1 of 73

1

2 of 73

Session 1

Understand �the Choice

Agenda

Big Decisions (5 min)
Get the Facts Straight (6 min)
Aerosol Analysis (11 min)
Consequences (10 min)
Reflection (3 min)

Homework

Activity 1c: Session 1 Review

2

3 of 73

Opening Question

If someone tells you to �“make good choices,” �what do you think �they mean?

3

4 of 73

Making Decisions for Yourself

Should I have a banana or an apple with my lunch?
Which college should I attend?
Which homework assignment should I do first?
Should I try out for the soccer team?

4

Choose a few student volunteers to share out their responses from the Opening Question.

Tell students that, as they get older, they’ll probably be allowed to make more and more decisions on their own. Ask them if they think they can make the best decisions and what they think affects those decisions. Tell them that knowing what affects their decisions can help them make the best possible decisions for themselves.

Tell students that some people—even adults—make all their decisions in the same way whether it’s a big or small decision. As we learn and grow, however, we often find it necessary to think more about big decisions.

Click and instruct students to look at the examples on the slide and take a volunteer for each example to ask them whether it’s a big or small decision. After each response, ask why the student thought it was a big/small decision, guiding them to the idea that big decisions potentially bigger consequences on your life.

Teacher Note: Numbers one and three are meant to be the small decisions with two and four being the big ones. If you have other examples you think would be more suitable to your class, please substitute those in!

Remind students that small decisions don’t need a lot of thought because, ultimately, they don’t have any big consequences. Do you want to wear red or blue today? Should you get a side of fruit or vegetable with my lunch? Other decisions that really have the potential of affecting their life should involve a little more thought. Should you try out for the team? Should you try to go on the big trip or not?

Key Talking Points:

Big decisions require more thought because they usually affect our lives in a big way.

5 of 73

Big Decisions

What would you want to know/do before making a big decision?

Big decisions require more thought because they affect our lives in a big way.

5

Have students think-pair-share their thoughts for the question on the screen: “What would you want to know/do before making a big decision?” Prompt them to think about the big decision examples from the previous slide if they get stuck. For example, for the big decision of which college to attend, you may want to know how much it will cost, what requirements there are to attend, what the surrounding city is like, how housing works, and what majors are offered, all of which can your quality of life during college and your job prospects and debt after college.

Teacher Note: If you haven’t used think-pair-share before, here is a quick explanation: After presenting the question, give students about 20 seconds to think quietly about it. Then, have the students turn to a partner and discuss their thoughts. Afterwards, call on a few students/volunteers to share what their pair discussed.

Students will likely say that they want to know more information about the possible effects/outcomes of their decision. Be sure to emphasize/mirror their point: “You want to know more information about the effects of your decision.”

If no one said they’d want to find out what their friends/family would think, ask: “Do you think that you’d want to hear what your family would say about it? Would your friends’ decisions affect yours?”

Click to make the green box with the key point appear and have a student read the key point.

Key Talking Points:

It is helpful to know about the potential effects of our choices before making a big decision.

6 of 73

Big Decisions

Is the choice to use or not use vaping products like e-cigarettes and other tobacco products a big or small decision?

6

7 of 73

In the CATCH My Breath program we’ll…

Learn information we need to �make informed decisions about �vaping.
Discuss what influences our decisions on vaping and other tobacco products.
Analyze the Big Tobacco industry and how it has targeted young people.
Practice skills that will help us get out of uncomfortable situations.
Create a social media campaign to help others learn what we’ve learned.

Classroom Norms

There are no bad questions

Respect others’ privacy

7

Say: “Today, we’re starting a program called CATCH My Breath. Like many of you said, the choice of whether or not to use tobacco products, including e-cigarettes/vapes, is a big decision. In order to make that decision, we’re going to make sure that you have the right information and the time to really think about it. Our program focuses mostly on e-cigarettes/vapes because they are newer, meaning lots of people don’t know all the facts about them.”

Have student volunteers read through the overall program objectives.

Tell students that, in order to get the most out of the lessons, there will be some additional classroom rules/norms.

Teacher Note: Feel free to skip this slide if it doesn’t work in your classroom. Other teachers have also used this slide to review some existing classroom norms that have been some trouble spots for the class.

First, there are “No Bad Questions.” Remind students that tobacco products and e-cigarettes are not often covered in classrooms. It’s ok to not know everything.

Second, “Respect Others’ Privacy.” Remind students that they may be talking about private things or telling sensitive stories, so it’s important not to use people’s names in those stories and not to share other people’s stories.

8 of 73

True or False?

In the left column:

Write “T” for statements you think are True .
Write “F” for statements you think are False.

Don’t know? That’s ok. Take a guess.

8

Remind the students that they want to know the possible effects of a decision before making that decision. Let them know when it comes to tobacco products there is a lot of misinformation that may make it hard to make the right decisions for themselves. In fact, some people may be making decisions on false information. Tell students that they are going to check what they think they already know about e-cigarettes.

Distribute one copy of Activity 1a: Understand the Choice to each student. In the top section of the worksheet, there is a list of statements (also listed below) about tobacco products and e-cigarettes. Some statements are true and some are false. On their own, students should write their guess in the left-hand column. Tell them that the answers to these statements will come up during the lesson and they’ll have a chance to check their answers at the end of class. Be sure not to reveal the answers until the end of the lesson.

Activity 1a: Understand the Choice Worksheet Statements:

The “cloud” from an e-cigarette is water vapor.
Some e-cigarettes are safe.
Most e-cigarettes contain nicotine, the addictive chemical found in other tobacco products.
You have to be at least 18 years old to buy or use tobacco products.
Nicotine harms healthy growth and development of the brain.
Fruit, mint, and candy flavored e-cigarettes are less dangerous than tobacco flavored e-cigarettes.
You can’t get addicted to nicotine unless you use it every day.

