FROM THE FIRST TO THE LAST ASH: The History, Economics & Hazards of Tobacco

FROM THE FIRST TO THE LAST ASH: The History, Economics & Hazards of Tobacco A Comprehensive Adult Basic Education Curriculum Developed By Marjorie Jacobs Community Learning Center (617) 349-6363 Funded by a Mass. Department of Public Health grant to The Cambridge Tobacco Education Program, Cambridge Department of Human Service Programs. Tobacco Control Activities are supported by the Health Protection Fund, established upon passage of voter referendum Question 1 (Tobacco Excise tax) in November 1992.Copyright 1995 by Marjorie Jacobs Revised 1997

2 DETAILED TABLE OF CONTENTS INTRODUCTION 4 UNIT 1: History & Economics of Tobacco 6 What is Tobacco? 6 History of Tobacco 8 Economics of Tobacco 14 Reading & Writing Activities: 24 Finding Important Facts/Details UNIT 2: Cigarette Advertising 33 Tobacco & Youth 35 Analyzing Assorted Tobacco Advertisements 37 Reading & Writing Activities: 42 Distinguishing Facts From Opinions UNIT 3: Why People Smoke 49 Interview #1 50 Interview #2 51 Why Do You Smoke? Test 55 Reading & Writing Activities: 60 Finding the Main Idea

3 UNIT 4: The Dangers of Smoking for Smokers 62 What s In A Cigarette & Disease: 62 Chemicals, Cancer and Heart Disease Cycle of Addiction 66 Other Health Dangers of Cigarettes 68 Reading & Writing Activities: 73 Vocabulary Through Context Clues UNIT 5: Health Dangers of Smoking for Nonsmokers 77 Smoking & Pregnancy 79 Reading & Writing Activities: 82 Vocabulary Through Context Clues UNIT 6: Quitting 90 Steps to Quit Smoking 91 Going Cold Turkey 93 Interview With An Ex-Smoker 94 Tapering Off Method 95 Quitting Smoking Resources 102 Reading & Writing Activities: 106 Drawing Conclusions BIBLIOGRAPHY 110

4 INTRODUCTION From the First to the Last Ash: The History, Economics & Hazards of Tobacco is a comprehensive tobacco education curriculum which integrates speaking, reading, writing, and critical thinking skills and focuses on cigarette smoking. It was funded in 1993 by the Massachusetts Department of Public Health grant to The Cambridge Tobacco Education Program, Cambridge Department of Human Service Programs. From the First to the Last Ash was written for native and non-native English speaking, adult populations reading at grade levels 6 through 12. It is comprised of six self-contained units. Individual units can be used in focus groups, adult and community education classes, and workshops or the whole sequence can be taught as an eight-week course. Each unit contains reading, writing, and speaking activities designed to teach content as well as to build written and verbal communication skills. The reading skills taught are as follows: locating important facts/details, distinguishing facts from opinons, finding the main idea of one or more paragraphs, learning new vocabulary through context clues, and drawing conclusions. There is a separate teachers guide complete with step by step lesson plans for each unit. The development of this curriculum dates back to February 1994 when over one hundred students at the Community Learning Center in Cambridge, Massachusetts were given a survey to assess their knowledge and interest in tobacco-related subjects. They were enrolled in English-as-a-second language, Adult Basic Education, and PreGED classes. The results of the survey were used to design a curriculum to meet students needs and interests. From the First to the Last Ash was written with three main objectives in mind. One was to increase the students understanding and awareness of the historical role of the tobacco industry in the U.S. economy and the health dangers of smoking to smokers and nonsmokers. Another was for students to develop strategies to protect themselves and others from cigarette smoke. The third

5 objective was to encourage smokers to quit and to assist nonsmokers in their efforts to help family members and friends to quit. From the First to the Last Ash was piloted from August 1994 to April 1995 with over 200 adult education students at the Community Learning Center. The students come from a diversity of age and ethnic/linguistic groups. Among the groups represented were 18-55 year olds from Haiti, Puerto Rico, El Salvador, Venezuela, Panama, Barbados, Trinidad, Jamaica, the United States, Portugal, Cape Verde Islands, Lebanon, Philippines, China, and Brazil. From the United States, there were African-American, Hispanic, Asian, and white participants. All students were low-income whether employed or on public assistance. At the end of the pilot, all students evaluated the curriculum. The course was rated as excellent by 99% of the participants. They felt that they had learned valuable knowledge and had also improved their reading, writing, thinking, and speaking skills. New materials were generated by the students through the various activities at the end of each unit. Several parents who smoke learned about ways to protect their children from second hand cigarette smoke. One woman in the early stages of pregnancy, who had been smoking for 15 years, quit smoking at the end of the course. Other students thought that they could now educate their children about the dangers of smoking and be supportive and influential in helping family members and close friends quit smoking. Final revisions were made to the curriculum in the fall of 1995 through the input of five, health education, community outreach workers from the Cambridge Tobacco Education Program and Cambridge United For Smoking Prevention. From the First to the Last Ash is currently being used by many tobacco education programs throughout the United States. Program personnel are using it as a resource to educate themselves and their staffs and to assist their target populations with tobacco education and cessation.

6 UNIT 1: HISTORY AND ECONOMICS OF TOBACCO WHAT IS TOBACCO? Tobacco is a green, leafy plant that is grown in warm climates. After it is picked, it is dried, ground up, and used in different ways. It can be smoked in a cigarette, pipe, or cigar. It can be chewed (called smokeless tobacco or chewing tobacco) or sniffed through the nose (called snuff). Nicotine is one of the more than 4,000 chemicals in cigarettes and its smoke. It is the chemical that makes tobacco addictive or habit forming. Once we smoke, chew, or sniff tobacco, nicotine goes into our bloodstream, and our body wants more. The nicotine in tobacco makes it a drug. This means that when we use tobacco, it changes our body in some way. Because nicotine is a stimulant, it speeds up the nervous system, so we feel like we have more energy. It also makes the heart beat faster and raises blood pressure.

Credit: Copyright by The New York Times Company. Reprinted by permission. Article appeared on 2/26/94. 7

8 HISTORY OF TOBACCO Tobacco has a long history in the Americas. The Mayan Indians of Mexico carved drawings in stone showing tobacco use. These drawings date back to somewhere between 600 to 900 A.D. Tobacco was grown by American Indians before the Europeans came from England, Spain, France, and Italy to North America. Native Americans smoked tobacco through a pipe for special religious and medical purposes. They did not smoke every day. Tobacco was the first crop grown for money in North America. In 1612 the settlers of the first American colony in Jamestown, Virginia grew tobacco as a cash crop. It was their main source of money. Other cash crops were corn, cotton, wheat, sugar, and soya beans. Tobacco helped pay for the American Revolution against England. Also, the first President of the U.S. grew tobacco. By the 1800 s, many people had begun using small amounts of tobacco. Some chewed it. Others smoked it occasionally in a pipe, or they hand-rolled a cigarette or cigar. On the average, people smoked about 40 cigarettes a year. The first commercial cigarettes were made in 1865 by Washington Duke on his 300- acre farm in Raleigh, North Carolina. His hand-rolled cigarettes were sold to soldiers at the end of the Civil War. It was not until James Bonsack invented the cigarette-making machine in 1881 that cigarette smoking became widespread. Bonsack s cigarette machine could make 120,000 cigarettes a day. He went into business with Washington Duke s son, James Buck Duke. They built a factory and made 10 million cigarettes their first year and about one billion cigarettes five years later. The first brand of cigarettes were packaged in a box with baseball cards and were called Duke of Durham. Buck Duke and his father started the first tobacco company in the U.S. They named it the American Tobacco Company.

9 Credit: An 1892 Duke of Durham box of machine-rolled cigarettes Tobacco Biology & Politics The American Tobacco Company was the largest and most powerful tobacco company until the early 1900 s. Several companies were making cigarettes by the early 1900 s. In 1902 Philip Morris company came out with its Marlboro brand. They were selling their cigarettes mainly to men. Everything changed during World War I (1914-18) and World War II (1939-45). Soldiers overseas were given free cigarettes every day. At home production increased and cigarettes were being marketed to women too. More than any other war, World War II brought more independence for women. Many of them went to work and started smoking for the first time while their husbands were away. By 1944 cigarette production was up to 300 billion a year. Service men received about 75% of all cigarettes produced. The wars were good for the tobacco industry. Since WW II, there have been six giant cigarette companies in the U.S. They are Philip Morris, R.J. Reynolds, American Brands, Lorillard, Brown & Williamson, and Liggett & Myers (now called the Brooke Group).

10 They make millions of dollars selling cigarettes in the U.S. and all over the world. In 1964 the Surgeon General of the U.S. ( the chief doctor for the country) wrote a report about the dangers of cigarette smoking. He said that the nicotine and tar in cigarettes cause lung cancer. In 1965 the Congress of the U.S. passed the Cigarette Labelling and Advertising Act. It said that every cigarette pack must have a warning label on its side stating Cigarettes may be hazardous to your health. By the 1980 s, the tobacco companies had come out with new brands of cigarettes with lower amounts of tar and nicotine and improved filters to keep their customers buying and to help reduce their fears. The early 1980 s were called the tar wars because tobacco companies competed aggressively to make over 100 low tar and ultra low tar cigarettes. Each company made and sold many different brands of cigarettes.

11 Credit: Smoking Tobacco & Health, Centers for Disease Control In 1984 Congress passed another law called the Comprehensive Smoking Education Act. It said that the cigarette companies every three months had to change the warning labels on cigarette packs. It created four different labels for the companies to rotate.

