As mentioned in the teacher’s instructions for Activities 1 and 2, adolescents may not understand the nature of tobacco and nicotine addiction. This activity will explain what nicotine is and how it affects the body so that students understand the concept of addiction as they make their decision to be tobacco and nicotine free.

To introduce this activity, ask students to define “addiction.” Write their thoughts on the board or chart paper. Students might give you examples of things people might be addicted to, such as drugs, alcohol, or tobacco and nicotine. Encourage them to define the term. Then, have a student provide the dictionary definition of “addiction.” 

Explain to your students that they are going to read about tobacco and nicotine addiction. Then, share the digital activity link below with your students. Have them complete the activity, including questions and answers, and then review the answers together. You may wish to present it on an interactive whiteboard or have students go directly to the activity on their computers. Have them work in groups to assess the risks and health consequences for the smoking/vaping scenario. Note that they may navigate back and forth between the activity screens by clicking the “Page” tabs at the bottom of the activity. 

Answers 
1) TRUE. Nicotine is a drug. 
2) FALSE. In order to be “True,” the statement should say: The adrenaline (or epinephrine) released by the body after absorbing nicotine stimulates the body and causes an increase in blood pressure, respiration, and heart rate. 
3) FALSE. In order to be “True,” the statement should say: Most smokers or vapers use tobacco regularly because they are addicted to nicotine. 
4) FALSE. In order to be “True,” the statement should say: Each year, nearly 35 million smokers want to quit. 
5) TRUE. Nicotine causes the same changes in the brain as heroin and cocaine. 
6) TRUE. Without nicotine, a smoker/vaper can feel irritable and depressed. 

After reviewing the answers together, share the following additional facts with your class: 

• Studies have shown that addiction can occur after smoking/vaping as few as 100 cigarettes or vapes. And some young people have shown symptoms of dependence within the first few weeks of using a nicotine product like a cigarette or vape.⁹
• Tobacco smoke contains more than 4,000 chemicals. The most dangerous chemicals in cigarette smoke, besides nicotine, are tar and carbon monoxide. Tar causes lung cancer, emphysema, and bronchial disease. Carbon monoxide causes heart problems.¹⁰
• In 2021, 65.3% of youth (middle and high school students) who currently used tobacco products reported that they were seriously thinking about quitting the use of all tobacco products.¹¹
• The younger people are when they begin smoking cigarettes or vaping, the more likely they are to become strongly addicted to nicotine.⁴
• Young people who try to quit  cigarettes or vapes suffer from the same nicotine withdrawal symptoms as adults.⁴
• Cigarette smoking is responsible for more than 480,000 deaths per year in the U.S.—approximately one out of every five deaths.¹² This fact from the CDC is very real. Even more startling, based on current smoking patterns, an estimated 25 million Americans alive today will die prematurely from smoking-related illnesses.¹²

To wrap up the activity and reiterate the health consequences of tobacco and nicotine use and the addictive nature of nicotine, discuss the warning labels that appear on tobacco and nicotine products. 

Explain to your students that the U.S. Surgeon General serves as the head of the United States Public Health Service and is the leading spokesperson on such matters for the U.S. government. There are specific health warnings placed on cigarette packages and advertisements on a rotating basis.¹³ Display the following warnings for your students to see, or write them on the board: 

• SURGEON GENERAL’S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy.
• SURGEON GENERAL’S WARNING: Quitting Smoking Now Greatly Reduces Serious Risks to Your Health.
• SURGEON GENERAL’S WARNING: Smoking by Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight.
• SURGEON GENERAL’S WARNING: Cigarette Smoke Contains Carbon Monoxide. 

The Comprehensive Smokeless Tobacco Health Education Act of 1986, as amended, requires that there be one of the following warning labels on smokeless tobacco packaging and advertisements. They are: 

• WARNING: This product can cause mouth cancer.
• WARNING: This product can cause gum disease and tooth loss.
• WARNING: This product is not a safe alternative to cigarettes.
• WARNING: Smokeless tobacco is addictive. 

Ask your students: 

• Have you seen these warning labels before?
• Were you aware that these health issues could result from tobacco and nicotine use?
• Why do you think these labels are important?

Conclude by telling students that you hope their knowledge of these health risks and the addictive nature of nicotine will help them make the right decision to be tobacco and nicotine free. 

As a group, brainstorm positive, healthy activities students can engage in as alternatives to using tobacco or nicotine. For example, they could exercise, paint, draw, sing, dance … the list is endless. 

⁴ U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C., 2012. Referenced 2017. http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf 

⁹ Milton, M.H., Maule, C.O., Yee, S.L., Backinger, C., Malarcher, A.M., Husten, C.G. Youth Tobacco Cessation: A Guide for Making Informed Decisions. Atlanta, Georgia: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004. Referenced 2023.https://stacks.cdc.gov/view/cdc/11319/cdc_11319_DS1.pdf 

¹¹ CDC. Smoking & Tobacco Use. Fact Sheet-Quitting Smoking. Referenced 2023. www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm

¹² CDC. Smoking & Tobacco Use. Fact Sheet-Tobacco-Related Mortality. Referenced 2017. www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm

¹³ CDC. Smoking & Tobacco Use. History of the Surgeon General’s Reports on Smoking and Health. Referenced 2017. www.cdc.gov/tobacco/data_statistics/sgr/history/