9 of 73

Vapor

Vapor Aerosol

9

Tell students that you’re going to start by learning the very basics about e-cigarettes. Tell them that many people refer to e-cigarettes as “vapes” and using e-cigarettes as “vaping.”

Ask students what they think of when they hear the word “vapor.”

Many will say ‘water’ or ‘a gas.’

Share the fact that e-cigarette “vapor” is NOT water vapor. Then play the video Vaping: Not Harmless Water Vapor.

Explain to students that an aerosol is a suspension of tiny particles of liquid, solid or both within a gas as opposed to water vapor, which is a substance (in this case water) in its gaseous phase.

Ask students what they think would happen if they inhaled the particles from some of their examples (spray paint, room fresheners).

They will likely mention things like coughing, feeling nauseated, getting a headache, and more.

Unfortunately, some students might say to get high. Huffing gasoline, glue, cleaners, or paint is very serious and can cause permanent brain damage.

Ask students what they think would happen if they inhaled those particles multiple times every day?

They will likely bring up big consequences like death or cancer. Steer them back to the concept of long-term harm to the lungs, asthma, and other unknown harms to the body.

Just like inhaling other aerosols, inhaling the aerosol of e-cigarettes is not safe. It may cause short term issues with your breathing, lungs, and nose/mouth and is linked to long-term consequences like heart disease.

Explain to students that an aerosol is a suspension of tiny particles of liquid, solid, or both within a gas as opposed to water vapor, which is a water in its gaseous phase. Inhaling the aerosol of e-cigarettes is not safe. It may cause short-term issues with your breathing, lungs, and nose/month and is linked to long-term consequences like heart disease.

Key Talking Points:

E-cigarette “vapor” is NOT water vapor. It is made up of tiny particles containing nicotine and toxic chemicals.
Inhaling the aerosol of e-cigarettes is not safe. It can cause short term issues with your breathing, lungs, and long-term consequences like heart disease and cancer.

10 of 73

E-liquid Ingredients

Propylene Glycol (PG)

Makes the “smoke” & carries other ingredients

Vegetable Glycerine (VG)

Makes the ”smoke” & carries other ingredients

Flavoring Chemicals

Hides the taste of the other stuff and attracts new users

Nicotine

Gets you hooked

There is no water in e-liquid

10

Tell students that they’re going to learn what’s actually in e-cigarette aerosol now that they know that it’s not just harmless water vapor.

Whether it’s in a refillable tank, a pod, a bottle of e-liquid, or a disposable vape, nearly all e-cigarettes have some of the same basic ingredients: vegetable glycerin /propylene glycol, nicotine, and flavoring chemicals.

Click to reveal the arrows pointing to vegetable glycerine and propylene glycol. These two ingredients are used in e-liquids to carry the other ingredients as well as to make the ‘smoke’ or ‘cloud’ that you see when someone vapes. Both have been tested and shown as safe to ingest but have not been approved to be vaporized and inhaled.

Heating and inhaling vegetable glycerin and/or propylene glycol are known to cause problems in your respiratory system (nose, mouth, throat, lungs). This means there are no safe e-cigarettes.

Click to reveal the arrow pointing to nicotine. The CDC reports that 99% of e-cigarettes contain nicotine, even some that claim that they have none.

Nicotine is the drug found in tobacco products that makes them addictive. That means that once you use it, your brain will continue to want more. When you use e-cigarettes, nicotine is quickly absorbed into your body and goes to your brain. Putting nicotine in your body is dangerously addictive, and it can also change your brain in a way that you are more likely to get addicted to other substances like drugs and alcohol. The CDC reports that 99% of e-cigarettes contain nicotine, even some that claim they have none. This means there are no safe e-cigarettes.

Click to reveal the arrow for flavoring chemicals. Tell students that e-cigarette companies also usually include flavoring chemicals in their products. Flavoring chemicals are added to e-liquid to make it taste like something else and cover up the taste of the other ingredients. Flavors are also used to attract new users.

Inform students that, while some of these flavoring chemicals may be safe to ingest, some can be very harmful or even toxic when vaporized and inhaled.

Click to reveal the ‘no water’ symbol and remind students there is absolutely NO water in e-cigarette liquid.

Key Talking Points:

The CDC reports that 99% of e-cigarettes contain nicotine, even some that claim they have none.
Many chemicals found in e-liquid have been studied and shown safe to ingest, but not to inhale.
There is no water in any e-cigarette liquid.

11 of 73

E-cigarette aerosol contains more than �just the ingredients of the e-liquid.

Each puff may also include:

Formaldehyde
Nickel
Cadmium
Tin
Acrolein
Lead

11

12 of 73

Nicotine Addiction is Heavy

Do Vapes Contain Toxic Metals_ The Real Cost.mp4

12

13 of 73

Peer Groups

13

14 of 73

Activity 1b: Aerosol Analysis

In your groups:

Read about your assigned chemical group.
Use sticky notes to write out the effects those chemicals have on the body and mind.
Choose one team member to put the sticky notes on the body part it affects.

Example: Write “Nicotine can make you moody” on a sticky note and then stick that up on the picture/sign for the brain.

The class will do a gallery walk after work time is over.

14

Remind students that e-cigarettes contain harmful chemicals and do not contain ANY water. Let them know that they’ll now have the opportunity to learn more about what’s actually in the aerosol and how those substances affect the body and mind.

Teacher Note: As described in the Educator Prep section, be sure to hang up the Organ Posters before the activity. Alternatively, you can write the names of these organs on chart paper/the board and have kids write/place notes underneath each organ name.