12 Public Law 98-474, Comprehensive Smoking Education Act, 1984 Credit: Smoking Tobacco & Health, Centers for Disease Control Since the 1980 s, federal, state, local governments, and private companies have begun taking actions to restrict cigarette smoking in public places. The warning labels were the first step. Tobacco companies cannot advertise cigarettes on television or radio. It is against a law that was passed by Congress in 1971. Many cities across the U.S. do not allow smoking in public buildings and restaurants. Since 1990, airlines have not allowed smoking on airplane flights in the U.S. that are six hours or less. State taxes on cigarettes have increased.

13 Credit: Reprinted courtesy of The Boston Globe, 4/10/94 As it becomes more difficult for tobacco companies to sell their products in the U.S., they are looking outside. U.S. tobacco companies are now growing tobacco in Africa, South America (Brazil and Paraguay), India, Pakistan, the Phillipines, Greece, Thailand, and the Dominican Republic. Fifty percent (50%) of the sales of U.S. tobacco companies go to Asian countries, such as Thailand, South Korea, Malaysia, the Phillipines, and Taiwan.

14 ECONOMICS OF TOBACCO Economics deals with the making and selling of products and services to consumers. Products are things like chewing tobacco, cigarettes, televisions, houses, and cars. Services include medical care, education, and insurance. Consumers are the people like ourselves who buy or receive the products and services. The U.S. has a capitalist economic system. Under this system, one or more people get together and form a company to make and sell something. They do this to make money. The money that they make after paying off their bills or expenses is called profit. In other words, a profit is the money they have for themselves after paying rent, salaries, utility bills (electricity, gas, telephone) and buying machines/computers and any other equipment they need to make their product and run their business. When companies sell more than they spend, they make a profit. Selling their products to other countries is called exporting. The product that is sold is called an export. Buying from other countries is called importing, and what U.S. companies buy is called an import. For example, if Ford Motor Company buys steel from Japan to make a car, it is importing a product. Steel is the import. When Ford sells its cars to Brazil, it is exporting. Cars are the exports. When companies or governments export more than they import, they have a trade surplus. A trade surplus is another way of saying a profit. On the other hand, when they import more than they export, they have a trade deficit. A deficit means a debt or money owed to someone else. Throughout history, tobacco companies have had a trade surplus. That is one big reason why they have been important to the economy of the U.S. In 1992 the tobacco industry reported a $5.65 billion dollar trade surplus. In the first half of 1992, tobacco exports were $2 billion more than imports. The taxes that the tobacco companies pay provide a lot of money for the U.S. government. In 1992, Philip Morris alone paid $4.5 billion in taxes. This makes it the largest tax payer in the U.S.

15 Credit: Copyright 1994 by The New York Times Company. Reprinted by permission. How Do They Live With Themselves? Roger Rosenblatt, The New York Times Magazine, 3/20/94 Tobacco companies export their products (cigarettes, cigars, chewing tobacco) to at least 146 countries around the world. They sell to Hong Kong, Saudi Arabia, United Arab Emigrates, Turkey, South Korea, Singapore, China, Russia, and many more countries. In 1992 Philip Morris sold 11 billion cigarettes to Russia alone. Credit: Associated Press, 1/26/94

16 One of the reasons tobacco growing is so profitable is because its costs are so low. There are only about 800,000 people working in the tobacco industry. There are 136,000 tobacco farms in more than 16 states. The making or manufacturing of cigarettes is almost completely automated. It is done by machines without people. Machines crush and clean tobacco leaves and add chemicals like nicotine. They also roll cigarettes, put on filters, cut them to length, and then package them. All of the six U.S. companies producing cigarettes are large and powerful. They are so strong that not even all the medical reports of the health dangers of smoking and all the laws restricting smoking and advertising have been able to weaken them. They are still able to make big profits by buying up other nontobacco companies in the U.S. and by selling and making cigarettes outside the country. For example, Philip Morris bought Miller Beer and Kraft General Foods, and R.J. Reynolds bought the Nabisco Food Group and General Entertainment Corporation.

17 TOBACCO COMPANIES: THE COMPANIES THEY OWN & THE PRODUCTS THEY MAKE Philip Morris Bird s Eye Louis Kemp Seafood Jello Louis Rich Meats Light n Lively Kool-Aid Crystal Light Lender s Bagels Kraft Minute Rice Oscar Mayer Tang Post Cereals Claussen Pickles Lowenbrau Stove-Top Log Cabin Country Time Millers Beers Maxim Coffee Maxwell House Shake and Bake Baboli Bread Seven Seas Miracle Whip Louis Rich Cool Whip Milwaukee s Best Beer Sharp s Beer Bulls Eye Sauce Knudson Meister Brau Beer Parkay Margarine Capri Sun DiGiorno Pasta Food Club Entenmanns Sealtest Ice Cream Bakers Chocolate Chiffon Richmix Candy Breyer s IceCream Brooke Group (formerly Liggett & Myers) MAI (computers, information systems) NBA Hoops (baseball cards) Basic Four LineDrive Pre-rookie(baseballcards) Distributor of football & hockey cards Marvel superhero cards GI Joe cards World Championship Wrestling cards Terminator II movie cards Disney cards NFL Proline Portraits 1992 Olympic cards Star Trek X-men Full House Perfect Strangers Family Matters DC comic book characters Lorillard Loews Hotels CNA Insurance Co. Diamond M. Offshore Drilling Regency Hotel, New York Loews Theatre Management Corp. Bulova Corp. (watches, clocks) Majestic Shipping Corp, Summit Hotel, New York

R. J. Reynolds 18

19 Brown & Williamson Appleton Papers Inc. Saks Fifth Ave. Marshall Field s Ivey s Breuners Farmers Group Inc. Credit: Dr. Joel Dunnington, Tobacco Almanac, 1993

20 We can see the power of the tobacco companies by reading about what happened to Greg Louganis, an Olympic diver. The Greg Louganis Story Take the case of Olympic diver Greg Louganis. He trained for the 1984 Olympics (where he was to win two gold medals) at the Mission Viejo training center in southern California. Mission Viejo had been the home of the top American swimmers and divers, including Mark Spitz, who won seven gold medals at the 1972 Olympics. The swimming club, and the town in which it is located, is owned by a subsidiary of Philip Morris called the Mission Viejo Realty Group. Greg Louganis was born in 1960. By the time he was eight years old he had started to smoke. He said to a congressional committee studying cigarette advertising, "Smoking was more of a way of rebelling than something I enjoyed. I thought I was cool and that it would make me more grown up like my parents who both smoked. I thought that my neighborhood pals would accept me if I joined the guys every day outside school to sneak a smoke. By the time I was in junior high, I was hooked on these deadly products, and I was willing to risk whatever future I might have had as a diver and an athlete, all to get my daily fix of those little tobacco sticks. I know now from reading the statistics on nicotine addiction and smoking habits that 85 to 90 percent of smokers start before or during their teenage years. As a diver I kept rationalizing that I didn't need a great amount of wind to succeed, just power and strength." Louganis continued to smoke until he was twenty-three, even though he had to do it surreptitiously: "My diving coach at the time, Dr. Sammy Lee, would never coach me again if he ever found out that I had even contemplated the idea of smoking cigarettes. " But then one day he had a personal epiphany that enabled him to quit smoking: "I had been practicing at the Mission Viejo facility one day and on the way out I noticed this twelve-year-old kid smoking. When I asked him why, he said that he wanted to be just like me! He knew I smoked and he figured that it did not seem to affect my diving performance, so he thought it must be all right to smoke. At that point I began to question what I was doing, and I quit smoking. I realized that in a way I was a 'Marlboro Man' of sorts..." Louganis later told me, "After I quit I wanted to tell every twelve-yearold that I had quit." So he started doing volunteer work for the American

21 Cancer Society. According to his manager, Jim Babbitt, the Mission Viejo executives were not very happy about this: "They grimaced when the ACS was mentioned." And they warned Louganis to "keep a low profile." "I was very disappointed," he says. "Number one, I was acting as an individual and I don't feel that it was right for the company to have the power to say, 'Don't say this, it's against what our company is selling.' Maybe they could say that I was biting the hand that fed me, but I believe that there is a higher value." Louganis's activities that the Mission Viejo executives and their masters at Philip Morris on Park Avenue found so displeasing reached a crescendo in January of 1984. In that Olympic year, Louganis was asked by the American Cancer Society to be national chairman of its annual Great American Smokeout. Babbitt was very enthusiastic. He told me, "I was pushing for it heavily. I thought this would have made Greg a hero in other areas than diving. It would have been a real coup for him, a great move for Greg and his career. And, after all, he's told me that he considers quitting smoking the greatest accomplishment of his life." An athlete of his stature in that position would have a major effect on the image of smoking among young people. But it was not to be. Babbitt got the message from the public relations department of Mission Viejo. If Greg were to accept the honorary position from the American Cancer Society, he would be barred from training at Mission Viejo. "It was done very subtly, very polished. But also very definite." Louganis's coach, Ron O'Brien, was the best in the world. The diver could not contemplate competing in the Olympics without his guidance. But O'Brien worked for Mission Viejo. Babbitt says the threat of Louganis's being sent away from Mission Viejo, away from his coach, was the sports world's equivalent of saying, "I'll kill your mother." And it didn't stop there. Two of the public relations people told Babbitt that if Louganis accepted the Cancer Society invitation, they too would be fired. "Heads would roll," Babbitt says. Both Louganis and Babbitt agreed that there was really no choice The diver declined the honorary position so that he could go to the Olympics. Of course, he could not explain why, at the time, since even this would have been considered a hostile act. Credit: Permission granted by William Morrow & Co., N.Y., N.Y. for Merchants of Death, 1988. The U.S. government and the tobacco companies help each other. Since 1964 all the Surgeon Generals of the U.S. have talked and written about the health

22 dangers of cigarettes. Still, cigarettes are made, advertised, and sold. The tobacco industry gives thousands of dollars to help cover the costs of political campaigns of people running for political office. These are people who want to be elected or reelected as Senators, Representatives, Vice-President, and President. In turn the politicians help the tobacco industry. One way politicians help is continuing the tobacco price support system. Under the price support system, tobacco can only be grown on a certain number of government-approved farms. The government gives farms special, low interest loans to help cover the costs of growing tobacco. The U.S. Department of Agriculture allows a certain amount of tobacco to be grown each year. This is called a quota. It also sets a minimum price for tobacco. When the farmer takes his/her tobacco to the market, any tobacco not sold one cent above the government price is bought by grower cooperatives and stored to be sold another year.

