tobacco primer
DESCRIPTION
Dr. Brian Primack's presentation at the 3rd Annual Media Literacy Conference in Harrisburg, sponsored by Drug Free Pennsylvania.TRANSCRIPT
![Page 1: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/1.jpg)
Tobacco Primer:Four Questions about
Smoking
Brian A. Primack, MD, EdM, MSMarch 2010
Drug Free Pennsylvania
![Page 2: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/2.jpg)
1. What’s the big deal?
![Page 3: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/3.jpg)
050000
100000150000200000250000300000350000400000450000500000
On 9/11/01 Annually fromsmoking
Deaths
![Page 4: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/4.jpg)
Worldwide deaths, 2010
0
1000000
2000000
3000000
4000000
5000000
6000000
Haiti Smoking
Deaths
![Page 5: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/5.jpg)
Costs
• Direct and indirect medical costs from one year of smoking in the US– $157 billion (75 direct, 82 indirect)
• Immunize the entire 3rd world– $2 billion
![Page 6: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/6.jpg)
![Page 7: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/7.jpg)
![Page 8: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/8.jpg)
“The Big Lie”
In the advertisement:
• Peace• Freshness• Good smells• Independence
In real life:
• Coughing• Stale taste, smoke• Bad smells• Dependence
(addiction)
![Page 9: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/9.jpg)
![Page 10: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/10.jpg)
Worldwide toll of smoking• Kills five million people annually worldwide• Will be over 10 million annually by 2050 (Some
countries with 10 million or fewer people: Hungary, Sweden, Belgium, Switzerland, Senegal, Portugal, Greece, Bolivia)
• Half of deaths in middle age (workforce needed for economic development)
• Half of deaths in rich nations, half in developing nations
• Apparent causes of death different (India TB, China COPD)
![Page 11: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/11.jpg)
2. How can it be that bad?
![Page 12: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/12.jpg)
Ingredients
• Dried tobacco leaves• Additives• Fire
![Page 13: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/13.jpg)
![Page 14: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/14.jpg)
Cigarette Additives that start with A or BAcetanisole, Acetic Acid, Acetoin, Acetophenone, 6-Acetoxydihydrotheaspirane, 2-Acetyl-3- Ethylpyrazine, 2-Acetyl-5-Methylfuran, Acetylpyrazine, 2-Acetylpyridine, 3-Acetylpyridine, 2-Acetylthiazole, Aconitic Acid, dl-Alanine, Alfalfa Extract, Allspice Extract, Oleoresin, And Oil, Allyl Hexanoate, Allyl Ionone, Almond Bitter Oil, Ambergris Tincture, Ammonia, Ammonium Bicarbonate, Ammonium Hydroxide, Ammonium Phosphate Dibasic, Ammonium Sulfide, Amyl Alcohol, Amyl Butyrate, Amyl Formate, Amyl Octanoate, alpha-Amylcinnamaldehyde, Amyris Oil, trans-Anethole, Angelica Root Extract, Oil and Seed Oil, Anise, Anise Star, Extract and Oils, Anisyl Acetate, Anisyl Alcohol, Anisyl Formate, Anisyl Phenylacetate, Apple Juice Concentrate, Extract, and Skins, Apricot Extract and Juice Concentrate, 1-Arginine, Asafetida Fluid Extract And Oil, Ascorbic Acid, 1-Asparagine Monohydrate, 1-Aspartic Acid, Balsam Peru and Oil, Basil Oil, Bay Leaf, Oil and Sweet Oil, Beeswax White, Beet Juice Concentrate, Benzaldehyde, Benzaldehyde Glyceryl Acetal, Benzoic Acid, Benzoin, Benzoin Resin, Benzophenone, Benzyl Alcohol, Benzyl Benzoate, Benzyl Butyrate, Benzyl Cinnamate, Benzyl Propionate, Benzyl Salicylate, Bergamot Oil, Bisabolene, Black Currant Buds Absolute, Borneol, Bornyl Acetate, Buchu Leaf Oil, 1,3-Butanediol, 2,3-Butanedione, 1-Butanol, 2-Butanone, 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One, Butter, Butter Esters, and Butter Oil, Butyl Acetate, Butyl Butyrate, Butyl Butyryl Lactate, Butyl Isovalerate, Butyl Phenylacetate, Butyl Undecylenate, 3-Butylidenephthalide, Butyric Acid
![Page 15: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/15.jpg)
Why Add?
• Enhance flavor• Change burn rates• Change tar/nicotine ratings• Increase delivery of nicotine
![Page 16: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/16.jpg)
What happens when you burn?
Over 4000 chemicals, including …
![Page 17: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/17.jpg)
Selected Chemicals Released When Cigarettes Are Burned
• Benzene• Formaldehyde• Urea• Arsenic• Cyanide• Acetone• Pyridine
• Ammonia• Tar• Carbon
Monoxide• DDT• Butane• Cadmium
![Page 18: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/18.jpg)
A is for Addiction
• Nicotine is a carcinogen itself• Binds to adenosine receptors in the brain,
releasing dopamine (rush); has effect within 10 seconds
• Potent withdrawal begins within minutes• Leads to the next cigarette
![Page 19: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/19.jpg)
B is for blood vessels
• Multiple chemicals in cigarettes cause endothelial damage
• Increases predisposition to clotting, plaque buildup, and heart attack
![Page 20: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/20.jpg)
Atherosclerosis
![Page 21: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/21.jpg)
Myocardial Infarction
![Page 22: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/22.jpg)
Stroke =CVA
(cerebro-vascular accident)
![Page 23: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/23.jpg)
Peripheral Vascular Disease
![Page 24: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/24.jpg)
59 year old female smoker
![Page 25: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/25.jpg)
C is for Cancer
![Page 26: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/26.jpg)
Some carcinogens in cigarettesPAHs:• Benzo[a]anthracene, Benzo[b]fluoranthene, Benzo[f]fluoranthene,
Benzo[k]fluoranthene, Benzo[a]pyrene, Chrysene, Dibenz[a,h]anthracene, Dibenzo[a,i]pyrene, Dibenzo[a],[1]pyrene, Indenol[1,2,3][c,d]pyrene, 5-Methytlchrysene
Aza-arenes:• Dibenz[a,h]acridine, Dibenz[a,j]acridine, 7H-Dibenzo[c,g]carbazole, QuinolineN-Nitrosamines: • 4-(methylnitrosamine)-1-(3-pyridyl)-1-butanone, N-Nitrosethylmethylamine, N-
Nitrosoanabasine, N-Nitrosodiethanolamine, N-Nitrosodiethylamine, N-Nitrosodimethylamine, N-Nitrosonornicotine, N-Nitrosopyrrolidine
Aromatic Amines:• Acetaldehyde, Aldehydes, 4-Aminobiphenyl, Crotonaldehyde, Formaldehyde,
2-Naphthylamine, 2-ToluidineMiscellaneous Organic Compounds:• Acrylonitrile, Benzene, Ethylcarbamate, 2-Nitropropane, Vinyl chlorideInorganic Compounds:• Arsenic, Cadmium, Chromium, Hydrazine, Nickel, Polonium-210
* From Reducing the Health Consequences of Smoking: 25 Years of Progress. Washington, DC, U.S. Department of Health and Human Services, 1989.
![Page 27: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/27.jpg)
D is for Destruction of Lungs (COPD)
![Page 28: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/28.jpg)
![Page 29: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/29.jpg)
E is for Environmental Smoke (Second-Hand Smoke)
![Page 30: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/30.jpg)
Second Hand Smoke
• 38,000 deaths each year (more than homicide and AIDS combined)
• Most pronounced in waiters, bartenders, spouses
• Infants
![Page 31: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/31.jpg)
“Safer” cigarettes …
• No additives• Low tar• Low nicotine• “Smokeless”
![Page 32: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/32.jpg)
![Page 33: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/33.jpg)
![Page 34: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/34.jpg)
![Page 35: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/35.jpg)
3. Who smokes, and why?
![Page 36: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/36.jpg)
Gender
0
5
10
15
20
25
30
Men Women
Percentsmokers
![Page 37: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/37.jpg)
Race
0
5
10
15
20
25
30
35
White AA Asian NA Hisp
PercentSmokers
![Page 38: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/38.jpg)
![Page 39: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/39.jpg)
Wilkinsburg
![Page 40: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/40.jpg)
![Page 41: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/41.jpg)
“Menthol X”
![Page 42: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/42.jpg)
Ever Smokers Who Have Quit
0
10
20
30
40
50
60
White Black
Percent
![Page 43: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/43.jpg)
African Americans
• Bear the greatest burden of mortality from smoking
• Don’t really smoke more• Is it the menthol?
![Page 44: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/44.jpg)
Poverty Level
0
5
10
15
20
25
30
35
Below Above
Percentsmokers
![Page 45: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/45.jpg)
Age
0
5
10
15
20
25
30
18-24 25-44 45-64 65+
Percentsmokers
![Page 46: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/46.jpg)
![Page 47: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/47.jpg)
“As this 14-24 age group matures, they will account for a key share of the total cigarette volume for at least the next 25
years.”
--RJ Reynolds
![Page 48: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/48.jpg)
“Our studies report on youngsters' motivation for starting, their brand
preferences, as well as the starting behavior of children as young as 5
years old.”
-- Brown and Williamson Tobacco Company
![Page 49: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/49.jpg)
![Page 50: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/50.jpg)
![Page 51: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/51.jpg)
![Page 52: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/52.jpg)
US Tobacco, quoted 1994
“Cherry Skoal is for somebody who likes the taste of candy, if you know what I’m saying.”
![Page 53: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/53.jpg)
![Page 54: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/54.jpg)
Smoke Top Advertised Brands
0102030405060708090
100
Youth Adults
SmokeMarlboro,Camel, orNewport
CDC, 2004
![Page 55: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/55.jpg)
![Page 56: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/56.jpg)
![Page 57: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/57.jpg)
![Page 58: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/58.jpg)
![Page 59: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/59.jpg)
![Page 60: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/60.jpg)
![Page 61: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/61.jpg)
![Page 62: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/62.jpg)
![Page 63: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/63.jpg)
$20 Sampler
![Page 64: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/64.jpg)
Regular $7.00Large $10.00
Arabic Coffee, Apple, Apple Alex, Double Apple, Apricot, Banana, Candy, Cappuccino,
Cherry, Carmel, Coconut, Cola, Grape, Jasmine, Lemon, Mint, Mango, Mandarin, Mixed Fruit, Orange, Pistachio, Peach
Rose, Salloum, Strawberry, Vanilla, Zaghoul Light, Zaghoul, Licorice
![Page 65: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/65.jpg)
![Page 66: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/66.jpg)
Smoke Volume
“A typical 1-hour long hookah smoking session involves inhaling 100-200 times the volume of smoke inhaled with a single cigarette.”– WHO, 2005– Shihadeh, 2004
![Page 67: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/67.jpg)
Smoke ContentsCompound
(mg)Hookah1 Cigarette2 Ratio
Tar 802 22.3 36
Nicotine 2.96 1.74 1.7
CO 145 17.3 8
1Shihadeh and Saleh, 2005
2Djordjevic, 2000
![Page 68: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/68.jpg)
![Page 69: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/69.jpg)
Carcinogen (ng) Hookah1 Cigarette2 Ratio
Benz[a]anthracene 677 35 19
Benzo[a]pyrene 370 10.1 37
Benzo[g,h,i]perlyene 307 7.9 56
Di-benzo[a,h]anthracene 140 2.5 245
Indeno[1,2,3-cd]pyrene 183 3.5 52
1Sepetdjian, 2008; 2Gmeiner, 1977
![Page 70: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/70.jpg)
![Page 71: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/71.jpg)
![Page 72: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/72.jpg)
![Page 73: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/73.jpg)
Tobacco Types
0
5
10
15
20
25
30
35
40
Cigarettes Hookah Cigars* Smokeless
Ever Used
Past 30 Days
* Includes little cigars, cigarillos
![Page 74: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/74.jpg)
Hookah Smoking by Grade Level
0
2
4
6
8
10
12
14
16
6th 7th 8th 9th 10th 11th 12th
Ever Used
Past 30 Days
Primack et al., Pediatrics 2009
![Page 75: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/75.jpg)
4. What do we do about it?
![Page 76: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/76.jpg)
![Page 77: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/77.jpg)
Legislation
• Ban on TV advertising 1971• MSA of 1998 (no billboards)• Clean air laws
![Page 78: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/78.jpg)
![Page 79: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/79.jpg)
![Page 80: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/80.jpg)
![Page 81: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/81.jpg)
![Page 82: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/82.jpg)
Public Service Announcements
• Do have an effect• About 50 “just say yes” for each “just say
no”• US PSA budget is about 1/30 of England,
Canada
![Page 83: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/83.jpg)
School Programs
• “Tar Wars” – 4th and 5th grade• “Social influences” programs
– Grade school: effect on body– Middle school: peer pressure, friends, family– High school: self esteem, aspirations
![Page 84: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/84.jpg)
HSPP• Peterson, AV, JNCI 2000• Curriculum for youth, 3rd-10th grades• 47.25 hours total• “Social Influences” approach• How to say no, effects on body, resisting
peer influence, self esteem, etc.• 20 school districts got the program, 20 did
not• 94% follow up, high implementation fidelity
![Page 85: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/85.jpg)
Results of HSPP
• No difference in smoking at 12th grade• No difference in smoking 2 years after
high school• No difference among boys or girls• No difference among people of other
subgroups (such as family risk for smoking)
![Page 86: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/86.jpg)
Is Media Literacy Different?
![Page 87: Tobacco Primer](https://reader033.vdocuments.us/reader033/viewer/2022052911/559e115e1a28abcf158b4662/html5/thumbnails/87.jpg)
Major Reasons for Media Literacy
• Fun, creative• Someone to rebel against• Developmentally appropriate• Most effective for the ones most at risk• Empowering, not protectionist