SMOKING CESSATION RESOURCE PACK

1. SMOKING CESSATION RESOURCE PACK Summer 2010

2. How To Use This Pack HOW TO USE THIS PACK: HOW TO DOWNLOAD: To download from website: • Click on the link to the pack you want to download • From the dialog box, choose to ‘open’ or ‘save’ the file then click OK • The pack will open as a slideshow: all links are live but you will need to left click to advance through the pack. • Choose PRINT from the drop down FILE menu to print all or some of the pages (see below) • Choose SAVE AS from the drop down FILE menu to save a copy to your hard drive HOW TO PRINT (NOTE – THERE IS NO NEED TO PRINT THE ENTIRE PACK, ONLY INDIVIDUAL SLIDES WITH ACTIVITIY SHEETS): • Before printing, delete ‘Index’ arrows by selecting and then pressing DELETE • Individual slides can be printed by selecting individual slide numbers or ranges in the PRINT menu • To print slides in black & white or grayscale, select the relevant option from the Colour/Grayscale drop down menu when you are about to print HOW TO VIEW LINKS/USE SLIDES • These slides may be used to form part of a presentation – press F5 to view as a slideshow • To delete individual slides, click on them to select then click on ‘cut’ in the Edit menu • To make links ‘live’ you will need to view the pack as a SLIDESHOW – go to the ‘View’ menu or press F5 If you have any comments regarding this pack, or need any additional help in using it, please contact me: SUZANNAH YOUDE: suze.youde@kent.gov.uk or tel: 01622 221678 All information in this pack was correct and all links active at time of upload but may be subject to change

3. Index • How to use this packGuidelines on downloading, saving and printing • IntroductionWhat do young people think about smoking? • Top 10 WebsitesThe best of the web • Other resourcesLinks to even more online resources • The Political CaseLooking at tobacco issues from the global perspective • The Economic CaseThe real cost of smoking • The Health CaseDoes smoking really make you look older – or just old? • IcebreakersGetting group work sessions off to a good start • Discussion PointsIdeas to get a dialogue going • My PledgeWe all have habits we’d like to change • Smoking Myths & Facts The truth about smoking • Smoking Myths & Facts factsheetWere you right? Or do you still have a lot to learn? • Session IdeasActivities for smoking cessation group work • More session ideasAnd more of the same! • Smoking Costs TableHow much do you spend a week/month/year? • Smoking Card SortAre there any reasons to smoke? • Health Benefits TimelineDid you know you feel the health benefits of stopping smoking in minutes? • Circle of FriendsWe all like to do what our mates do – but how many really smoke? • What’s in your cigarette?A few of the 4,000 chemicals (and 69 carcinogens) in a cigarette • What’s in your cigarette answersDid you know your cigarette is full of fertiliser, rocket fuel and wee?!

4. Introduction CURRICULUM CHAPTERS: 10 (Healthy Living), 25 (Working with Young Men & Women) CURRICULUM PACKS: Healthy Living, Health & Wellbeing 09, Alcohol Awareness OTHER RESOURCES: Healthaware Books We’re all aware of the statistics about smoking – how half of all teenagers who are currently smoking will die from diseases caused by tobacco if they continue to smoke and how one in two long-term smokers will die prematurely as a result of smoking - but the traditional health related statistics and scares don’t influence the thinking and behaviour of young people when it comes to smoking: “The real issue is that these health messages can fall on deaf ears with children,” says Professor Anne McNeill, of the University of Nottingham’s school of community health sciences. “Young people live in the here and now. Thirty is a lifetime away and they can’t imagine being that old.” http://www.timesonline.co.uk/tol/life_and_style/health/child_health/article7119928.ece The aim of this pack is to try and reframe the smoking cessation debate in ways that make it relevant to young people – through political, economic and (to a lesser extent) health arguments where smoking impacts on skin and dental hygiene. You’ll find a range of ice breakers, discussion points and session ideas to help with the planning, delivery and evaluation of work around smoking cessation. The following have some interesting insights into approaching and designing smoking cessation work with young people: www.nice.org.uk/nicemedia/documents/smokingcessation_youngpeople.pdf www.ashscotland.org.uk/files/DDSCSforyoungpeople.pdf eazysecure12a.net/nya.org.uk/dynamic_files/yw4h/nyaseminar/Siobhan%20LLoyd%20DudleyOur%20Voice%20Our%20Help%20Our%20Health.pdf