23 When Ronald Reagan was campaigning for President in 1980, he wrote the following letter: REAGAN/BUSH COMMITTEE Dear Mr. Galloway, I would like to take this opportunity to write to you and several other well-known North Carolina tobacco farmers to spell out my views on federal tobacco programs. First, I want to assure you that I fully support this nation's tobacco price-support program. Tobacco price supports have helped to sustain more than a quarter of a million family farms in 16 states, and have proven to be an unqualified success. The Secretary of Agriculture in a Reagan/Bush administration will represent my feelings in this regard, as will all officials and agencies which play a role in tobacco programs. I also want to assure you that my Administration will end what has become an increasingly antagonistic relationship between the federal government and the tobacco industry. The Carter administration has all too often singled out the tobacco industry for selective criticism and damaging restrictions. Tobacco-no less than corn, wheat, or soyabeans-should be viewed as a valuable cash crop with an important role to play in restoring America's balance of trade. I can guarantee that my own Cabinet members will be far too busy with substantive matters to waste their time proselytizing against the dangers of cigarette smoking. I can also guarantee you that I will seek Senator Helms's views on any decision my administration makes concerning federal tobacco policies. I hope that you consider these matters in deciding which candidate to vote for this November. Sincerely (Signed) Ronald Reagan Credit: Coyright 1984 by Petyer Taylor. Reprinted by permission of Pantheon Books, a division of Random House, Inc. The Smoke Ring, pp.252-253.

24 UNIT 1: HISTORY & ECONOMICS OF TOBACCO ACTIVITY 1: LOCATING & UNDERSTANDING IMPORTANT FACTS AND DETAILS FROM UNIT 1 After reading Unit 1, answer the questions below in complete sentences. To locate the answer, you should look at words in the questions and look for the same ones in the reading. 1. What are the different ways tobacco is used? 2. How many chemicals are found in cigarettes? 3. Who built the first factory to make cigarettes? 4. Who invented the cigarette making machine? 5. What chemical makes cigarettes an addictive drug? 6. What does nicotine do to the body? 7. Why does the Food & Drug Administration say that tobacco companies are controlling the amount of nicotine they put into cigarettes? 8. Who were the first people in North America to use tobacco?

25 Unit 1: History & Economics of Tobacco 9. How and why did Native Americans use tobacco? 10. What was the name of the first pack of cigarettes? 11. What are the names of six U.S. cigarette companies? 12. What is the name of the first cigarette company in the U.S.? 13. When did the number of women smoking in the U.S. begin to increase? 14. What and when were the tar wars? 15. What did the Surgeon General of the U.S. report in 1964? 16. What did the Comprehensive Smoking Education Act say? 17. What do two warning labels on cigarette packs say? 18. What are three restrictions on cigarette smoking in the U.S. today? 19. As it becomes harder for tobacco companies to sell cigarettes in the U.S., where are they going?

26 Unit 1: History & Economics of Tobacco 20. What is capitalism? 21. What is a profit? 22. What is a trade surplus? 23. How have tobacco companies helped the U.S. government? 24. How have tobacco companies been able to keep making so much money with cigarette sales in the U.S. going down? 25. What non-tobacco products does Philip Morris sell? 26. What non-tobacco products does R.J. Reynolds sell? 27. What happened to Greg Louganis? 28. Why did Greg Louganis turn down the honorary position from the American Cancer Society?

27 Unit 1: History & Economics of Tobacco 29. What is the tobacco price support system? 30. Which tobacco company has the largest share of the U.S. cigarette market? ACTIVITY 2: PUTTING DATES ON A TIME LINE, SMOKING THROUGH THE YEARS The purpose of this exercise is for you to find important dates from the unit and to read a time line/line graph. Write the missing events on the time line. Reread the section on History of Tobacco to find the dates. Or if your teacher has written the events on small cards, place each card at the correct year on the time line.

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29 ACTIVITY 3: MAKING A FAMILY TREE TO TRACE SMOKING HISTORIES The purpose of this activity is to show you how to make a family tree and to find out the smoking histories of family members who are alive or dead. Interview any family members who smoke now, smoked at some time in the past, or know about the smoking habits of other family members. Use the family tree below as an example. You should put the following information on your own family tree: the dates family members smoked (beginning and ending) what smoking related illnesses family member(s) have (had) what smoking related diseases any family member(s) died of

30 Unit 1: History & Economics of Tobacco ACTIVITY 4: FINDING OUT ABOUT THE ECONOMIC EFFECTS OF TOBACCO AT THE LOCAL LEVEL As more people stop smoking, convenience stores like 7-11 and Store 24 will lose business at first. To make up the money that comes from tobacco sales, they will have to sell other things. Read the article below, and in complete sentences answer the comprehension questions that follow. THE COSTS OF CUTTING BACK Credit: Reprinted courtesy of The Boston Globe. The Cost of Cutting Back, John Kennedy, The Boston Globe s Breaking the Habit series, 4/12/94 COMPREHENSION QUESTIONS: 1. According to Dimanno and Lane, what one product brings in a lot of money for convenience stores? 2. As of April 1994, how much money goes to the Massachusetts government from each pack of cigarettes sold?

31 Unit 1: History & Economics of Tobacco 3. Before the excise tax increase on cigarettes, about how much money did the state government receive from each cigarette pack sold? 4. In what year did the excise tax on cigarettes double? 5. What products does Philip Morris sell in addition to tobacco? 6. What do convenience store chain stores plan to do to make up for the money they are losing from lower cigarette sales? 7. What type of store may go out of business as tobacco sales drop? Visit one or two convenience stores in your community. Speak to a manager to find out what percentage of sales comes from the sale of cigarettes. Ask what products the store is thinking of selling or is currently selling to take the place of cigarettes. Write up a report and share your findings with your class. ACTIVITY 5: WRITING A BUSINESS LETTER Write a letter to your U.S. Senator or Representative asking him/her to introduce a bill not allowing tobacco companies to make cigarettes based on the Food & Drug Administration s labelling of cigarettes as a dangerous drug. You should suggest ideas for the cigarette companies of what they could make and sell

32 to take the place of cigarettes. Quit smoking aids ( like special gums and candies) could become profitable for the tobacco companies.

33 UNIT 2: CIGARETTE ADVERTISING Cigarettes are the most heavily advertised product in the U.S. The tobacco companies spend 4 billion dollars a year or 11 million dollars a day to try to get people to buy cigarettes. Every day the tobacco industry is fighting against the growing number of reports about the health dangers of smoking. Smoking is not as popular or socially acceptable as it once was. Many people are quitting smoking. Others are never starting to smoke. Through their advertisements in magazines and newspapers, on billboards, and through promotions, the cigarette companies are trying hard to sell their products. Numbers of Tobacco Ads in Magazines Magazine Cigarette Ads Magazine Cigarette Ads In A Single Issue In A Single Issue Penthouse 20(3)* Vogue 4 Playboy 14(3) Newsweek 4 Cosmopolitan 12(4) Sports Illustrated 4 Rolling Stone 11(3) 4 Wheel Off-Road 4 Glamour 8 Ebony 3 Road and Track 8 Time 3 Life 7 Inside Sports 3 Sport 7(1) U.S. News & World TV Guide 6 Report 1 Working Woman 6 New Republic 0 People 6 Business Week 0 US 5 Forbes 0 Motor Cyclist 5 Fortune 0 *Numbers in parentheses indicate how many free packs of cigarettes readers could obtain from coupons in that issue. Credit: Dr. Joel Dunninton, Tobacco Almanac, Revised

34 In addition, they spend millions of dollars a year sponsoring sporting, art, and music events. Virginia Slims each year sponsors the Virginia Slims Tennis Tournament, and Marlboro provides the money for country music concerts advertising them as Marlboro Music. Tobacco companies also contribute to scholarships, such as the United Negro College Fund. They give donations to many organizations, such as the NAACP (National Association for the Advancement of Colored People), the National Urban League, Goodwill Industries, the National Puerto Rican Forum, the Boy Scouts, the Girl Scouts, the United Way, and the Y.M.C.A. In their promotions, the tobacco companies give out free samples of cigarette brands, tee shirts, baseball caps, beach towels, and discount coupons. Also, with the purchase of one or more packs of cigarettes, a person can get many other things free or at a discount price.