Distribute one Activity 1b: Aerosol Analysis worksheet and pad of sticky notes to each group. Assign each group to one of the chemical categories from the handout: Toxicants, Flavor Chemicals, Carcinogens, Heavy Metals, Volatile Organic Compounds. Let Peer Facilitators know it is their job to read the information on the worksheet aloud for the group and elicit responses. They can designate someone else in the group to read and another member to record, if needed.

Read the directions and instruct students to begin working.

In their groups, students should read about the substance, looking for the health effects on different parts of their bodies. The groups will use the sticky notes to write the effect that chemical category has on the different body parts. For example, they may write “Nicotine can make you moody” on a sticky note and then they stick that up on the picture/sign for the brain.

We recommend giving students about 5 minutes to complete this portion of the activity.

Once time is up or most groups look like they’re done posting their notes, tell students that they will be doing a brief gallery walk to see all the effects of e-cigarettes on the body. Instruct them to browse the posters/signs around the room with their group and discuss their reactions quietly.

To provide some more structure, you can assign each group a poster and instruct them to gather around that poster. After one minute, signal to the students to switch to the next poster. Repeat until all groups have seen all posters and then instruct students to return to their group’s table.

Alternate: If you don’t think a gallery walk will work in your classroom set-up, you can also have a volunteer go up to each poster and read out some of the effects that were posted.

Once students have returned to their seats, ask for a few volunteers to share what information surprised them the most.

15 of 73

Less Harm ≠ Harmless

E-cigarettes contain nicotine which is addictive and toxic especially for young people.

E-cigarette aerosol contains ultrafine particles, heavy metals (such as nickel, tin, and lead), and other toxic chemicals that can harm the lungs, heart, and brain.

There are no safe e-cigarettes, especially for people your age.

15

16 of 73

E-cigarettes are harmful to the environment.

E-cigarette batteries can be toxic to the environment.
Some e-cigarettes are so toxic that when you throw them away, they can count as hazardous waste. The batteries, leftover liquid, and metals in the device can pollute the environment.
In recent years, the number of e‑cigarette devices sold remains in the hundreds of millions in the U.S., and globally electronic waste now reaches about 62 million tonnes annually.

16

Explain to students that, in addition to harming their bodies, e-cigarettes are also harmful to the environment.

E-cigarette batteries can be toxic to the environment if not disposed of properly and the lithium batteries inside are a fire hazard. In order to properly recycle e-cigarettes, the batteries must be separated from the device by an outside service professional. Encourage students to talk to an adult about disposing of and/or recycling e-cigarette devices and vaping-related items if found.

Let them know that some e-cigarettes contain enough toxic chemicals to qualify as hazardous waste. Broken devices can leak heavy metals (including mercury, lead, and bromine), battery acid, and nicotine into the local environment, affecting humans and other organisms. For this reason, if you do see a broken device or pod laying around, let an adult know about it and don’t touch it/move it without gloves.

In recent years, the number of e‑cigarette devices sold remains in the hundreds of millions in the U.S., and globally electronic waste now reaches about 62 million tonnes annually.

Key Talking Points:

E-cigarette batteries can be toxic to the environment.
Some e-cigarettes have enough levels of toxic chemicals to qualify as hazardous waste.
E-cigarettes contribute to the 62 million metric tonnes of electronic waste each year.

https://ewastemonitor.info/gem-2020/

https://truthinitiative.org/research-resources/harmful-effects-tobacco/toxic-plastic-problem-e-cigarette-waste-and-environment

17 of 73

Heads up: in the U.S., you have to be 21 or older to buy any vaping products, including e-cigarettes. It doesn't matter which state you're in — it's a federal law.

17

Inform students that there are laws and rules in place to protect them from harmful e-cigarettes. In December 2019, the Federal Food, Drug and Cosmetic Act was amended, raising the minimum age to purchase vaping products from 18 to 21 years across the United States.

As of a final rule by the Food and Drug Administration effective September 30, 2024, retailers must verify photo ID for any purchaser under the age of 30.

It is illegal for a retailer to sell any tobacco product—including e-cigarettes—to anyone under 21.

Teacher Note: If a student asks about exemptions, you can inform them that the law applies to everyone in the US including people in the military and those living on Native American reservations.

Key Talking Points:

As of December 31, 2019, it became illegal to sell any tobacco product—including e-cigarettes—to anyone under 21 everywhere in the United States.

18 of 73

Our School Rules

It is against school rules for you to possess, use, sell, or buy any type of vaping or tobacco product on campus.
This includes cigarettes, �e-cigarettes (vapes), cigars, and all other tobacco products.

18

Share your school code of conduct and district policy about tobacco and e-cigarettes as well as any consequences the students might incur if they use, possess or sell e-cigarettes or other vaping products on school property.

Must exit presentation mode to type consequences
Teacher Note: If queried by students regarding marijuana or THC vape vapes, consult your school resource officer (SRO) to learn more about your area’s policies and regulations. Additionally, to see some school policy templates for e-cigarette use/possession on school property, check out the teacher resources.

Key Talking Points:

It is against school rules for you to possess, use or sell any tobacco product, including cigarettes cigars or e-cigarettes on campus. There are consequences for using tobacco products on school grounds.

19 of 73

Negative Consequences of Using E-cigarettes

On your index card or paper:

List negative consequences of using e-cigarettes.

19

20 of 73

Write an additional negative consequence on your note card

In order to play videos, click the Enable Content button above.

20

21 of 73

Legal trouble
Harm the environment
Costs a lot of money
We don’t know the long-term effects
Tricked by tobacco companies

Affect grades
Get in trouble
Kicked off team
Distract from goals

School

Health

Social Life

Family

Other

Vaping

Consequences

Addiction
Sore throat
Nose bleeds
Headaches
Makes Asthma worse

Friends might not like it
Anxiety
Depression
Mood swings
Takes time away from other things

Bad role model
Lose trust
Get in trouble
Disappoint parents

21

22 of 73

True or False?