5. Reframing the Debate – Allan Gregory Traditionally, tobacco education has concentrated on the health impacts - however, Kent partners are advocating a new approach of 'reframing the debate' looking at tobacco industry tactics and the impact on the environment and people’s lives. The Kent Tobacco Control Strategy states: “Despite sustained education about the health effects of smoking, adolescents continue to smoke, suggesting that traditional approaches may educate, but they do not influence.  Young people tend to respond to social trends. Evidence from youth advocacy forums show they want ‘just the facts’ to allow them to make up their own mind about tobacco, rather than being told the ‘rights and wrongs’ of tobacco use. Social influence is probably therefore the best intervention.” The new Kent Tobacco Control Strategy  "Towards A Smokefree Generation" has the support of a wide range of Kent Partners.  In adopting and implementing the strategy, all partners will sign up to actively engaging young people in their tobacco control initiatives; groups who want direct access to a range of services from Customs, Trading Standards, Health, Police, Fire Services, etc.  Should contact Allan Gregory allan.gregory@kent.gov.uk Support is also available from KASH (the Kent Alliance on Smoking & Health) – their website is in development but follow them on Twitter www.twitter.com/KASH_tweets Allan Gregory is a tobacco control officer for [Kent County Council] who has worked with young people to create campaigns to celebrate No Smoking Day and has already been runner up and winner in the Best Newcomers Category! He has funding to take a group of young people to the NSD launch in November and then follow up with an innovative NSD event in March . Allan also makes grants to youth led tobacco control projects and would like to hear from you if you have young people leading on smoking cessation work at your project – if you’re interested please contact Allan Gregory allan.gregory@kent.gov.uk

6. Top 10 Websites

7. Other Resources

8. The Political Case The Global Perspective • Growing tobacco uses a lot of land. It has been estimated that if food crops were grown instead of tobacco this land could feed between 10 and 20 million people • In 2002, the Chief Executive Officer of Phillip Morris, one of the world’s biggest tobacco companies made $3.2 million in salary and bonuses • It would take a tobacco farmer in Brazil, 2,140 years to earn what a tobacco company director earns in one year • A 1994 study reported that about 43 percent of tobacco estates in Malawi employ children directly • In 2007 the combined revenues of the three leading tobacco companies (PMI, BAT and JT) was $147 billion • Channel 4 are screening ‘Tobacco’s Child Workers’ http://www.channel4.com/programmes/unreported-world/episode-guide/series-2010/episode-4 Smoking and the Media • Studies show that smoking in movies misleads young people into thinking that tobacco use is normal, acceptable, socially beneficial and more common than it is • The current rate of smoking scenes in Hollywood films has returned to the high levels of the 1950s, after reaching its lowest levels in 1980 The Big Sell • In 1997, a Big Tobacco executive once said, under oath, that he believed Gummy Bears were addictive like cigarettes. The tobacco industry has also likened the addictiveness of cigarettes to caffeine, television and M&Ms • In 1985, one tobacco vice president wondered, in reference to smoking-related deaths, if we should ban sleep since according to him the majority of people die in their sleep.+ • In 1997, one tobacco company CEO said he would probably "instantly" shut his doors " to get a better hold on things " if it were proved to his satisfaction that smoking causes cancer. That same company now admits on their website that smoking causes cancer, but they’re still open for business.+ • As late as 1999, tobacco companies placed in-store advertising signage at a child’s eye level. To find out more visit: www.seethroughtheillusion.co.uk/handy-stuff/www.thetruth.com/facts/old.ash.org.uk/html/conduct/html/tobexpld8.html#target www.corpwatch.org/article.php?id=1128

