Your students know that there are health consequences with tobacco and nicotine use, but do they know the specifics? Do they think smoking and vaping-related diseases and side effects can affect only adults or people who have smoked for years?

The risks are serious! Health consequences of smoking, such as cancer, heart disease, emphysema,¹¹ and nicotine use consequences to brain development including nicotine addiction, mood disorders, permanent lowering of impulse control, and impact to attention and learning ⁴ will give your students something to think about—especially if they are considering or currently using tobacco or nicotine.

To introduce this activity, ask students what they think of when they hear the words “tobacco, nicotine or vaping.” Refute any notions that smoking or vaping is “appealing” by referencing the health consequences listed under “Talking About It.”
 
For example, if a student says smoking or vaping is appealing because it makes people look “cool,” ask what’s cool about a person who reeks of smoke - or who’s addicted to nicotine?
 
Share the digital activity link and ask students to answer the questions independently.

Review the answers as a class.

Answers, Numbers 1–8

1) Using tobacco can cause me to have bad breath (halitosis), stained teeth, and__________.
a. Oily skin
b. Bleeding in the mouth
c. Acne
Stained teeth, bad breath, and bleeding in the mouth are all consequences of using tobacco.⁸

2) If I smoke, I am at risk for the following disease(s):
a. Heart disease
b. Lung cancer
c. Emphysema (a lung condition resulting in labored breathing and susceptibility to infection)
d. All of the above
All of the diseases listed are health consequences of tobacco use.⁹  

3) If I smoke, the toxins released from cigarette smoke travel_________.
a. To my heart
b. To my lungs
c. Everywhere the blood flows in my body
The toxic ingredients in cigarette smoke travel throughout the body.⁹

4) If I use a smokeless tobacco, I am at risk for the following disease(s):
a. Gum disease
b. Mouth sores
c. Cancer of the mouth
d. All of the above
All of these diseases can be caused by smokeless tobacco.¹¹ 

5) In the U.S., ______ is the leading preventable cause of death.
a. Alcohol
b. Cigarette smoking
c. Drugs
Cigarette smoking is responsible for about 1out of 5 deaths per year in the U.S., or about 480,000 deaths.⁹ 

6) Second hand smoke exposure harms and kills people in the U.S.
a. True
b. False
Since 1964, about 2,500,000 people who did not smoke died from health problems caused by second hand smoke exposure. ⁶

7) Throughout the world, tobacco use results in approximately _____deaths per year.¹³ 
a. 1 million
b. 5.4 million
c. 10 million
Worldwide, approximately 5 million people die each year resulting from tobacco use.¹³ 

8) Nicotine is a chemical found in tobacco that is__________.⁶ 
a. Not harmful
b. Addictive for adults only
c. Addictive for adults and young people
Nicotine is an addictive drug that can affect adults and young people. Most young people who smoke regularly are addicted tonicotine.⁶ 

Answers and Correct Statements, Letters A—F

A) TRUE. Nicotine is a drug.
B) TRUE. A person’s blood sugar and breathing rate are both increased by nicotine.
C) FALSE. In order to be “True,” the statement should say: Neurons are also referred to as brain cells.
D) TRUE. The limbic system is the brain’s pleasure and reward circuit.
E) FALSE. In order to be “True,” the statement should say: Without nicotine, a smoker feels irritable and depressed.
F) TRUE. Nicotine causes the same changes in the brain as heroin and cocaine.

Review the information about nicotine addiction with your students.

When a person is dependent on (or is addicted to) nicotine and stops using it, their body and brain must get used to not having nicotine. This can result in temporary symptoms of nicotine withdrawal. People might keep using tobacco products, like vapes, to try to make these symptoms feel better. Nicotine withdrawal symptoms include:

• Irritability
• Restlessness
• Feeling anxious or depressed
• Trouble sleeping
• Problems concentrating
• Craving nicotine
• Youth might turn to vaping to try to deal with stress or anxiety. This can create a cycle of nicotine addiction, which can also be a source of stress.

Youth vaping and cigarette use have also been linked to mental health symptoms, such as depression.⁷

Emphasize that nicotine addiction is real that it can and does happen to young people-it’s not just an adult issue. The safest way to avoid addiction is never to use tobacco or nicotine products.

Have your students research testimonials from people who smoked, vaped or used other tobacco/nicotine products and have tried to quit—successfully or unsuccessfully. Understanding the plight of others may deter some students from using tobacco and nicotine.

⁶ https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ftobacco%2Fbasic_information%2Fyouth%2Finformation-sheet%2Findex.htm

⁸ CDC. Smoking & Tobacco Use. Information Sheets. You(th) and Tobacco—What Youth Should Know About Tobacco. Referenced 2023. www.cdc.gov/tobacco/basic_information/youth/information-sheet/index.htm

⁹ https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm


¹¹ CDC. Smoking & Tobacco Use. Fact Sheet—Smokeless Tobacco Facts. Referenced 2023. www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/health_effects/index.htm

¹³ CDC. Global Tobacco Control. Referenced 2023. www.cdc.gov/tobacco/global/