Think back to what we’ve learned in today’s lesson.

In the right column:

Write “T” for statements you think are True.
Write “F” for statements you think are False.

False—Correction: The “cloud” from an �e-cigarette is a harmful aerosol.
False—Correction: There is no such thing �as a safe e-cigarette.
True—Extension: 99% of e-cigarettes �contain nicotine.
False—Correction: You have to be at least 21 years old to buy tobacco products.
True—Extension: Nicotine harms healthy growth and development of the brain, especially in young people.
False—Correction: Fruit, mint, and candy �flavored e-cigarettes are just as dangerous as tobacco-flavored e-cigarettes.
False—Correction: You can get addicted to nicotine even if you are not using it every day.

22

Instruct students to look at the statements on Activity 1a: Understand the Choice and their responses from the beginning of class. Remind them that they’ve learned a lot in just this one session and they may want to change their answers. Instruct them to write down “T” for “True” and “F” for “False” on the right column of their worksheet, armed with their new knowledge.

Ask a volunteer to give their response to each statement to say whether they think the statement is true or false. Reveal the answers to the students and prompt them to make sure their answers are correct. See the answers below and correct statements:

The “cloud” from an e-cigarette is water vapor.

False—Correction: The “cloud” from an e-cigarette is a harmful aerosol.

Some e-cigarettes are safe.

False—Correction: There is no such thing as a safe e-cigarette.

Most e-cigarettes contain nicotine, the addictive chemical found in other tobacco products.

True—Extension: 99% of e-cigarettes contain nicotine.

You have to be at least 18 years old to buy or use tobacco products.

False—Correction: You have to be at least 21 years old to buy tobacco products.

Nicotine harms healthy growth and development of the brain.

True—Extension: Nicotine harms healthy growth and development of the brain, especially in young people.

Fruit, mint, and candy flavored e-cigarettes are less dangerous than tobacco flavored e-cigarettes.

False—Correction: Fruit, mint, and candy flavored e-cigarettes are just as dangerous as tobacco-flavored e-cigarettes.

You can’t get addicted to nicotine unless you use it every day.

False—Correction: You can get addicted to nicotine even if you are not using it every day.

23 of 73

Lesson Summary & Reflection

Consider what you thought about vaping before you came into class and what you think now. Have your thoughts and opinions changed?
If so, what changed your mind and what do you think now?
If your opinions about vaping stayed the same, what information supported your beliefs?

23

Choose a few student volunteers to read out the key points of the lesson.

Tell students that they will now have the chance to reflect privately about what they’ve learned. Instruct students to look at the big box underneath the True/False section of their Activity 1a: Understand the Choice worksheet where they will complete their reflection. Let them know that the reflection is just for them and you will not require anyone to share out their answer.

Give the students about 2 minutes to answer the questions on their paper:

Consider what you thought about vaping before you came into class and what you think now. Have your thoughts and opinions changed?
If so, what changed your mind and what do you think now?
If your opinions about vaping stayed the same, what information supported your beliefs?

When they are done, ask if there are any volunteers that want to share out and praise students for their learning. Do not require any student to share their personal thoughts. It’s ok if no one wants to share.

Look for the optional worksheet titled Activity 1c: Session 1 Review. Consider using the worksheet as an Exit Ticket, Homework Assignment, or Quiz.

Exit Ticket: Use the worksheet to check how well the students understood the lesson. Allow them to choose 2 of the 4 questions in each section or allow them to choose on section to complete.
Homework: Issue these options as homework. Announce it as an assignment and have them return it at the beginning of the next CATCH My Breath session.
Quiz: If you’re looking for quiz or test questions, the worksheet can be used as a reference.

Should you use the parent info sheets, distribute one to each student at this time and instruct them to bring it home to their parents.

24 of 73

Session 2

The Brain Rewired

Agenda

The Stats (5 min)
Nicotine & Addiction (15 min)
Under Pressure (5 min)
Talk to Yourself! (10 min)

Homework

Adult Interview

24

25 of 73

Opening Question

What percentage of middle schoolers do you think choose NOT to use e-cigarettes? Why do you think that?
What percentage of high schoolers do you think choose NOT to use e-cigarettes? Why do you think that?

25

26 of 73

What percentage of middle schoolers do you think choose NOT to use e-cigarettes?

97% of middle schoolers choose NOT �to use e-cigarettes.

Getting closer to lifelong addiction with every puff.

26

27 of 73

What percentage of high schoolers do you think choose NOT to use e-cigarettes?

93% of high schoolers choose NOT to use e-cigarettes.

More than half have already tried to quit �at least once.

27

28 of 73

Think-Pair-Share

Why do you think a lot of students’ guesses were too high or too low?
Why do you think most people your age choose NOT to use e-cigarettes?

Middle School Students

2.6 % Use

97.4% Don’t Use

High School Students

7.1% Use

92.9% Don’t Use

28

Have students think-pair-share on the questions on the screen.

Teacher Note: If you haven’t used think-pair-share before, here is a quick explanation: After presenting the question, give students about 20 seconds to think quietly about it. Then, have the students turn to someone near them (an “elbow partner,” perhaps) and discuss their thoughts. Afterwards, call on a few students/volunteers to share what their pair discussed.

As students share answers, guide them to the following ideas for each question:

Why do you think most kids guessed too high or too low?

Pro-vaping advertising, signs in convenience stores, news coverage, social media, word of mouth, or gossip may cause them to think that more students are using e-cigarettes than actually are.

Why do you think most kids choose NOT to use e-cigarettes?

There are many reasons why the majority of people their age choose not to use e-cigarettes. They might want to avoid the negative health, social and financial consequences we talked about in the first session (eg: getting in trouble, anxiety, respiratory problems, etc.) or they may have tried it and just didn’t like the taste, smell, or how it made them feel.