9. The Economic Case ‘A tobacco company once gave $125,000 worth of food to a charity, according to an estimate by The Wall Street Journal. Then, they spent well over $22 million telling people about it. I guess when you sell a deadly, addictive product, you need all the good PR you can get’ (truth website) Smoking costs – not only in terms of the amount of money that a packet of cigarettes costs but also in terms of health and wellbeing. Smoking affects your skin, your fertility, clogs your arteries, causes premature ageing and a range of cancers. Financial estimates for the direct impact of smoking on the NHS came to £5.2 billion for 2005/6, which equates to 5.5% of the total NHS budget for that year – a proportion that has not changed since the early 1990s – and this is thought to be an underestimation because it doesn’t include lost productivity and informal care; the costs of treating disease caused by passive smoking, or the full range of conditions associated with smoking.  Tobacco also has a cost to our environment: • Tobacco plants are highly sensitive to disease and require huge amounts of pesticides to protect the crop. Since tobacco isn’t a foodstuff, most of the chemicals used are unregulated • 1 in 8 trees cut down in the world is due to tobacco growing or drying – nearly 9 million acres of forest are lost each year • 2,700 tonnes of cigarette litter is dropped on Londons streets alone each year. This is the equivalent of 6,750 million cigarette ends. Cigarette butts take at least 10 years to biodegrade • Cigarette butts have been found in the stomachs of fish, birds, whales and other sea creatures, who mistake them for food. • Cigarettes & matches are the most common cause of deadly house fires in the UK The NHS has a smoking calculator that looks at the financial and health costs http://www.nhs.uk/tools/pages/smoking.aspx?tag= Truth has an interactive ‘useful cigarette’ showing all the ingredients – from urine to embalming fluid to antifreeze – that go to make up a cigarette http://www.thetruth.com/facts/usefulcig/ For more on the human cost see C4’s ‘Tobacco’s Child Workers’ http://www.channel4.com/programmes/unreported-world/episode-guide/series-2010/episode-4 (click on the ‘Watch Now’ button to see the programme)

10. The Health Case I smoke fewer than 5 a day – what’s the problem? Studies show that people who smoke five cigarettes a day are three times more likely to die of heart disease. Smoking just one cigarette a day trebles your risk of lung cancer and raises the risk of chronic lung disease, as well as cancer of the mouth, throat, bladder, pancreas and many more. It also makes it more difficult to conceive, lowers sperm count and causes more complications in pregnancy. Study after study shows that the risks increase the more you smoke, but all risks start with just one cigarette. There’s no problem - if I give up smoking when I’m older I’ll be OK. Anyway, it takes ages before giving up makes any difference. Someone who starts smoking at 15 is three times more likely to die from cancer due to smoking than someone who starts smoking in their mid-20’s. And your lungs start to clean up after 24 hours so the sooner you quit the quicker you can start looking good and feeling great! Menthol cigarettes and rollies are safer than ordinary cigarettes, right? Menthol cigarettes are not safer than any other brand. In fact, they may even be more dangerous. The added menthol produces a cooling sensation in the throat when the smoke is inhaled. It also decreases the cough reflex and covers the dry feeling in the throat that smokers often have. People who smoke menthol cigarettes can inhale deeper and hold the smoke in longer. It’s proven that rollies cause a higher level of tobacco in the lungs. But ‘light’, ‘mild’ or ‘low tar’ are better for me, aren’t they? No. If you smoke 'light', 'mild' or 'low tar' cigarettes you are likely to inhale as much tar, nicotine and other poisons as those people who smoke regular cigarettes. The use of these misleading descriptions was banned from cigarette packaging in the EU in September 2003. For more information about 'light' and 'mild' cigarettes read www.cancerpage.com/news/article.asp?id=4039 If I give up I’m going to get fat! You might put on a few pounds but that’s healthier than smoking! And there are specially designed exercise programmes to help you get fit and quit – exercise actually helps you to give up www.quit.org.uk/quitandkeepfit.php I like smoking – it makes me feel relaxed and it makes me look cool and more mature. You might think you feel relaxed but , actually, smoking a ciagrette increases your heart rate. And the only way cigarettes make you look older is by ageing your skin and giving you wrinkles! For more information on smoking and your health: NHS Atlas of Risk http://www.nhs.uk/Tools/Pages/NHSAtlasofrisk.aspx