35 The purpose of cigarette ads and promotions is to make sure smokers keep smoking, get people who quit to start smoking again and increase the number of cigarettes people smoke each day. Most importantly, cigarette ads and promotions encourage young people to start smoking. Many ads are specially made to attract teens, women, and Blacks. The advertisements are very successful. According to U.S. Surgeon General Joycelyn Elders, every day 3,000 teens smoke their first cigarette. In the U.S. 3 million people between the ages of 13 and 19 smoke cigarettes. The average age when a smoker tries his/her first cigarette is 14.5 years old. R.J. Reynold s advertises Camel cigarettes with the cartoon figure Joe Camel. These ads have been very popular with young people. Since Joe Camel ads were first introduced, cigarette sales to youth have increased from 6 million to 476 million dollars. Philip Morris Marlboro cowboy ads, first created in 1954, also attract young people. These ads show a tough or macho, independent cowboy. A sad fact is that one of the cowboys pictured in Marlboro ads, Wayne McLaren, died of lung cancer. He died in 1992 after smoking for 25 years. Still about half of all youth smoke Marlboros.

Credit: Permission granted by Associated Press. Article printed in The Boston Globe, 2/25/94 36

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38 Since World War II (1939-45), the cigarette companies have been trying to get women to smoke. Through ads, smoking has been pictured as going along with independence, careers, sexual freedom, as well as beauty. Since the 1970 s, Virginia Slims ads have said, You ve come a long way, baby. Ultra Slims, the long thin cigarettes, were made for women. In ads of these types of cigarettes, the women look very thin to give the idea that smoking will not make a person fat. Cigarette ads appear in most women s magazines, such as Glamour, Redbook, Working Women, Cosmopolitan, People, and Vogue. Cigarettes are heavily advertised in African-American magazines too. Ebony, Jet, and Essence magazines have ads showing beautiful and handsome Black men and women smoking. Outdoor billboards have been another way for tobacco companies to reach African-Americans. The number of outdoor billboards advertising cigarettes is four times higher in Black communities than in White communities. Cigarette companies target mentholated cigarettes to Blacks. Newports, Kools, and Salems are very popular brands among African-Americans. Because mentholated cigarettes can be inhaled deeper into the lungs, they are more dangerous than non-mentholated ones. Whether they were made for teens, women, or African-Americans, all cigarette ads have the same message: smoking is fun, healthy, and attractive. Ads show men who look masculine or manly, hip, cool, adventurous, mature, and strong. Women look sexy, stylish, beautiful, glamorous, relaxed, secure, and independent. Many ads show athletic people who are wind surfers, aerobic dancers, motor cycle racers, horseback riders, roller bladers, and basketball players.

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41 Cigarette ads give the impression that smokers are Alive with pleasure and that smoking is good for you. Unfortunately, nothing could be further from the truth. The U.S. government has labelled cigarettes as a dangerous drug that causes lung cancer, heart disease, and many other serious illnesses and conditions. Many people all over the country are talking about whether tobacco companies should be allowed to advertise cigarettes or even to make cigarettes. USA Today, 2/28/94

42 UNIT 2: CIGARETTE ADVERTISING ACTIVITY 1: DISTINGUISHING FACTS FROM OPINIONS What are facts? Facts are phenomena that can be observed, proven, measured, and/or quantified with numbers and statistics. Facts can be viewed the same way and agreed upon. What are opinions? Opinions are related to people s feelings, values, thoughts, senses, aesthetics, and people view them differently. Opinions are sometimes expressed with words such as, I believe, feel, or think, in my opinion, in my viewpoint, should, ought to, etc. Write down two fact and two opinion sentences. You can observe the people and things in your classroom, and write your sentences based on what you see. For example, Maria is wearing glasses. Gustave is wearing a beautiful shirt. Read your sentences aloud. The other students will label them as a fact or an opinion. Go through Unit 3: Cigarette Advertising and write down 2 fact sentences and two opinion sentences. Read the sentences you selected aloud. Your classmates will discuss what makes each one factual or opinionated. ACTIVITY 2: FACTS & OPINIONS CONTINUED What makes the following sentences factual? 1. Surgeon General Joycelyn Elders said that the tobacco industry spends nearly $4 billion a year on advertising. Facts/Proof:

43 Unit 2: Cigarette Advertising 2. Elder s 314-page report, put together by government scientists and researchers, said adolescents smoked their first cigarette at 14.5 years. Facts/Proof: 3. According to the graph on Teen Smoking Rising, daily smoking among teenagers increased in 1993 1-2%. Facts/Proof: Look at the language in Voices Across the U.S.A. and give examples of the words that express each person s opinion. For example, Stacy Connors says I don t think, should, I may not agree, I think, and should remain to express her opinion. Opinion words of Jack Baugher: Opinion words of Ervin Malcheff: Opinions words of Gene Thickening: Opinion words of Lisa Kohnke:

44 Unit 2: Cigarette Advertising ACTIVITY 3: MORE ON DISTINGUISHING FACTS FROM OPINIONS Do the following exercise by yourself, and together as a class go ever the correct answers. Explain why you labelled each sentence a fact or an opinion. Directions: Label each of the following sentences as a fact or an opinion. Write an F on the line for fact and an O on the line for opinion. 1. Every day the tobacco industry is fighting against the thousands of reports about the health dangers of smoking. 2. Life magazine has seven cigarette ads in one issue. 3. Virginia Slims sponsors the Virginia Slims Tennis Tournament every year. 4. Cigarette ads give the impression that smokers are Alive with pleasure. 5. You ve come a long way, baby. 6. The number of outdoor billboards is 4 times higher in Black communities than in White communities.

45 Unit 2: Cigarette Advertising 7. Cigarette ads appear in women s magazines. 8. Joe Camel was created to get young people hooked on smoking. 9. 3 million Americans between the ages of 13 and 19 smoke cigarettes. 10. Smoking cigarettes makes teenagers look sexy and successful. ACTIVITY 4: ANALYZING CIGARETTE ADVERTISEMENTS Cut out cigarette ads from magazines and newspapers to bring to class. Using the ads included in Unit 2 and the ones you have, what are the messages about smoking which the ads get across? Use the questions below to guide your discussion about each advertisement: 1. What group(s) of people (age, race, culture) is the tobacco company trying to reach? 2. What is the message? If you smoke this brand of cigarettes, you will... 3. How is this ad misleading?

46 Unit 2: Cigarette Advertising ACTIVITY 5: WRITING ANTI-SMOKING ADVERTISEMENTS Write an anti-smoking advertisement for the radio. It should be one minute long when read aloud. In writing these ads, you may want to go to Units 4 and 5 and read about the health dangers of smoking for smokers as well as nonsmokers. With your classmates, identify the facts and opinions you put in your ad. Read your ads aloud for the other students to comment whether your ads are mainly factual or opinionated. ACTIVITY 6: CONDUCTING A SURVEY Go over the directions and all items on the Community Assessment of Tobacco Marketing and Sales survey to make sure you understand the form and how it is to be used. Select one store or outdoor location (such as a cab stand) in your neighborhood to see what kind of tobacco-related advertisements there are. Answer as many questions as possible on the survey. The results of the surveys should be shared with the class, and in pairs or groups map out the location of places with tobacco-related advertisements in your city.

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49 UNIT 3: WHY PEOPLE SMOKE Most people start smoking when they are in their teens and are addicted by the time they reach adulthood. Some have tried to quit but have returned to cigarettes because smoking is such a strong addiction. It is a habit that is very difficult to break. There are many different reasons why people smoke. Three of the main reasons that young people smoke are to look mature, to be like their friends, and to experiment. Since teens see older people all around them smoking, especially their parents and relatives, they smoke to act older. If their friends or peers smoke, they may feel pressured into doing the same to be accepted. The last reason is the excitement of experimenting with something that is forbidden. In Massachusetts it is against the law for anyone under 18 years old to smoke. Usually parents do not allow their under age teens to smoke. Therefore, smoking becomes very attractive. It is exciting to get cigarettes and sneak away to smoke without being caught. Adults smoke for other reasons. They may have a lot of stress and pressures because of economic and personal problems. They may be unemployed or working but not making enough money to take care of themselves and their families. They may be homeless, or they may be dealing with alcohol or cocaine/heroin addictions. Some may be in bad marriages or relationships in which there is physical and/or verbal abuse. All these people may smoke to feel relaxed or to give them energy while going through a hard time. Whether young or old, some people smoke to control their weight. Smokers, on the average, weigh seven pounds less than non-smokers. Smoking reduces a person s appetite. It lessens his/her sense of taste and smell. This could be why exsmokers gain weight after quitting cigarettes. Food tastes and smells so much better. Finally, there are people who say they love to smoke. Smoking gives them pleasure. It just makes them feel good. The following two interviews were conducted at the Community Learning Center in Cambridge in February 1994. One was with a current teacher and former student at the Learning Center. She was born in the U.S. and is a mother of three

50 children and currently a smoker. The other was with a 19 year old high school student from Cambridge Rindge and Latin School. He is from Haiti and is a senior. Interview #1 1. Do you smoke cigarettes now? Yes. 2. Which brand and why? I m smoking Marlboros and Newports for a change of pace. 3. At what age did you start smoking? At 11. I started smoking Chesterfields, Lucky Strikes, and Camels when my friend and I stole her grandfather s cigarettes. 4. Do you remember how and why you began smoking? Yes, it was like an adventure. I thought I was so grown up. My girlfriend and I used to sneak in her basement and smoke a whole pack of cigarettes, one after another. In junior high school, I used to sneak in the girls room, and when we were bold just light up a cigarette, take quick drags, and watch the head of the cigarette get long and red. I d stand on the toilet seat and smoke, never thinking the smoke was coming out over the top of the stall. 5. How has smoking made you feel? As a kid, I felt grown up. As I got older, it was just a habit. I just smoked and didn t think about it. 6. When do you smoke? After breakfast, always in my car. I light up before I turn the key on. I take breaks throughout the day. After I eat, I smoke. If I m home during the