Key Talking Points:

Sometimes we overestimate the number of teens who use e-cigarettes due to things like pro-vaping advertising, social media, people who talk a lot about it, and more.
There are many reasons why most kids choose not to use e-cigarettes. It may be to avoid negative health, social, and financial consequences or they just don’t like it/find it appealing.

29 of 73

Nicotine rewires your brain.

Almost every e-cigarette has nicotine — and it's seriously addictive. It rewires your brain so stopping feels nearly impossible, even when you want to.

One vape can have as much nicotine as a whole pack of cigarettes. Let that sink in.

Nicotine can also make you dizzy, nauseous, confused, and on edge.

29

Remind students that one of the reasons there are more high school students who vape than middle school students who vape might be because they may have gotten addicted and now find it really hard to stop.

Explain that the brains of young people are still growing and developing, making it easy to get addicted to nicotine. Addiction is a brain disease. This means once you start using nicotine-based products like e-cigarettes or cigarettes (or any kind of tobacco), your brain gets rewired and restructured. Nicotine changes your brain's pathways so it starts needing it. Go without vaping and withdrawal kicks in — mood swings, anxiety, and intense cravings. This makes it hard to quit using any product that contains nicotine.

Inform students that nearly all e-cigarettes contain nicotine which is a HIGHLY addictive chemical. Some e-cigarettes can contain as much nicotine as a whole pack of cigarettes.

Key Talking Points:

99% of e-cigarettes contain nicotine.
Many disposable e-cigarettes contain an extremely high dose of nicotine.
Nicotine causes addiction, which rewires the brain and makes it hard to quit.

30 of 73

Signs of Nicotine Addiction

Bad Mood

Feeling annoyed, nervous, restless or anxious when you can’t vape or smoke. Nicotine can cause or worsen anxiety.

Can’t Focus

Having difficulty concentrating on a task (such as schoolwork/assignments), chores or activities when you can’t vape/smoke

Clingy

You feel like you can’t go anywhere without your vape �or can’t go long periods of �time without taking a few puffs

High Risk

You can’t stop yourself from vaping in places you know you could get caught

Loss of Control

You’ve tried to stop but found it really hard

Morning and Night

Strong craving/need to vape/smoke first thing when you wake up or last thing before you go to bed

30

31 of 73

What are some of the signs of addiction that you notice?

Bad Mood
Can’t Focus
Morning & Night
Loss of Control
Clingy
High Risk

In order to play videos, click the Enable Content button above.

31

Let students know that you are about to show a video of real-life teens talking about their experiences with e-cigarettes. Instruct them to look for the signs of addiction that were covered in the last slide as they watch the video and ask students to describe different ways in which the mental health of these teens is being negatively impacted by vaping.

Click to play the video: My Vaping Mistake: How it affected my mental health (https://drive.google.com/file/d/1n6uSlRQ9zBfbdC3NlNIVjq_8zG5y8cNQ/view?usp=sharing).

If video does not play, be sure to exit presentation mode click the Enable Content button.

After the video, ask the class what signs of addiction they noticed and how the mental health of the teens is being negatively impacted by vaping. Answers may include:

Panic attacks
Anxiety
“Holding a power over me”
Leaving class to use it
Craving more and more
Depression and sadness

32 of 73

Resources To Help Teens Quit

TEXT	DITCHVAPE to 887-09 QUIT to 478-48
CALL	1-800 QUIT NOW 1-855-891-9989*
VISIT	Teen.SmokeFree.gov MyLifeMyQuit.com*
TALK TO	School counselor or trusted adult Doctor or other medical professional

*Resources available in the following states only: MA, CO, MI, MT, NV, OH, PA, or UT

32

Let students know that there are a lot of resources out there to help teens who think they might be addicted to nicotine. We recommend talking to your school resource officer and/or school counselor ahead of time to find out if there are any options for students who are interested in cessation.

Teacher Note: At this time, there are no FDA-approved cessation resources specifically for e-cigarettes and youth. The resources listed on the screen (other than DITCHVAPE), however, have been proven to support nicotine addiction for traditional tobacco products and are currently considered the best resources available for e-cigarettes.

Text DITCHVAPE to 887-09 (The Truth Initiative)
Text QUIT to 478-48 (FDA approved cessation resource)
1-800 QUIT NOW
1-800-891-9989*
Teen.SmokeFree.gov (National Cancer Institute)
MyLifeMyQuit.com*

* Resources available in the following states only: MA, CO, MI, MT, NV, OH, PA, or UT

Teacher Note: Consider printing out Tobacco & Cessation Resources Handout and distributing one to each student or posting it somewhere in your classroom.

33 of 73

Pressure to Use Tobacco Products

Media

Advertising or promotion of tobacco products

Self

Unhelpful feelings or thoughts we have that �tell us to use tobacco

Other People

Friends and family that �use tobacco or support tobacco use

Pressure to use tobacco products

33

Remind students that they’ve learned a lot about tobacco products, especially e-cigarettes. They know that vaping and smoking bring a lot of negative consequences in the short- and long-term and most people their age choose NOT to use tobacco products. However, being a teen is hard and there are many pressures around them that try to trick them into thinking that tobacco is a good choice.

Tell students that they’re going to look at some of those pressures to use tobacco so that they know how to make the best choices for themselves.

Explain to students that, while there are many types of pressure, they’re going to focus on three specific types: pressure from ourselves, other people, and the media.

Pressure from “self” can be feelings or thoughts that make us want to try tobacco products. These could be positive, negative, and even neutral feelings. For example, someone may feel like they’re growing up and want to do something “adult.”

Explain that we sometimes feel pressure from the people around us as well like our friends, siblings, and classmates. We may feel that pressure if someone directly asks us to use a tobacco product or if they are doing it around us.