11. Icebreakers • Walking Vote set up two signs saying YES and NO at either end of the room. Then ask the following questions and get young people to vote by using their feet! After each question ask a few young people to talk about their choice. HEALTHY LIVING: Have you ever smoked? Do you get your 5 a Day? Do you eat fast food/takeaways more than once a week? Do you exercise once a week? Do you sunbathe? (do you think that’s a healthy choice?) TRUE OR FALSE? (all statements are true) getting older increases your chance of getting cancer/most cases of lung cancer are caused by smoking/getting sunburnt increases your risk of getting skin cancer/eating healthily can help guard against cancer/being overweight increases your risk of getting diabetes or heart disease (why did you think that was true/false?) FUTURE PLANNING Did you clean your teeth this morning? Do you have any savings in a bank account or building society? Would you like to be able to see into the future (what was the reason for your answer?) • Smokefree Friends Put the group into pairs, trying to pair up young people who don’t know each other so well. Give each of them a few minutes to find out the following information from each other: do you smoke? What do you think about smoking? What’s your best idea for encouraging people to stop smoking? Then go round the group and ask each pair to feedback about each other. • Human Knot Ask the group to stand in a small circle facing each other. Everyone sticks their hands into the center of the circle and randomly grabs someone else's hand with each of their own hands. The objective of the game is to untangle this "human knot" without anyone letting go of a hand, ending up with one large circle (although sometimes, two separate or linked circles might be the end result). The participants have to step over or under each others linked arms, with the close physical proximity and silly maneuvers breaking the ice between strangers. This game also requires team work and decent leadership skills in one or more participants. You can make the point that, although being tangled up is like the dependency of smoking, by working with other people we can break that dependency. • Height Order ask the group to arrange themselves in a line in height order (you could also do this by age, date of birth or alphabetical order of names). Make the point that, by working together in a team, you can achieve results – just as you’ll achieve better results by working with other people to stop smoking rather than going it alone!

12. Discussion Points • Paper Carousel – Quit Lists: Write the following four questions on 4 pieces of flipchart paper What gets people to stop smoking? How do people stop smoking? What are the good things you get from stopping smoking? How can you help someone you know who is trying to stop smoking? Now divide the group into 4 and give each group a different coloured pen and one of the 4 questions. Give each group a set amount of time to brainstorm their responses, then move the groups round to the next question until each group is back to their original question. Allow some time for the group to read the responses and comment on them, then ask them to choose a set number of points to feed back on (could be as few as 2 or as many as you like). The paper carousel is a good way of getting young people to discuss issues, comment on each other’s choices and reflect on their learning. • Making Changes discuss some of the bad habits you have that you might like to change. Discuss how we can all make changes but sometimes we need some help and moral support to make them, however good our willpower! Now make your pledge about what you intend to change – these can be pinned up on the wall, pasted in a book or hung from a tree branch to represent a Tree of Change, removing pledges from the branches when they are filled. • The Costs of SmokingDraw the outline of a body on a sheet of flip chart paper and ask young people to brainstorm the costs of smoking – any that affect health/beauty (lung cancer, wrinkles, stained teeth) draw inside the body and any others (secondary smoke, smelly clothes etc) outside the body. This article http://www.costofsmoking.com/ has some other costs you might like to introduce to get young people thinking about the way that the cost of smoking is potentially everywhere. • Smoking – Myths & Facts Using the smoking myths and truths information below either as a straight quiz or as a team game: divide the group into 2 teams. Tell them they will each draw a statement from a container and they must decide between them whether the statement is a myth or a fact (explain that myths refer to untrue information passed around as fact). If they identify whether the statement is myth or fact correctly they score 1 point. If they can say why it’s a myth or fact they gain a bonus point. During the plenary, ask questions like why young people would take those risks, and how would they stop their peers from taking risks with their sexual health. [Cut up the statements below and keep the factsheet for answers) . More ideas can be found here: http://www.quit.org.uk/guides/mythsguide/QUIT_Myths_Guide.pdf • Smoking Keyring http://news.bbc.co.uk/local/surrey/hi/people_and_places/arts_and_culture/newsid_8468000/8468313.stm Would this invention make you think twice about smoking? Can you think of any better ideas to get the no smoking message across?