51 evening, I smoke up a storm. And just when I decide I m going to bed, I have one more cigarette. 7. Where do you smoke? Mostly in my living room and car. I just don t smoke in the bedroom. I m afraid I ll walk in and out of there and leave a cigarette behind. I m afraid of fire. Interview #2 1. When did you start smoking? I started smoking 3 years ago in Haiti. 2. How and why did you start? I went to a big party at a gymnasium where I saw a guy the same age as me. He was standing smoking a cigarette, and I was looking at him thinking, Oh, man, this looks like fun. I wanted to know how to smoke then. There were five girls, a lot of girls, playing around with him. One week later, I asked my cousin to show me how to smoke. It wasn t that easy for me. I was not feeling well. I felt dizzy and had to sit down. Every day I bought one cigarette for 25 cents. After that when I knew how to do it, I went to buy a pack with my friends. Any time I had money, I went to the clubs to buy cigarettes to smoke and drink beer. 3. When and where do you smoke? Any time I m driving my car and when I m outside too. I can t smoke at home. If I m not going anywhere, I walk around just to smoke. I used to sleep over my brother-in-law s house, and I used to smoke a lot of cigarettes, more than three before I went to bed. 4. How does smoking make you feel?

52 I feel like a gentleman. All my friends and my cousins smoke. It makes me feel better after I eat. I don t really know how it makes me feel. 5. Have you ever tried to quit and why? Yes, I tried to quit. My girlfriend and I we both smoke. On December 23 we made a bet if one of us smokes in the new year, we re going to break up. On January 2, I couldn t stay away from cigarettes. I went to my brother-inlaw s and asked him for a cigarette. I couldn t really quit. I then went to my girlfriend s, and she said I was smoking. I told her I couldn t quit just like that. Then she asked me for a cigarette. I d like to quit because I m lifting weights. I have to quit. I ll have to stay away from my friends. That will help me, but I can t. Below are some other interviews about why people smoke. They were printed in The Boston Globe in April 1994.

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54 Why do you smoke? Credit: Reprinted courtesy of The Boston Globe, Interviews by Ric Kahn.

55 Why Do You Smoke? Test Here are some statements made by people who describe what they get out of smoking cigarettes. How often do you feel this way when smoking? Circle one number for each statement. Important: ANSWER EVERY QUESTION.

How to Score 56

57 The six factors measured by this test describe different ways of experiencing or managing certain kinds of feelings. Three of these feelings-states represent the positive feelings people get from smoking: a sense of increased energy or stimulation; the satisfaction of handling or manipulating things; and the enhancing of pleasurable feelings accompanying a state of well-being. The fourth is the decreasing of negative feelings by reducing a state of tension or feelings of anxiety, anger, shame, etc. The fifth is a complex pattern of increasing and decreasing "craving" for a cigarette, representing a psychological addiction to smoking. The sixth is habit smoking, which takes place in an absence of feelingpurely automatic smoking. A score of 11 or above on any factor indicates that this factor is an important source of satisfaction for you. The higher your score (15 is the highest), the more important a particular factor is in your smoking and the more useful the discussion of that factor can be in your efforts to quit. Credit: Why Do You Smoke? National Cancer Institute, National Institutes of Health Publication No. 92-1822, Reprinted January 1992

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60 UNIT 3: WHY PEOPLE SMOKE ACTIVITY 1: UNDERSTANDING MAIN IDEA What does topic refer to? What does main idea mean? What is a topic sentence? What questions should you ask yourself to find the main idea of a paragraph or a passage with several paragraphs? Give the main idea of each paragraph on the first page of Why People Smoke. ACTIVITY 2: FINDING THE MAIN IDEA FROM INTERVIEWS Give the one main reason that each person interviewed in The Boston Globe smokes. In giving the reason, you will be finding the main idea. Then, what reasons, details, facts, and/or examples are provided to support the main idea? ACTIVITY 3: WRITING THE MAIN IDEA Working together in a group, look at the scoring sheets of Examples 1 and 2 of the Why Do You Smoke? test. A person can have more than one reason. Figure out why each of these people smokes and write the main idea in one sentence. When you are finished, you should have written two sentences with a different main idea in each one.

61 Unit 3: Why People Smoke ACTIVITY 4: CONDUCTING AN INTERVIEW Interview a smoker or ex-smoker you know well using the following questions: 1. At about what age did you first start to smoke? 2. How did you start smoking? 3. When do (did) you smoke? 4. Where do (did) you smoke? 5. How does (did) smoking make you feel? 6. Why do (did) you smoke? Write out the answers to each of the above questions in complete sentences. Also, Write a one paragraph summary from your written answers to the interview questions. In this summary you will be giving the main ideas from your interview. Share your summary with the class by reading it aloud.

62 UNIT 4:THE DANGERS OF SMOKING CIGARETTES FOR SMOKERS WHAT S IN A CIGARETTE & DISEASE The main ingredient in cigarettes is tobacco. Tobacco is a green, leafy plant that is grown in warm climates. Farmers use many chemicals to grow tobacco. They use fertilizers to make the soil rich and insecticides to kill the insects that eat the tobacco plant. After the tobacco plants are picked, they are dried, and machines break up the leaves into small pieces. Artificial flavorings and other chemicals are added. Some chemicals are put in cigarettes to keep them burning; otherwise, they would go out. There are over 4,000 chemicals in cigarettes. 51 of them are known to be carcinogenic. A carcinogen is something that causes cancer. Cancer is a disease that often kills those who have it. There are many types of cancer: breast, lung, larynx, stomach, prostrate, kidney, leukemia (cancer of the blood), etc. In all kinds of cancer, the cells keep dividing and forming new, abnormal cells. These cells are not normal or healthy. Our bodies are made up of thousands of cells. In a healthy person, new cells are made only when the body needs them. In a person with cancer, the abnormal cells destroy the normal cells, invading them like an army. If cells divide when new cells are not needed, a growth or hard mass forms. It could be small like a pea or large like a grapefruit. A cancerous growth is called a malignant tumor. Cancer usually kills a person when it spreads to other parts of the body. Sometimes cancer cells break away from a malignant tumor and find their way into the bloodstream. They travel to another part of the body or organ like a kidney or lung. There they start multiplying and dividing and form new cancerous tumors. For example, if a woman who has a malignant tumor in her breast does not have it removed while it is small, part of the tumor might break away and go into her bloodstream. From there it may travel to her brain and give her brain cancer.

63 Chemicals in cigarettes and cigarette smoke are known to cause not only cancer but also other serious health problems. Many of the chemicals are poisonous. If a person ate one pack of cigarettes, he/she would die. FAMILIAR CHEMICALS IN CIGARETTES Chemical Found in: carbon monoxide car exhaust nicotine bug sprays tar material to make roads arsenic rat poison ammonia cleaning products hydrogen cyanide gas chamber poison cyanide deadly poison acetone nail polish remover butane cigarette lighter fluid DDT insecticides formaldehyde to preserve dead bodies sulfuric acid car batteries cadmium used to recharge batteries freon damages earth s ozone layer geranic acid a fragrance methoprene a pesticide maltitol a sweetener not permitted to be used in foods in the U.S. Sources: Dr. Joel Dunnington, Tobacco Almanac, Revised, May 1993. Three of the most widely known chemicals are nicotine, tar, and carbon monoxide. Nicotine is a strong poisonous drug. It is the main ingredient in insecticides or bug sprays. In its pure form, just one drop on a person s tongue would kill him/her.

64 Tar is the oily material which remains after tobacco passes through the filter. When a smoker inhales, a lot of the tar sticks to and blackens the lungs. Carbon monoxide is a poisonous gas. A smoker inhales this gas which is also found in the exhaust of a car. This gas interferes with our respiratory (breathing) and circulatory (heart, arteries, and veins) systems. When we breathe in air through our nose and mouth, the air passes down the windpipe (trachea) and bronchial tubes into the lungs. The cilia which are made up of small hairs and mucous (a sticky fluid also found in the nose) help to clean this air as it moves down and into the lungs. The cilia remove small pieces of dirt, dust, and germs. Credit: Cancer of the Larynx, National Cancer Institute, NIH, 2/92 We each have two lungs. They are protected by the ribs and separated by the heart. In a healthy nonsmoker, the lungs are made up of soft, spongy, pinkishgray tissue.

65 The lungs also have hundreds of air sacs that fill with air when we inhale or breathe in. They are elastic like rubber bands. One of the jobs of the lungs is to take oxygen in from the air. This oxygen is carried in the blood to the heart. The heart pumps the oxygen rich blood throughout the body by arteries. Arteries are large tubes with thick, strong walls. Oxygen is used by all cells of the body to do their work. The lungs also must get rid of carbon dioxide which is the waste product of the cells work. When we exhale, breathe out, we are getting rid of the carbon dioxide from the body. When a person smokes cigarettes, the carbon monoxide in the smoke gets into his/her blood stream. This reduces the amount of oxygen going to the heart. In addition, the chemicals in cigarette smoke narrow the walls of the arteries. With less oxygen passing through the arteries, the heart must work harder. Blood pressure also goes up.