Explain that another source of pressure comes from media sources like advertising or when they see celebrities or people on social media supporting/using e-cigarettes.

Key Talking Points:

Many pressures around us try to trick us into thinking tobacco is a good choice even when we know it is not.
Even when we know we don't want to use tobacco products, we have a lot of pressure that can make it hard to stick to our decisions.

34 of 73

Activity 2a: Talk to Yourself!

Unrealistic Thought:

Everyone here is vaping. They’re going to think I’m weird if I don’t do it too.

Helpful Fact:

Is it really everyone? Probably not. I can go hang out with people who aren’t vaping.
They probably won’t even notice whether or not I’m vaping.
I know that most teens choose not to vape.
If they judge me for my choice, then they aren’t real friends.

34

Distribute one Activity 2b: Talk to Yourself handout to each student.

Tell students that they’ll be learning ways to deal with these pressures that they identified today. They’ll be starting with the innermost level: Self.

Remind students that we sometimes unintentionally create pressure within ourselves to make choices that don’t line up with who we are or who we want to be. By replacing these unrealistic thoughts with factual ones, we can stick to our decisions and our values.

Show the example of an unrealistic thought someone might have that would put pressure on themselves to use tobacco products: “Everyone here is vaping. They’re going to think I’m weird if I don’t do it too.”

Allow students a few seconds to think about facts that would be helpful in this situation. Take a couple of responses from the students and praise them for being able to find facts to counter unrealistic thoughts, like the fact that most teens choose not to use.

Click to reveal the suggestions on the screen one-by-one and emphasize new ones that students didn’t mention already.

Instruct students to read some of the common unrealistic thoughts a teen might have if they were about to try a vaping product and then write a fact they learned that is helpful to counter that thought.

Teacher Note: The recommended format of this activity is to allow students to try it on their own at first and then work in the group to compare ideas. However, it can be done entirely solo, entirely as a small group, or entirely as a whole class depending on time and your classroom culture.

If time permits, instruct them to also complete the challenge question at the bottom of the worksheet: “Use the back of the paper to write some other unrealistic thoughts someone might have about vaping products. Then, counter them with facts.”

Key Talking Points:

Some of the pressure we feel comes from our thoughts and feelings.

35 of 73

Adult Interview

Interview a trusted adult about their e-cigarette knowledge and bring it back for the next lesson.

35

36 of 73

Lesson Summary

The Real Talk Recap:

Most teens are actually vape free. You're not alone in saying no.
Addiction can hook you from the very first puff and gets stronger every time.
Over 60% of teens who use nicotine are already trying to quit by high school. Quitting is way harder than never starting.
Even when you know you don't want to vape, pressure can make it hard to stick to that.
A lot of that pressure comes from inside your own head, but you can shut it down by calling out those thoughts and hitting them with facts.

Middle Schoolers

2.6 % Use

97.4% Don’t Use

36

37 of 73

Session 3

Stand Firm on Your Choices

Agenda

Refusal Skills (15 min)
Advertising Tricks (15 min)
Social Media Campaign �(10 min)

Homework

Activity 3c: #BeVapeFree Campaign

37

38 of 73

Adult Interview Debrief

What facts did your adult know about e-cigarettes?
What were some examples your adult shared for resisting peer pressure?

38

Engage students by asking the following questions about their experience with the Adult Interview student handout:

What facts did your adult know about e-cigarettes?
What were some examples your adult shared for resisting peer pressure?

Have students think about the questions or write down their responses on the back of their worksheet (Activity 3a: Old Friends, New Habits).

Be sure to thank the students for their hard work and emphasize positive key points that their interviewee made.

Remind students that while e-cigarettes are new, peer pressure and advertising are not. Some adults didn’t have to deal with e-cigarettes when they were younger, but they did have to deal with advertising and peer pressure to use regular cigars, cigarettes, or spit tobacco.

Tell students that many people don’t have all the available information about e-cigarettes because they are newer. Now that they know more, they can share that information with people in their lives, like the interviewee.

Key Talking Points:

While they might not have dealt with the exact same pressures, most adults also had to deal with peer pressure when they were younger.
Many people, including adults, do not know all the facts about e-cigarettes, so sharing the new information could be really helpful.

39 of 73

ARE you kidding me? I would never vape!

Avoid

Avoid uncomfortable or risky situations

Refuse

Say “no” if someone offers you a tobacco product like a cigarette or a vape.

Exit

If the refusal isn’t working or you just feel uncomfortable, leave the situation.

39

Explain to students that there are three common ways that people their age stand firm on their choices about vaping.

AVOID: Some teens find it easiest to avoid these situations in the first place. This means avoiding people who you know use e-cigarettes or going to places where you know there will be vaping.
REFUSE: Of course, it’s not always possible to avoid these situations so we also have to know how to refuse e-cigarettes if someone offers one to use. Refusal skills are creative ways to say ‘no.’
EXIT: If refusal isn’t working or we just don’t feel comfortable saying ‘no,’ we usually have the choice of getting out of—exiting—the situation with an excuse or suggesting something else to do.

Key Talking Points:

We can stick to our choice not to vape by avoiding, refusing, and exiting the situation.
When possible, you can prevent pressure to use e-cigarettes by avoiding people that vape or places where you know there will be vaping.
A refusal skill is something that can help you say ‘no’ in a creative way.
An exit strategy is a thoughtful way to get out of an uncomfortable or risky situation.

40 of 73

Liz’s Story

Media

Advertising or promotion of tobacco products

Self

Unhelpful feelings or thoughts we have that �tell us to use tobacco

Other People

Friends and family that �use tobacco or support tobacco use

Pressure to use tobacco products

40

Remind students of the three sources of pressure they learned in the last session: self, other people, and media. Let them know that, in this session, they’ll be learning more about pressure from other people and from the media.

