Before starting the activity, ask your students:

• What have you learned about tobacco and nicotine?
• What/who has given you information about smoking, vaping or use of other tobacco and nicotine products? (e.g., television/media, magazines/books, parents/family members, teachers, peers/friends) 

Then, direct students to the online survey in the website by clicking “Launch Activity” below. We recommend emailing the link to your students, posting it on a class web page, projecting it on an interactive whiteboard, and/or writing it on a chalkboard.

Explain to your class that they are going to take a survey about tobacco and nicotine. Encourage them to answer the questions as honestly as they can. Let them know that the first eight questions ask them about their experience with tobacco and nicotine and are only going to be used by you to get a sense of what they have experienced. Tell them the survey will be entirely anonymous and no identifying information will be included in the responses they email to you. Inform students that once they have finished the survey, you will share some information with them related to Part Two. Explain that being informed is an important element of making the right decisions. Then, let students know that they will learn facts about tobacco and nicotine use and tips for coping with peer pressure in this unit, “Keeping Healthy.”

Once the survey is complete, share with your students the facts listed in the answer key part of the “Wrapping Up” section to dispel misperceptions they may have about tobacco and nicotine use and to reinforce the message that most young people don’t use tobacco or nicotine. Also, encourage students to volunteer answers during your discussion if they feel comfortable.

Answers, part one
Answers will vary. Review the answers students provided for questions 1–8. This will give you a sense of your students’ experience with tobacco and nicotine, but it should not be shared with the students. 

ANSWERS, Part Two 
1–8. Explain to students that most young people do not smoke or vape. Only about 1 of every 100 middle school students (1.0%) reported that they had smoked cigarettes in the past 30 days, and 1 out of every 30 middle school students (3.3%) reported that they had used e-cigarettes/vapes in the past 30 days.²

Point out to students that the younger people are when they start smoking, the more likely they are to become addicted.

4. Ask students if they want to volunteer answers about why young people use tobacco. Note their answers on the board. Explain to students that some of the reasons young people try or start to use tobacco include:^{4, 3}

They don’t feel good about themselves (low self-esteem and self-image). 
They don’t know about the health consequences of smokeless tobacco. 
They think lots of people smoke or vape (overestimating number of people who smoke/vape). 
They don’t realize that they can become addicted (not understanding the addictive potential of nicotine).

5. Ask students if they want to volunteer answers about why they think young people choose to be tobacco and nicotine free. Explain that some people may choose to be tobacco and nicotine free because:^{4, 5}

Their friends don’t use tobacco or nicotine products. 
They know about the health consequences. 
They want to be tobacco and nicotine free.

6–7. Explain to students that some young people try tobacco because of a “lack of self-efficacy in the ability to refuse offers to use tobacco,”⁴ or they don’t know how to tell their friends they don’t want to try it. 

Explain to students that people their age are sometimes pressured to use tobacco or nicotine products, and that pressure can be difficult to handle. Let them know that in this unit, they are going to learn some ways to say “no” and cope with peer pressure so they can be tobacco and nicotine free.

If students volunteer stories, remind them not to use names. Listen to their concerns and explain to students that feeling pressure from friends happens, but that they will learn some ways to deal with the pressure.

8. Explain to students that there are health consequences related to tobacco use. According to the Surgeon General, symptoms such as coughing, shortness of breath, nausea, and phlegm production can develop in young people who smoke.⁴ Youth and young adults are also uniquely at risk for long-term, long-lasting effects of exposing their developing brains to nicotine. These risks include nicotine addiction, mood disorders, and permanent lowering of impulse control. Nicotine also changes the way synapses are formed, which can harm the parts of the brain that control attention and learning.⁴ Tell them that they will learn more about the health consequences in Activities 2 and 3. If students want to volunteer answers, write them on the board and then revisit the list when you read Activity 2. 

9. Students might have heard that quitting tobacco and nicotine is difficult, but they may not know why. Read to your students the following passage from the Surgeon General’s Report “Preventing Tobacco Use Among Young People”:⁴

Most young people who smoke regularly are already addicted to nicotine, and they experience this addiction in a manner and severity similar to what adult smokers experience. Most adolescent smokers report that they would like to quit smoking and that they have made numerous, usually unsuccessful attempts to quit. Many adolescents say that they intend to quit in the future and yet prove unable to do so. Those who try to quit smoking report withdrawal symptoms similar to those reported by adults.⁴

Students will learn more about addiction in Activity Three. 

10. Answers will vary. However, explain to your students that a survey of teens reports that 65% of teens strongly dislike being around smokers.⁶

For additional information on factors that influence young people to use tobacco and nicotine for reasons most of them abstain, review the Overview Booklet. 

To end the lesson, display the “Tobacco & Nictoine: Myth or Reality?” poster in the “Materials” section and review the content with your students. The poster will reinforce the message that most young people are tobacco free. 

To assist you with evaluating your students’ anonymous responses to this tobacco survey, we have created a data-collection spreadsheet that will allow you to input and view quantitative and qualitative measures. Click here to access the downloadable survey-response spreadsheet. You’ll also find it in the “Materials” section below.

¹ CDC. Smoking & Tobacco Use. Fact Sheet—Youth and Tobacco Use: Estimates of Current Tobacco Use Among Youth. Referenced 2017. www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/

² Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future National Survey Results on Drug Use, 1975-2015: Volume I, Secondary School Students. Ann Arbor: Institute for Social Research, The University of Michigan. Referenced 2017. www.monitoringthefuture.org/pubs/monographs/mtf-vol1_2015.pdf

⁴ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C., 2012. Referenced 2023. https://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf

⁵ CDC. Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. MMWR 1994; Vol. 43, No. RR-2; 1-18. Referenced 2023. https://www.cdc.gov/mmwr/PDF/RR/RR4302.pdf

⁶ U.S. Department of Health and Human Services. Preventing Tobacco Use among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.