66 The result is that the heart may not receive enough oxygen rich blood. When this happens, the heart may stop beating, and part or all of the heart muscle may die. This is called a heart attack or coronary arrest. If a large enough part of the heart muscle stops working, the person dies. CYCLE OF ADDICTION Nicotine is the chemical that makes cigarette smoking addictive. It is just as addictive as heroin or cocaine. Smoking is a habit that is not easily stopped. The body and mind want and need the nicotine. If a person smokes more than five cigarettes a day, he/she is usually addicted. When people inhale the smoke of cigarettes, the nicotine goes deep into the lungs. From the lungs it goes into the bloodstream and is carried to the heart and then the brain. It only takes six seconds for nicotine to reach the brain. How Cigarettes Addict Credit: Figure 6,Tobacco: Biology & Politics, HEALTH EDCO, Waco, Texas.

67 Nicotine is a stimulant. It speeds things up. It makes the heart beat faster and increases blood pressure. It makes smokers feel more alert or awake. After about 45 minutes when the level of nicotine in the blood goes down, they start to feel withdrawal symptoms. Withdrawal is the feeling they have when the nicotine is taken away. They may feel tired and irritable (angry, impatient, nervous). Smokers slowly increase the number of cigarettes they smoke to prevent the bad feelings of withdrawal. They keep increasing the number of cigarettes until they reach a certain level of nicotine in their blood. Usually they will light up a cigarette before they start to feel any withdrawal symptoms. People smoking low tar and nicotine cigarettes will have to smoke more cigarettes to reach their maintenance level. After sleeping, the level of nicotine in the blood is lower than it is during the day. Therefore, heavy smokers will usually begin their day with a cigarette very soon after waking up. The nicotine will stimulate them and make them feel awake. A person can tell how addicted he/she is to smoking by how soon after waking, he/she lights up the first cigarette of the day.

68 OTHER HEALTH DANGERS OF CIGARETTES FOR SMOKERS Most people know that smoking is bad for the health and causes lung cancer and heart attacks. What they may not know is that smoking causes many other diseases and illnesses. It is also the single most preventable cause of death in the U.S. Tobacco causes about 435,000 deaths or 1 out of 6 deaths in the U.S. each year. 20,000 flu and pneumonia deaths are tied to smoking. Every year 174,000 smokers will die from heart disease. Smoking increases the risk of dying of a heart attack by 60%. Every year 143,000 smokers will die from different cancers, 83,000 from lung cancer alone, and 26,000 from strokes. A stroke happens when the brain does not get enough oxygen. For example, when a person has a stroke,

69 he/she may not be able to talk and/or move a part of his/her body for awhile or forever. Because of smoking, 40% of men and 28% of women die prematurely, before their time. According to the Surgeon General Report of 1985, Smoking has killed more people in the U.S. alone than the number of Americans killed in battle or who died of war related diseases in all wars ever fought by this nation. The total number of U.S. deaths in the Vietnam War was 58,151. Smoking is the number one killer in the African-American community. Adult black males have a greater chance of dying from cigarettes than adult white males. This is partly because black males are more likely to smoke mentholated cigarettes like Newports, Kools, and Salems and higher tar and nicotine brands. Mentholated cigarettes are particularly dangerous because the smoke is pulled deeper into the lungs. Credit: African Americans and Smoking At A Glance, U.S. Dept. of Health & Human Services, CDC Cigarette smoking is responsible for 30% of all cancer deaths. Smokers die not only of lung cancer but also of cancers of the mouth, larynx (throat), esophagus, bladder, kidney, cervix, and blood (leukemia). 87% of all lung cancers are caused by smoking. Since 1987, lung cancer has been the number one killer of women. Women who smoke more than 15 cigarettes a day double their risk of getting cervical cancer.

70 Lucky To Be Alive Credit: Reprinted with permission of the Boston Herald, 2/7/94 Cigarette smoking also causes or increases the risk of getting other lung diseases and conditions. Smoking causes bronchitis and emphysema. When a smoker has bronchitis, his/her bronchial tubes become inflamed or irritated. They produce too much mucus. This mucus blocks the tubes, and the smoker coughs a lot. Emphysema is a lung disease that has no cure. A person with this disease has difficulty breathing because the walls of the small air sacs in the lungs are being destroyed. This makes big air surfaces. A person with emphysema gets tired very easily. He/she uses up so much energy just to breathe. As the disease gets worse, he/she cannot breathe in enough oxygen from the air and has to breathe through tubes attached to an oxygen tank. There is no cure for emphysema.

71 Smoking greatly increases the risk of getting other diseases and health problems. It speeds up the loss of bone in older women leading to osteoporosis. Osteoporosis is a disease in which the bones get thin and weak. The bones can break very easily. People who are HIV positive are twice as likely to develop full blown AIDS if they smoke. Smokers also have a greater chance of getting stomach ulcers. Ulcers are sores in the stomach that are very painful and can bleed. Heavy smokers also increase their chances of getting Peripheral Vascular Disease (PVD). In this disease the arteries that lead to the limbs (arms and legs) keep getting narrower. As a result, not enough oxygen-rich blood goes to the arms and/or legs. PVD causes pain in the arms or legs. It also makes it harder for the body to fight off infections. When an arm or leg is hurt, it cannot heal well. If the arteries get closed and no blood gets to a limb, the person gets gangrene. The limb then dies and must be cut off (amputated). A man with Peripheral Vascular Disease may have trouble performing sex. His penis cannot get erect or hard because it does not receive a good flow of oxygen-rich blood.

72 Smoking-Related Diseases () indicate the % of diseases caused by cigarettes Cardiovascular Diseases coronary artery disease (21-40%) heart attacks strokes (18%) pain in the legs & gangrene atherosclerosis Lung (82%) emphysema (90%) chronic bronchitis Cancer (30%) lung cancer (80-85%) mouth larynx (84%) esophagus pancreas kidney leukemia cervix myeloma bladder (40-60% in men, 20-30% in women) Cataracts Gum disease Raynaud s Ulcers Colds Tuberculosis Leukoplakia (white patches in the mouth) Caries (tooth decay or cavities) Credit: Dr. Joel Dunnington, Tobacco Almanac, Revised, May 1993.

73 UNIT 4: THE DANGERS OF SMOKING CIGARETTES FOR SMOKERS ACTIVITY 1: LEARNING ABOUT AND USING CONTEXT CLUES There are five context clues that writers use to help the read understand hard vocabulary words. They are definition, explanation, restatement, example, and punctuation. Activity 1: Exercise on Context Clues On the blank space in front of each sentence, write the context clue the writer used to help the reader understand the meaning of the underlined word. Then, go back to the reading to locate the word. See how the writer used it, and in your own words, give the meaning of the underlined word. 1. Farmers use insecticides to kill the insects that eat the tobacco plant. Your sentence: 2. A carcinogen is something that causes cancer. Your sentence: 3. A cancerous growth is called a malignant tumor. Your sentence: 4. Nicotine is the main ingredient in insecticides or bug sprays. Your sentence:

74 Unit 4: Dangers of Smoking for Smokers 5. Carbon monoxide interferes with our respiratory (breathing) system. Your sentence: 6. The cilia which are made up of small hairs help to clean the air we breathe in as it moves down and into the lungs. Your sentence: 7. Air sacs fill with air when we breathe in and are elastic like rubber bands. Your sentence: 8. When a person s heart stops beating and part or all of the heart muscle dies, he/she has had coronary arrest. Your sentence: 9. Nicotine is the chemical that makes cigarette smoking addictive. Your sentence: 10. A stroke happens when the brain does not get enough oxygen. Your sentence: 11. Because of smoking, 40% of men and 28% of women die prematurely, before their time. Your sentence: 12. Osteoporosis is a disease in which the bones get thin and weak. Your sentence:

75 Unit 4: Dangers of Smoking for Smokers ACTIVITY 2: MORE ON CONTEXT CLUES Go to the text and find two or more examples of the use of context clues that were not found in the Activity 1 exercise. ACTIVITY 3: INGREDIENTS IN CIGARETTES Without looking at the chart on the Familiar Chemicals in Cigarettes, list five commonly known ingredients in cigarettes and state where else (in what specific products, brands) these chemicals are found. Make a list of products you have at home that have some of the same chemicals found in cigarettes. Bring the list to your next class. ACTIVITY 4: IDENTIFYING CONDITIONS/ DISEASES THROUGH SYMPTOMS On a folded piece of paper, your teacher will give you one or two of the following words: lung cancer stroke osteoporosis ulcers emphysema tobacco addiction coronary arrest peripheral vascular disease chronic bronchitis

76 Unit 4: Dangers of Smoking for Smokers Do not tell anyone else what illness(es) you have on your piece(s) of paper. Look for the discussion of the illness(es) in the text and write a paragraph describing your symptoms. Every sentence in the paragraph should be written in a complete sentence. The teacher picks a rotating doctor from the class. You will have a turn to read aloud your symptoms to the doctor and class. Then the doctor will tell you the name of your illness/condition. If there is no doctor, the class will figure out what illness/condition you have from your symptoms. ACTIVITY 5: WRITING WARNING LABELS Write two warning labels to be rotated on a pack of cigarettes. Your teacher, someone in your class, or you will type up the class list of cigarette warning labels. ACTIVITY 6: CONDUCTING A MOCK U.S. CONGRESSIONAL HEARING Pretend your classroom is holding a hearing in the U.S. Congress. You will be discussing whether the sale of cigarettes should be banned (not be allowed) because they are a dangerous drug. Have 2 to 6 people be members of the Tobacco Committee of the U.S. Congress. You will have one representative from the Food & Drug Administration, Philip Morris, a former smoker who has lung cancer, and a current smoker speak before the committee. At the end of the hearing, the members of the Tobacco Committee will vote on whether or not to ban cigarettes. For homework or in class, write up your opinion as to whether or not the sale of cigarettes should be banned as a dangerous drug.

