products is a financial burden upon completion of
the program.
As
the pie chart above displays, there was a significant change in the students’ thoughts to
37
Strongly Disagree
6% Dis-agree11%
Neutral28%
Agree50%
Strongly Agree6%
Chewing Tobacco is PainfulPre-Test Results
Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
Strongly Disagree
6%Neutral
17%
Agree39%
Strongly Agree39%
Chewing Tobacco is PainfulPost-Test Results
Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
whether or not chewing tobacco is painful. The pre-test showed that only 6% of students
answered that they strongly agree that chewing tobacco is painful, where as the post-
test displayed that 39% of students felt that way. Interestingly, there was also a change
in those that answered “agree,” but the percentage actually decreased from 50% to
39%. Overall there was improvement as the chart illustrates the decrease in strongly
disagree, disagree, and neutral answers by the sophomore health students at Parkway
North High School.
Discussion
38
The purpose of this program was to provide Parkway North High School students
with information about tobacco products and their dangers to high school students. This
was accomplished through a series of activities including a lecture on types of tobacco
and health effects of use, a Pop Rocks activity representing how the chemicals in
smokeless tobacco moves across the membrane of the gums, a Big Red gum activity
that represents the sensation of smokeless tobacco use, an activity in which a hat box
represented a can of smokeless tobacco which contained various chemicals found
within the actual product, and a social math activity that informed students on the
financial burden of tobacco use.
The program showed an overall knowledge improvement of 44%, which was
calculated through an overall percentage of correct answers on the pre-test versus the
post-test. When asked about the average cost of a pack of cigarettes in their area of
Missouri, only 39% of participants could correctly identify that the average cost was
$4.50. By the end of the program, 100% of the students were able to identify the cost.
This shows that during the lecture, all students were engaged enough to all fully retain
the information. The students were also asked to rate their feelings on the painful
effects of smokeless tobacco. At the beginning, only 56% of the students marked agree
or strongly agree to the smokeless tobacco being painful. At the program’s conclusion,
78% of students rated agree or strongly agree to the painful affects. This result may
have been due to varying sensitivities of the gums of the students or their reaction to
cinnamon flavored gum. Students were also asked whether they believed that chewing
tobacco cuts the gums; only 28% correctly identified that chewing tobacco does not cut
the gums. By the end of the program, the percent of students that could correctly
39
identify that chewing tobacco does not cut the gums increased to 67%. While this was a
great increase from the pre-test results, there was some confusion between the
students beliefs, the teacher’s opinion, and what we were informing the class. This
resulted in a less than ideal result on the post-test. When asked about the contents of
smokeless tobacco on the Pre-Test, 44% of students could correctly identify that lead
was a content of smokeless tobacco, in comparison to 78% on the Post-Test. We
believe the 78% success rate on the post-test was a result of the toilet bowl cleaner
containing “Clorox Bleach,” confusing the students on the test where “bleach” was an
option. The Pre-Test also showed that only 28% could correctly identify the financial
burden of chewing tobacco use. After the completion of the program, 100% of students
could correctly identify that the yearly financial burden is about $1,095. It was evident
that through the use of social math and teaching students of products they could buy
with their saved money instead really interested the students. This resulted in every
student answering the question correctly. The final question students were asked about
regarded the health consequences of tobacco use. Prior to the program, only 39% of
students could correctly identify that weight gain was not a health consequence of
tobacco use. This percent increased to 83% of students being able to correctly identify
after the program’s completion. This drastic increase in correct answers shows the
lecture portion was effective in helping students understand which conditions are
caused by tobacco use.
The data on smokeless tobacco use in high school students is limited. When
researching, there is a wealth of information on smoking, including at risk populations
and health effects. Smokeless tobacco, however, is more in the gray area of hard facts.
40
According to our needs assessment and findings by the CDC, smokeless tobacco use
by high school students is on the rise. The CDC reported that in 2009, 6.1% of high
school students were current smokeless tobacco users.. We found that the females in
the class were more physically uncomfortable with the activities representing the effects
of smokeless tobacco, such as having to spit, which coincides with the CDC data stating
that only 1.5% of female high school students use smokeless tobacco, in comparison to
11% of males. Another contrast found was that smoking was more prevalent amongst
high school males in comparison to all tobacco products (Tomar, Alpert & Connolly,
2009). This is in direct contrast with what we found in the high school where smokeless
tobacco was the biggest of tobacco use. We believe this difference is a result of the
campus being tobacco-free. Cigarettes and cigars give off a noticeable smoke that can
be easily detected by faculty, whereas smokeless tobacco can easily be hid in pockets
and gives off no cloud of smoke.
There were a number of limitations that restricted the effectiveness of the
program. The first limitation was the class size. There were only 21 students in the
classroom, thus only 21 students that were able to participate in the program. A small
class size inhibited the distribution of information to a larger audience. Of these 21, only
19 students were present on the day of implementation, again, limiting the amount of
people that the information was dispersed to. Limiting even further was a student who
came in after the Pre-Test was dispersed. While she was still allowed to participate in
the activities, we could not use her scores on the Post-Test because we had no way of
knowing what was prior knowledge and what was learned through the program,
resulting in only 18 usable Pre and Post-Test results. Other limitations involving the
41
students included some students being uncomfortable with or unwilling to participate in
discussion, one student with the inability to chew gum, and some students being unable
to feel the effects of the Big Red activity. Other limitations included a window of only 20
to 30 minutes in which we had to implement and the campus being tobacco free, thus
limiting the demonstration tools that could be used.
To improve this project for future implementations, there are a number of
changes that can be made. In the future, we hope for a larger class size so that
information is dispersed to a wider array of students with more diversity in age. We
would also like to be able to show actual tobacco products so that the students could
experience the actual sensations of touch and smell of smokeless tobacco. A larger
classroom would also be a benefit for future implementation. The students tended to
talk to each other since they sat so close together, so more space would mean less
chance of the students getting off track by talking to each other at the wrong times.
Future implementations could also benefit from research of other sugarless cinnamon
gums that could replace Big Red for those with braces. Water being available for the
students after the Pop Rocks activity would also benefit the flow from that activity to the
Big Red activity, as a few students got the candy stuck in their gums waiting for the
candy to melt. We also would consider adding a guest speaker using information from
Truth.org.
For health professionals and practitioners, this program can be modified to its
optimal state. One recommendation is that this program be targeted at student athletes.
Based upon discussion with students at the high school, we found that smokeless
tobacco use is high among those who play sports such as baseball. Targeting this
42
population may lower the numbers of athletes who begin using as a result of the
tobacco use culture many sports are associated with. Practitioners may also want to
implement to a younger age group. By the time the students are sophomores in high
school, many are already exposed to the tobacco use culture. Targeting a younger age
would instill a confidence in their non-use of tobacco products that may be unaffected
by high school peer pressures. Practitioners should continue to use hands on learning.
The Pop Rocks and Big Red activities increased students interest in the topic, thus
increasing their participation and knowledge gains in the topic area. The practitioner
should also find ways to engage the student more during the lecture content of the
program. These focuses will allow a mindset that the students will never use tobacco
products.
43
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