13. My Pledge My first step towards change:

14. Smoking Myths & Facts

15. Smoking Myths & Facts - factsheet • Smoking helps you relax False – it doubles your heart rate • Smoking makes giving birth easier because the baby is smaller True – but smaller babies have more health problems • Cigar smoking is safe because you don’t inhale False – you are still at risk of mouth cancers because cigars contain the same carcinogens (cancer causing chemicals) as cigarettes • The only cancer caused by smoking is lung cancer False – smoking causes a range of cancers like mouth, throat and bladder cancer • When you stop smoking you feel the benefits almost immediately True – within 20 minutes blood pressure is back to normal • When inhaled, nicotine reaches the brain faster than any other drug True – nicotine reaches the brain in 8 seconds as opposed to 12 seconds for heroin and cocaine • Cigarettes contain weedkiller and rocket fuel True – there are over 4,000 chemicals in a cigarette • Tobacco was once known as ‘herba panacea’ or herbal cure all True – it was thought to cure many diseases including lung problems • Stopping smoking causes weight gain True – but gaining weight that you can lose later is much healthier than smoking • You can smoke and take the pill without any problem False – the combination can cause blood clots and even stroke • Smokers are generally white middle class men False – most smokers are women and young people from low income brackets, especially in the developing world • The tobacco plant is poisonous True – it’s often used as a natural pesticide • On average, smokers live 7 years less than non smokers True – each cigarette takes 5 ½ minutes off your life • Workers on tobacco farms can suffer tobacco poisoning True – workers can absorb the poison from the leaves through their skin • Herbal cigarettes produce tar and carbon monoxide – True – although they don’t contain nicotine they do have all other nasties • Second hand smoke causes cancer True – 4 of the chemicals in second hand smoke are known to cause cancer • Nicotine replacement patches are as bad for you as cigarettes False – they don’t contain tar, carbon dioxide and the other 4,000 chemicals found in a cigarette • 69 of the chemicals used in cigarettes can cause cancer True – though nicotine isn’t one of them (but it is highly addicitive) • Smoking while pregnant can cause miscarriage True – all the chemicals in cigarettes are passed to the foetus in the womb • Occasional smoking is not harmful False – even occasional smoking raises the risk of smoking related diseases like heart trouble and lung disease

16. Session Ideas • DIY smoking calculator: Use any of the smoking cost calculators online – or ask young people to complete the table below to get an idea of how much you would save a month or a year if you gave up smoking. Now invent your own calculator – what would really encourage you to give up smoking? Being able to buy an iPod after a month? Being able to have a nice holiday? Develop a handout/poster/webpage to encourage other young people to make informed choices about their budget. • Smoking Card Sort : print out the card sheet then cut each card out separately. Either deal the cards out to the group at random or leave them in a central pile and ask young people to select them one at a time. The ask them to place them under the headings: ‘Reasons to smoke’ and ‘Reasons not to smoke’. Encourage a discussion about their choices: - some are obvious, but some may be ambiguous: low birth weight may be seen as desirable, the high addiction level of nicotine is a reason not to smoke but the fact that cigarettes contain nicotine may be seen as a reason why people have to smoke. The fact that it’s illegal to buy cigarettes may encourage risk taking behaviour in under 18s. The cost of growing tobacco is extremely high but some may argue that buying cigarettes aids farmers in the developing world. • Smoking Leaflets download some smoking cessation leaflets here http://www.patient.co.uk/display/16777223/ or obtain hard copies from Health Promotions. Ask young people to review and rate a number of them – are they relevant? Would they encourage you to stop smoking? How would you improve them? Divide the group into smaller groups and ask them to design leaflets that they would find effective. Then bring the group together and compare the different leaflets – why did they take the approach that they took? Which one leaflet would be the most effective and why? • Anti Smoking Ads http://www.canstopsmoking.com/PreventionDefault.htm and http://www.w-west.org.uk/videos.html look at the ideas for advertising here – discuss with the group: do they agree that anti smoking advertising that focuses on cosmetic/social effects is more effective than ads that focus on health effects? These ads have caused a storm of controversy in France because of their sexual nature – does the group find them effective (please screen for appropriateness) http://www.telegraph.co.uk/news/worldnews/europe/france/7301977/Anti-smoking-advert-with-sexual-innuendo-shocks-French.html Now divide the group into smaller groups and ask them to brainstorm and storyboard their own anti smoking ads. You can then support each group to produce a video of their ad (camera phones are good for this) or you can bring the group back together to compare the different ideas, vote on the most effective and then ask the whole group to film and edit their ad. Why not upload to a site like TruTube http://www.truetube.co.uk/ or Digital Kent http://digital.kent.gov.uk/