Distribute one Activity 3a: Old Friends, New Habits worksheet to each student.

Teacher Note: If you don’t want to print the worksheet, you can also tell kids to simply write down their responses on a piece of notebook paper.

Tell students that they are going to read a story about a girl named “Liz.” Like most kids their age, Liz has made the choice to be vape free. However, Liz is going to be put into a situation where she is going to be pressured by other people to vape.

Instruct students to get into their small groups. The Peer Facilitator will read the story aloud or designate someone else to read. Then the peer facilitator will guide the group through the questions.

41 of 73

Liz’s Story

Even though Liz knows she doesn’t want to vape, what factors might make it harder for her to say ‘no’?

41

42 of 73

What could Liz have said/done to Avoid the situation?

Plan a time to hang out with Xavier and Tess when the other people wouldn’t be there.
Told Tess that she wasn’t allowed to leave without her parent’s permission
Told Tess that she didn’t feel like going.

Avoid

Avoid hanging out with tobacco users

Avoid going places where you think there might �be tobacco use

Avoid uncomfortable or risky situations

42

Remind students that Liz went to Xavier’s house knowing that there were people there that probably vaped.

Ask groups to share responses for #2: What could have said or done to avoid being in the situation in the first place. Give students some time to write their answers on their papers then share responses.

Take a couple of responses from the students and then click to reveal some other examples on the screen.

Ask students where else might someone be offered an e-cigarette. Remind them of the classroom rules to respect others’ privacy, which means not using names if telling personal stories. Answers may include:

Sporting events, on the bus, outside the mall, in school bathrooms, outside during student activity time/recess, etc.

Remind them that they already know a lot of places where e-cigarette pressure could happen we can be smart about where we go and who we hang out with to avoid e-cigarette pressure when possible.

43 of 73

What are some ways Liz could Refuse �the vape?

“No thanks. I’m good.”
“Those things are really bad for you.”
“I can’t. I have soccer tryouts next week.”
“No way. I hate the smell of those things.”

Say “no” in your own way

Give a reason you can’t/don’t want to use

Add some humor

Refuse

Say “no” if someone offers you a tobacco product like a cigarette or a vape.

43

44 of 73

How could Liz Exit the situation?�

“Do you guys wanna watch the trailer for next week’s episode?”
“Where’s the bathroom?”
“Oh shoot! Is it 8:30 already? �I gotta get back.”

Exit

Suggest something else to do

Go to another room or place

Make up an excuse to leave

If the refusal isn’t working or you just feel uncomfortable, leave the situation.

44

45 of 73

If you decided you didn’t want to vape but were in this situation, do you think it’d be hard for you to say ‘no’? Why or why not?

Avoid

Avoid hanging out with tobacco users

Avoid going places where you think there might �be tobacco use

Avoid uncomfortable or risky situations

Say “no” in your own way

Give a reason you can’t/don’t want to use

Add some humor

Refuse

Say “no” if someone offers you a tobacco product like a cigarette or a vape.

Exit

Suggest something else to do

Go to another room or place

Make up an excuse to leave

If the refusal isn’t working or you just feel uncomfortable, leave the situation.

45

46 of 73

Let’s Practice!

On your own, fill in the “you” lines by refusing and/or exiting to resist vaping.

46

47 of 73

Practice with a Partner

Stand facing your partner and take turns saying the lines you wrote.

47

48 of 73

Show off your Avoid-Refuse-Exit Skills to the class

48

After it seems like most pairs have finished practicing their scenarios together, instruct students to return to their desks and ask for some volunteers to practice out loud for the class.

Read the ‘your friend’ lines and have the volunteer respond with the ’you’ lines that they wrote. Be sure to praise students for their good work and reinforce the idea that they can effectively refuse pressure.

Teacher Note: If you feel your class needs to be more “creative” with their responses, consider allowing the class to do one silly one, laugh along with them, and then move onto the “real” ones.

After each example, ask the class one of the following questions (Try to ask each question at least once):

How did you feel practicing your responses?
Do you think these responses would work in real life?
What did you think of the person that was pressuring you?
By the third line, the friend who was pressuring you was being very persistent. In real life, do you think it’s likely that someone would pressure you that much or is it more likely that they would have stopped earlier?

Remind students that there are many effective ways to get out of uncomfortable situations and resist pressure. The most effective ones are usually the ones that are most natural to you.

�

49 of 73

Media

Advertising or promotion of tobacco products

Self

Unhelpful feelings or thoughts we have that �tell us to use tobacco

Other People

Friends and family that �use tobacco or support tobacco use

Pressure to use tobacco products

49

50 of 73

Advertising Facts

FACT:

About 80% of middle and high school students reported exposure to tobacco product advertising, including e-cigarettes

FACT:

Youth exposed to e-cigarette advertising are more likely to report current e-cigarette use.

50

Explain to students that they may feel pressured to try e-cigarettes because they see advertisements that are designed to make them curious about e-cigarettes and to try one.

Read the first statistic about advertising: “In 2019, nearly 9 in 10 middle and high school students (22.9 million) reported that they had seen tobacco product advertisements or promotions.”

If students ask specifically about e-cigarettes, inform them that the same survey revealed that 6 in 10 middle and high school students had reported seeing e-cigarette advertising.

Tell students to raise their hand or snap their fingers if they’ve seen advertisements for e-cigarettes or other tobacco products.

Click to reveal the second fact: “Studies show that young people who see tobacco advertising are more likely to pick up the habit.” Tell students that there is a reason tobacco companies spend a lot of money on advertising – it works. Studies show that teens who see tobacco advertising are more likely to experiment, pick up the habit, and become addicted.�

Key Talking Points:

About 80% of youth are exposed to tobacco advertising.
Just as cigarette advertising caused youth a generation ago to start using tobacco products, today we see youth who see e-cigarette advertisements are more likely to use e-cigarettes.

51 of 73

The Tobacco Industry spends A LOT of money on advertising.

While advertising works to get some teens hooked,

the majority of people your age choose NOT to vape.

$8.01 Billion / Year

$24 Million / Day

$1 Million / Hour

51

52 of 73

You are a Target

"We don’t smoke that stuff. We reserve that for the young, the poor, and the stupid.”

—RJ Reynolds Tobacco Company Executive

(R.J. Reynolds brands include Newport, Camel, Kent, Vise and more.)

52

Explain to students that tobacco companies have been known to target young people in the past and have been accused of doing the same more recently with e-cigarettes.

Ask students why tobacco companies would want to target teens. After taking a few answers, click to reveal the quote on the slide from an RJ Reynolds Tobacco Company executive: "We don’t smoke that stuff. We reserve that for the young, the poor, and the stupid.”

Teacher Note: In 1998, tobacco industry manufacturers were required to release all internal documents, including those regarding marketing their products, due to the Master Settlement Agreement. While this quote pertains to cigarettes, they discuss marketing their products to youth. It supports that youth were a target market for the cigarette industry in the past and likely the vaping industry today.

Teacher Note: The quote has been slightly modified for classroom use. The original quote was "We don't smoke that sh*t, we just sell it. We reserve that for the young, the black, the poor, and the stupid."

Tell students that the earlier they start, the more likely they are to get addicted and the longer they’ll be a customer to give their money to tobacco companies.

Key Talking Points:

Big tobacco companies have a history of targeting young people to replace smokers that have died.
Tobacco companies target young people because people who get addicted younger are more likely to be a lifelong customer.

53 of 73

The 4 P’s of Targeting Teens

Products:

Sweet/fun flavors
Colorful and customizable devices
Modern and sleek
Bright characters/cartoons on packaging

Promotion:

Making it look young and cool in ads
Using young people in ads
Paid influencers
Celebrity endorsements
Trick videos and sponsored competitions

Price:

Offering coupons to get them to start and form lifelong addiction

Placement:

Social media ads
Event sponsorships
Eye-level ads for young people

53

Tell students that the tobacco industry uses the “4Ps of Marketing” to attract teens to their products.

Products: E-cigarette companies specifically design products to look like something that would appeal to teens.

This includes the variety of sweet/fun flavors and making a device that is modern and easy-to-hide. Many also use fantasy characters (e.g., unicorns) or bright colors and customizable options that teens like.

Promotion: E-cigarette companies also create advertisements and promote events that appeal to young people.

Advertisements are often colorful, eye-catching, and include models that appear young. They sometimes appear to be selling something other than an e-cigarette like make-up, a high-tech product, or an exciting experience.
Companies also create advertisements that online users may not even realize are ads. Social media platforms like Instagram, Snapchat, TikTok, and YouTube commonly include advertising for tobacco products like e-cigarettes.
The posts, and even the comments on these posts, are sometimes paid for by the tobacco and e-cigarette companies.

Price: Tobacco companies also try to make entry/starter prices affordable to attract new users

Often, e-cigarette companies will use something called a “limited time offer” or a coupon to get a new user started. The companies know once someone is addicted, they’re often a lifelong customer and the company will make profits from that addiction.
They may also provide coupons for frequent use and automatic shipping to encourage continued use.

Placement: Tobacco companies are deliberate about where they choose to display their ads and sell their products.

Tobacco companies “target” users on social media and through banner ads by using a few pieces of information about you (age, gender, location). These ads can also “follow you” from site-to-site based on your usage behavior.
Tobacco companies also sponsor events at colleges, concerts, sporting events, vaping competitions, and festivals attended by young people. In retail stores, e-cigarette products and ads are sometimes placed at eye-level of younger people to attract their attention.

Reinforce that despite all the advertising, most people their age choose not to use e-cigarettes. (95% of middle schoolers and 80% of high schoolers).

Key Talking Points:

E-cigarette advertising surrounds us all the time (product, promotion, price, placement) and is designed to make us want to try the product.
E-cigarette advertising is even in places we might not think about like posts from our favorite social media influencers or festivals attended by young people.
Despite all the advertising, most people their age choose not to use e-cigarettes.

54 of 73

(Mis)Truth in Advertising

Advertisements cannot state lies but they can leave out important information or imply misleading or exaggerated messages.

Implied Message: �a message or feeling that is suggested without being said directly.

Implied message in advertising:

Vaping will make you super cool. Everyone in the school will suddenly start liking you and you will instantly be more attractive! You’ll be free from all of your parents’ rules and feel so much more mature. Just keep buying our product. Trust me. Why would I lie about it?

54

Tell students that the rest of the class session is going to focus more on the second “P”, “Promotion”.

Explain to students that many advertisers exaggerate the benefits and leave out the negative aspects of their products. They may leave out information or imply a message that they can’t say directly.

Explain that it is illegal for advertisements to directly lie about a product or suggest something that is false. However, they can imply something positive about the product that is an exaggeration or doesn't really have to do with the product itself.

An implied message is a message or feeling that is suggested without being said directly. For example, advertisers cannot say that vaping will make you popular but an advertisement that shows people vaping at a party may imply that it can.

Key Talking Points:

Advertising does not give us all the information we need to make informed decisions for our lives.
In order to attract people to buy their products, advertisers often imply something positive about their products that is an exaggeration or doesn't really have to do with the product itself.

55 of 73

The ImpLIED messages tobacco companies have used to attract teens.

Freedom & Individuality

Popularity & Fitting In

Being Attractive & Good-looking

Adventure & Having Fun

55

56 of 73