77 UNIT 5:HEALTH DANGERS OF SMOKING FOR NONSMOKERS Cigarettes do not just harm the people who smoke. They also harm the people who are near cigarettes and breathe the smoke. This includes fetuses (unborn babies still inside their mothers) and small children. They are breathing second hand smoke. Second hand smoke is the smoke that comes out of the lit end of a cigarette and that a smoker exhales (breathes out). Second hand smoke is also called passive smoke, involuntary smoke, and environmental tobacco smoke (ETS). About 53,000 people die from second hand smoke every year. When we breathe second hand smoke, we are breathing the same 4,000 chemicals a cigarette smoker breathes. 51 of those chemicals cause cancer. That is why a U.S. government agency called the Environmental Protection Agency (EPA) has labelled cigarettes as a Group A carcinogen. A carcinogen is something that causes cancer. The EPA put cigarettes in the same group with arsenic, which is a deadly poison, and asbestos, a cancer causing material that used to be put around pipes to insulate them. Source: Centers for Disease Control

78 In 1986 the Surgeon General of the U.S. wrote about the dangers of second hand smoke. He listed three conclusions: First: Involuntary smoking is a cause of disease, including lung cancer, in healthy nonsmokers. Second: The children of parents who smoke compared to children of nonsmoking parents have an increased frequency of respiratory infections, increased respiratory symptoms and slightly smaller rates of increase in lung function as the lung matures. Third: Simple separation of smokers and nonsmokers within the same airspace may reduce, but does not eliminate, exposure of nonsmokers to environmental tobacco smoke. Environmental tobacco smoke (ETS) is dirtier than the smoke that is inhaled in a cigarette because it is not filtered. The filter on the end of a cigarette removes some the harmful chemicals. ETS is the largest source of indoor air pollution. Restaurants that allow smoking can have six times the pollution of a busy highway. When people breathe ETS or second hand smoke on a regular basis in the workplace, their lungs are affected. Their lungs look as if the people smoked one to 10 cigarettes a day. That means nonsmoking workers in a smoking office have the same lung damage as a mild smoker. They have a 34% higher risk of getting lung cancer than workers who do not smoke or breathe second hand smoke on the job. Every year second hand smoke causes 3,000 deaths from lung cancer in nonsmokers over 35 years old. These deaths are not just from people breathing cigarette smoke in the workplace. Second hand smoke increases the risk of lung cancer even in dogs. It increases the risk of heart disease in human beings by 30%. Every year 37,000 nonsmokers die from heart disease caused by exposure to ETS.

79 Credit: Hey, Girlfriend, California Dept. of Health Services Second hand smoke is particularly dangerous for pregnant women and their children. All the poisons from cigarette smoke that enter a mother s blood are passed along to her fetus. The carbon monoxide reduces the amount of oxygen in the unborn baby s blood. That is why babies of smokers are more likely to be born with low birth weights (less than 5 1/2 pounds) and birth defects. Each year 53,000 babies are born under weight. They are sometimes born prematurely (before 9 months) or even born dead (stillbirth). Smoking also increases a woman s chance of having a miscarriage by 24%. Credit: California Dept. of Health Services, funded by Proposition 99, funded in 1988

80 A smoking mother s baby might die within the first 28 days of life from Sudden Infant Death Syndrome (SIDS or crib death ). SIDS is the sudden, unexpected death of a baby who seems very healthy. It is much more common in babies of mothers who smoke than in babies of mothers who do not smoke. Infants and young children are very affected by second hand smoke because their lungs are weak and are just beginning to develop. Each year passive smoke causes 300,000 respiratory or lung infections in children younger than a year and a half. 15,000 of them must be hospitalized. Children of smokers have more colds, pneumonia, bronchitis, ear infections, and asthma attacks. They may suffer from coughing, wheezing, too much phlegm or mucus, burning eyes, headaches, and sore or dry mouth. In addition, smoking can make any allergies related to breathing worse. Credit: California Dept. of Health Services, funded by Proposition 99, funded 1988

81 Parents, as well as all adults, should remember that they are role models for children. Children copy what they see. They learn many things, like smoking, by watching adults. Credit: Mass. Dept. of Public Health

82 UNIT 5: HEALTH DANGERS OF SMOKING FOR NONSMOKERS ACTIVITY 1: UNDERSTANDING VOCABULARY THROUGH CONTEXT CLUES Skim Unit 5 and identify 6 words for which the author directly gave the meanings by a definition, punctuation clues, or restatement. The teacher will write a list of all the words given on the blackboard. Explain what each of these words mean in your own words. ACTIVITY 2: VOCABULARY REVIEW FOR UNITS 4 & 5 Make a list of the unfamiliar or new vocabulary which the author defined through context clues in Units 4 & 5. You will be given 4 to 8 index cards. On one card write the vocabulary word on the lined side and its definition on the lined side of another card. This should be done for each assigned word. When all the cards are completed, join a group of 4 to 5 students and each play the game of concentration. In concentration all cards are placed face down on a table so you cannot see any writing. People take turns playing the game. The first player turns over any 2 cards. If the vocabulary word and the definition match, that person keeps the cards and gets another turn. If the 2 cards do not match, another player takes a turn. The game continues until there are no more cards face down on the table. The person with the most cards wins the game.

83 Unit 5: Second Hand Smoke ACTIVITY 3: CROSSWORD PUZZLE Before beginning the exercise, make sure you know the meanings of the words on the crossword puzzle list. Provide the definitions in your own words either by memory or by looking back at the reading material. If you have never filled in a crossword puzzle, work with another student who is familiar with crossword puzzles. You can choose to fill in the crossword puzzle by yourself or with a partner.

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86 Unit 5: Second Hand Smoke ACTIVITY 4: MAKING A LIST OF THE DANGERS OF SECOND HAND SMOKE AND YOUNG CHILDREN Summarize the specific dangers of cigarette smoke to young children presented in the reading. Make a list of things adults and teenagers can do to protect babies and young children from second hand smoke. Write up all the specific suggestions and bring or send the list to a nearby daycare center to be given out to parents. Begin the list with a couple of sentences stating the dangers of second hand smoke, particularly to babies and young children. ACTIVITY 5: WRITING A BUSINESS LETTER TO REQUEST A NO SMOKING POLICY Brainstorm about how you feel when people around you in a restaurant, bar, or club are smoking. Then pick one restaurant, bar, or club that allows smoking and write a letter to the manager/owner of that establishment. The letter should explain the dangers of second hand smoke and request a smoke free environment. In your letter, discuss the benefits of a smoke free policy. Use a copy of Tips for Effective Letters to help you write your letter. ACTIVITY 6: GIVING ADVICE TO PREGNANT MOTHERS ABOUT THE DANGERS OF SECOND HAND SMOKE In pairs write a dialogue between a pregnant woman who smokes and her doctor. The doctor tells the woman that she is two and one half months pregnant

87 and talks to her about the dangers of smoking for her and her baby. The doctor should provide enough information to convince her to want to quit smoking. When your partner and you are ready, read your dialogue aloud to the other members of the class.

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89 Unit 5: Second Hand Smoke ACTIVITY 7: HOLDING A MOCK CITY COUNCIL MEETING LEADING TO THE PASSAGE OF NO SMOKING LEGISLATION Turn your classroom into a mock city council meeting. Volunteer to represent one of the following people: a city councillor presenting a bill, a doctor, the owner of a restaurant that has live music and a bar, a smoking customer, a nonsmoking customer, and an official from the Environmental Protection Agency. The city councillor s bill makes it against the law for anyone to smoke in a public building, restaurant, or bar. The doctor, restaurant owner, EPA official and both customers will be asked to testify or give their opinion about the bill. The council will vote to pass or reject the bill as it is written or pass it with some changes or compromises. ACTIVITY 8: WRITING A SMOKING POLICY FOR A WORK SITE Join a group of at least three people. Each group makes up the board of directors for a large insurance company employing two hundred workers. Currently, smoking is allowed everywhere in the company. The work site is a closed building with windows that do not open. There are many copy machines and computers in the space. Each group must write up a smoking policy for the company and support the policy with a list of specific reasons. Go back to Unit 5 to get specific information on the dangers of second hand smoke.

90 UNIT 6: QUITTING As more people learn about the dangers of cigarettes to everyone, city, state, and national governments are passing laws against smoking. Smokers are finding fewer places outside their own homes and cars where they can smoke. Smoking is no longer socially acceptable. Less than ten years ago, people could smoke almost anywhere and feel comfortable. One result of these new laws and increased public information about cigarettes is that more and more smokers are quitting. More than 3 million Americans quit smoking each year. Today, the U.S. government is talking about stopping smoking in all workplaces. Smoking is no longer allowed in any military workplace, whether in an office, airplane, helicopter, or tank. The U.S. Postal Service has gone smoke free. In 1992, 42 states had laws restricting smoking in government buildings, and 21 have them in private work sites. 39 states did not allow smoking on buses and trains. Local and state governments are even passing laws that say that no one can smoke in restaurants and/or bars. In 1992, 505 cities in the U.S. had passed ordinances (local laws) restricting or not allowing smoking in restaurants. As of April 1995, all restaurants in New York City, California, Maryland, and Washington are smoke-free.

91 To make it harder for youth to buy cigarettes, cities are passing laws against vending machines. In 54 cities cigarettes vending machines are banned, not allowed or against the law. Under other city ordinances, vending machines must have lock- out devices. To buy a pack of cigarettes from a vending machine with a lock out device, a person has to show someone like a store clerk an ID. If the person is 18 years old or older, the clerk will remove the lock out device, and the customer can buy a pack of cigarettes. Quitting smoking is not easy. It usually takes a person several tries to really quit. Many heavy smokers say that they have found it harder to stop smoking than stop drinking or stop using cocaine or heroin. There are many different ways to quit. One way does not work for everyone. Each person must try what works best for him/her. However, there are some basic steps that all smokers can take. The first step in quitting is deciding whether or not a person is ready. The more reasons a person has to quit, the more likely he/she will really do it. After deciding that a person is ready, he/she should write a list of all his/her own reasons for quitting. YOUR REASONS FOR QUITTING 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

92 Are You Ready to Quit Smoking? The Cambridge Tobacco Education Program, 51 Inman St., Cambridge, MA 02139, (617)349-6353, is funded by the Massachusetts Department of Public Health. Tobacco Control Activities are supported by the Health Protection Fund, established by the passage of voter referendum Question 1 (Tobacco Excise Tax) in November 1992.

93 The second step is choosing a quit date. A person must decide when is the best time for him/her. He/she should pick a date when no big changes are going on in his/her life. It would not be good to choose a stressful time. One should not try to quit smoking if he/she just lost a job, started a new job, separated from a husband or wife, lost his/her housing, moved into a new apartment, or bought a house. Before the quit date arrives, some people change cigarette brands. They keep trying brands that have less and less nicotine and tar than the brand they usually smoke. They might also not inhale the smoke as deeply as before. The less nicotine in the body, the easier it can be to quit. The third step is to decide how to quit. There are two main ways: cold turkey and tapering off. When a person goes cold turkey, he/she throws away all cigarettes, lighters, and ashtrays. He/she just stops and does not smoke another cigarette. People who quit by going cold turkey do it on their own or with help. They might visit a hypnotist, acupuncturist, counselor, or doctor.

94 Interview With Joan Bruzzese, Teacher at the Community Learning Center 1. Have you ever quit cigarettes and for how long? Yes, seven years ago I quit for five years. After five years, I started smoking again by taking two puffs off of someone s cigarette. The next day at work, I bummed a cigarette off of a co-worker, and that evening on the way home, I bought a pack, and I ve been smoking ever since; it was just as if I never stopped. 2. Why did you quit five years ago and how did you do it? I decided that I wanted to do something healthy for myself. I felt if I didn t smoke, I d eat better because cigarettes are a good substitute for food, anger, anxiety, and stress. Without knowing, you use cigarettes almost like a comforter. Psychologically it kept me from losing my self-control. When I decided to quit smoking, I called the office of Yefim Shubentzoff, known as The Russian. His office is in Brookline and, at the time, he charged $35 for just one visit. He s the man who deals with people who have all kinds of addictions: over-eating, drugs, cigarettes, alcohol, and nail-biting. I had to wait nine months for an appointment. Walking into his space, I was very impressed with how clean his place was -- bare wood floors, white paint, light colored furniture, and white sheer curtains. We sat around in a semi-circle with him in the front of the room. Behind him were the windows. He was wearing a clean, cream shirt and beige pants, and he was standing behind this light oak desk with nothing on it. It was bare. I had become aware about how bad my car, my clothes, and my hair smelled from cigarette smoke. I said to myself while sitting in the semi-circle, This is the time to quit.

95 The Russian stood in front of the room and said many people had come to him with their problems and said they couldn t stop. He believed they could stop and needed them to believe they could stop. People would make excuses about why they couldn t quit, saying such things as, I ll get fat, I tried before and all I did was yell at my family. The Russian said, You didn t need to overeat or yell at your husband or children. He d make a point by asking, Were you out of control? Did you eat because you were hungry? You don t need to do that. If you feel the urge to eat, you don t have to eat fattening foods. Keep fresh fruit and vegetables around you all the time. Take a minute to think before you yell or snap at someone. The Russian encouraged people to ask questions. He said, If you didn t really want to quit, you wouldn t. He stressed that it was important to exercise like walking outside in fresh air, swinging your arms when you walk. Breathe. People who smoke do not breathe. They only take deep breaths when they inhale cigarettes. He said, You need to encourage yourself to take deep breaths. Drink lots of water. When a person quits smoking by tapering off, he/she reduces the number of cigarettes smoked little by little over a period of time. Also, he/she may switch brands by gradually going from a brand that is high in nicotine to one that is lower and lower. One day he/she is not smoking anymore.

96 Switching Cigarette Brands Credit: Permission granted by Fox Chase Cancer Center, PA, Pathways to Freedom,1992.

97 Some people who taper off see a doctor. The doctor may prescribe either nicotine chewing gum or a patch. Both work the same way to decrease the amount of nicotine in the person s system. With nicotine gum, the smoker chews it whenever he/she feels the desire to smoke. Over time he/she chews fewer and fewer pieces of gum and feels less desire for a cigarette. The nicotine patch is placed on a smoker s skin by a doctor. It releases a continuous amount of nicotine through the skin into the bloodstream. Over a period of time, the doctor changes the patch to smaller and smaller ones. Eventually it is removed. If a smoker continues to smoke with either the nicotine patch or chewing gum, he/she could get very sick or even die from too much nicotine in the body. Whatever method a person chooses to quit, he/she will probably feel bad during the first week or two of quitting. The first 2 or 3 days are the worst. This is the time when the body is getting rid of the nicotine. People who quit can expect to have headaches, dry mouth, a cough, and trouble sleeping. They may feel nervous, irritable or in a bad mood, depressed, tired, and hungry. They need to drink a lot of water and fruit juices, especially during the first week of quitting. They should also eat plenty of fruits and vegetables, chew sugarless gum and toothpicks, and suck on cough drops and hard candies. They need to stay busy by exercising, getting new hobbies, and visiting nonsmoking friends and relatives. Above all, they should avoid foods and situations that remind them of smoking. For example, many people find it helpful not to drink alcohol or coffee or hang out in bars (See the list of nicotine withdrawal symptoms on the next page.).

98 It is natural to gain weight when quitting smoking. On the average, people gain five pounds. To prevent weight gain and help fight the desire to smoke, people must exercise and eat a low fat/low sugar diet. It does not mean dieting. Look at the chart below. Credit: Quit For Life, Martin, Wilner, Hansen, and McHenry, U. of CA School of Medicine, S.F., CA.

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100 Walking just 30 minutes each day is something that almost everyone can do. People should see their doctor to make a safe exercise plan. Practicing deep breathing or meditation helps people to stay smoke free. It relaxes them. It can be done almost any where or any time. When they feel that strong desire for a cigarette, they sit in a comfortable position or lie down on their back. If it is possible, they should remove their shoes, eyeglasses, and any tight clothing. They then breathe in through the nose saying the word calm to themselves and slowly breathe out saying relax. They should be breathing through their diaphragm. The diaphragm is located below the ribs and above the belly button. It fills with air when we inhale and moves outward. When we exhale, it releases air and moves inward. People begin meditation by practicing deep breathing for ten full breaths. To get more relaxed, they can increase the number of breaths and length of time they meditate. This should be done gradually or little by little. Within weeks of quitting, ex-smokers start to feel much better. Their senses of taste and smell return. Their cough goes away. They have more energy. They get rid of bad breath and the smoky smell on their clothes and in their hair. They have improved their chances of a longer, healthier life.

101 Credit: Figure 25,Tobacco: Biology & Politics, HEALTH EDCO, Waco, Texas. For many ex-smokers, the desire to start smoking again is very strong. For some people it takes several tries to quit forever. What it takes is a strong decision, commitment, willingness to make changes in one s life, and a positive outlook. There are many places to go for help. There are a few free hot lines with counselors and many organizations with programs and support groups to help a person quit.

102 Quitting Smoking Resources In & Outside Massachusetts I. Hot lines: Hot lines have staff that will answer your questions about smoking or quitting, offer support if you feel the desire to smoke and want to talk with someone, or refer you to local programs to help you quit smoking. Quit line: 1-800-TRY-TO-STOP (English) 1-800-DEJALO (Espanol) 1-800-TDD-1477 (deaf/hearing impaired) National Cancer Institute Cancer Information line: 1-800-4-CANCER II. Groups: There are many support groups to help people quit smoking. They teach people to make the changes needed to stop smoking. Cambridge Hospital Harvard Pilgrim Health Plan Department of Behavioral Medicine Freedom From Smoking Program Cambridge, MA Various sites/cities (617)498-1520 (617)731-8223 Mount Auburn Hospital Mass. Alliance of Portuguese Speakers Cambridge, MA Somerville, MA (617)499-4214 (617)628-6065

103 III. Self-Help Materials: The following organizations offer quitting kits and free brochures with guidelines and tips on quitting: American Cancer Society (Fresh Start Program): 1-800-952-7664 X4664 American Lung Association: (617)272-2866 National Cancer Institute: 1-800-4-CANCER Cambridge Tobacco Education Program: (617)349-6353 Mass. Tobacco Education Clearinghouse: (617)482-9485 Tobacco Education Clearinghouse of California: 1-800-258-9090

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