17. Session Ideas • ‘I Want to Break Free’ video The ‘We Quit’ site have done a remake of the classic Queen song with Duncan Banantyne from ‘Dragon’s Den’ – visit http://www.wequit.co.uk/ and click on ‘Win A Spa Weekend’ to see the video, and Queen’s original, in a pop up window. Scroll down for ideas on props, costumes and staging then let your imagination go wild! If Queen don’t do it for you, visit http://www.w-west.org.uk/videos.html and watch the ‘Why do you Keep Running, Boy?’ video. Now either recreate with your own props and dance moves or use it to inspire your own anti smoking song – using any style of music to get the message across. • Flash Mob Everyone’s seen the T-Mobile dancing ‘flash mob’ ads – why not stage an anti smoking flash mob outside your centre or even in your local high street – for ideas and examples see: http://www.teachertube.com/viewVideo.php?video_id=176615&title=Anti_Smoking_Flash_Mob http://www.yourkenttv.co.uk/community/tvpopupnew.aspx?aid=11810&vid=5033 You could research figures for death’s & serious illnesses in your area and find a way to present those in a flash mob format http://www.kmpho.nhs.uk/geographical-areas/primary-care-trusts/eastern-and-coastal-kent-pct/?assetesctl1877273=63528 • Make your choice video Have a look at the Metropolitan Police’s ‘Choose Your Ending’ campaign http://www.met.police.uk/campaigns/anti_knife_crime/index.htm This uses a series of youtube videos that have used annotations to give you a choice as to where the story should go. Why not develop a similar campaign focusing on smoking – what are the temptations to smoke? And what are the choices once you start to smoke? • Health Benfits Timeline Game use the health benefits timeline as a template – write the benefits on strips of card and then write the timeline on a piece of flipchart paper. Now give young people a benefit card and ask them to place it on the timeline where you think it goes. Once you’ve used all the cards, ask the group to discuss their choices and review them as necessary – tell them they have another X minutes to put the cards in their final order. Once this is done, compare their timeline to the official one. How well did they do? Are they surprised at how quickly some of the benefits occur? Is there anything in the timeline that would discourage young people from giving up smoking? Anything that would encourage them to quit?

18. Smoking Cost Table Can you complete the table – 1 pack cigarettes = £6.20

19. Smoking Card Sort

20. Health Benefits Timeline Information from http://www.quit-smoking-stop.com/quit-smoking-benefits.html

21. Circle of Friends How many friends do you have? Mark a segment for each friend in the circle (this one is marked for 4, but you’ll need to add more – just draw lines that pass through the centre point)

22. What’s in your cigarette? A lot of the chemicals in a cigarette have common everyday uses – can you link the name to the product? Toluene Image From http://tjblogs.tjsays.com/2007/09/16/whats-in-a-cigarette.aspx

23. What’s in your cigarette - answers • Cadmium (batteries – causes cancer) • Toluene (industrial solvents e.g. Engine degreaser) • Hexamine (barbecue lighter fuel) • Methanol (rocket fuel) • Carbon Monoxide (car exhaust fumes - poisonous) • DDT (pesticide used for crop spraying - causes cancer & environmental damage) • Acetic Acid (vinegar) • Acetone (nail varnish remover) • Formaldehyde (embalming fluid – cancer risk) • Ammonia (household cleaner – can cause cancer) • Stearic Acid (candles) • Arsenic (rat poison – causes cancer) • Hydrogen Cyanide (Gas used by the Nazis as Zyklon B in the gas chambers, still used in executions in the USA ) • Nicotine (Pesticide) • Ethanol (fuel, particularly as a biofuel – causes cancer) • Methane (gas produced by cows – responsible for global warming) • Butane (lighter fluid)

24. Get Smokefree – Escape the Maze!

25. Up in Smoke Reason to quit: Reason to quit: Reason to quit: Reason to quit: Reason to quit: