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A Curriculum for Produced by the California Nonsmokers' Rights Foundation in cooperation with the Risk and Youth: Smoking Project Lawrence Hall of Science University of California, Berkeley

Additional copies of this curriculum may be purchased from the California Nonsmokers' Rights Foundation (2054 University Ave., Suite 500, Berkeley CA 94704). Individual copies cost.S5 each, 100 copy lots cost $200 (i.e., $2 per copy). Prices include shipping and taxes. All orders must be prepaid. A detailed evaluation of how this curriculum affects sixth graders, including how to implement it in cooperation with a local television station, is available from the California Nonsmokers' Rights Foundation for $5. Production of this curriculum was made possible by: KRON-TV of San Francisco Arthur Rock Pacific Telephone Company Zellerbach Family Fund Henry J. Kaiser Family Foundation American Lung Association of San Francisco Pyramid Film and Video California Nonsmokers' Right Foundation These materials were adapted by Alan E. Schnur, Herbert D. Thier, and Stanton A. Glantz from a larger curriculum based on the work of the Risk and Youth: Smoking Project (RAY:S) of the Lawrence Hall of Science. The RAY:S curriculum was developed by Drs. Herbert D. Thier, Alan E. Sehnur and Carol L. Omelich, with overall conceptual guidance provided by Professors Martin V. Covington and Carol N. D'Onofrio. That larger work was supported by Public Health Service Grant Number I RI8 CA29558-01, awarded by the National Cancer Institute, Department of Health and Human Services. Any opinions, findings, and conclusions.expressed in this work are those of the authors and do not necessarily reflect the view of the National Cancer Institute. Copyright ©1983 by the California Nonsmokers' Rights Foundation. Material on page 2 through 26 copyright ©1983 by the Regents of the University of California, used with permission.

INTRODUCTION The California Nonsmokers' Rights Foundation is pleased to provide this booklet containing a self-contained curriculum for upper elementary and junior high school students to supplement the viewing of "Death in the West." Considered by many to be the most powerful anti-smoking documentary ever made, "'Death in the West" contrasts the advertising image of the "Marlboro Man" with the reality of six American cowboys dying of cigarette-related illnesses. The film, produced in England in 1976 and later suppressed by the Philip Morris Company, makers of Marlboro cigarattes, illustrates the intrinsically false nature of cigarette advertising. It makes the Marlboro Man less attractive. The "Death in the West" Curriculum is designed to maximize the educational and emotional impact of seeing the documentary. The curriculum is based on a comprehensive smoking prevention program created and tested by the Risk and Youth: Smoking Project of the Lawrence Hall of Science, University of California, Berkeley. The activities included here were developed in classrooms throughout the San Francisco Bay Area and adapted specific- ally for use with the airing of "Death in the West" by KRON-TV of San Francisco. The activities are easy to use: they require little teacher preparation and only 15 to 45 minutes of classroom time each. The activities are written with the assumption that the teacher has no background in health or science. The majority of the required materials are supplied in this booklet. The few remaining items are all commonly avail- able. (A 59¢ mustard squeeze bottle is the most expensive piece of"equipment" needed.) Finally, the activities, like others developed by the Lawrence Hall of Science, are self-discovery in orientation and stress the "scientific meth- od"; they encourage the youngster to question, research independently, and make informed conclusions on the vital issues surrounding cigarette.smoking. In this way, we believe that many students will make the decision not to begin to smoke. The curriculum experiences are engaging for both the teacher and student, while exploring a set of important topics: • the negative physiological effects of cigarette smoking; • the nature of addiction and the difficulty experienced by many smokers who attempt to quit -- but can't; • the efforts made by the cigarette industry to attract young people between the ages of 12-18 years to smoking; and, • the deviousnature of the cigarette industry in its attempts to keep secret important information about the health hazards of smoking. If this guide is used in conjunction with a television broadcast of "Death in the West," the start of the curriculum should be timed so that the students watch "Death in the West" on the evening of Day 4. (Ideally, the broadcast would be on a Thursday night, so that the curriculum runs M~nday through Friday.) The impact of "Death in the West" on those attitudes and beliefs that lead to smoking is equally high if the program is shown in class at the end of Day 4. As a community service, Pyramid Film and Video is .making a 16mm film and video cassettes 'of the documentary available for educational use. An order form can be found on page 28. We welcome you to this unique community effort to prevent smoking among youngsters. Do not hesitate to contact us if there is anything that we can do to assist you in your use of these materials. Alan E. Schnur, Ph.D. Board Member, California Nonsmokers' Rights Foundation Consultant, Lawrence Hall of Science Herbert D. Thier, Ed.D. Associate Director, Lawrence Hall of Science Stanton A. Glantz, Ph.D. President, California Nonsmokers' Rights Foundation Associate Professor of Medicine, UC San Francisco

DAY 1: INTRODUCTION TO AN INVESTIGATION OF CIGARETTES AND SMOKING (Estimated time required: 15 minutes) PURPOSE l. Students are introduced to the mini- curriculum by inviting them to become experts on cigarettes; 2. The term addiction is discussed; and, 3. The "Smoker's Interview" is assigned as homework. MATERIALS Smoker's Interview (1 for each student) large piece of butcher paper (for wall hanging) several cigarette advertisements GETTING READY 1. Smoker's Interviews. Tear out and reproduce enough of .the Smoker's Interviews for your class (page 19). Note: The back of the torn out page will be needed for a later activity. 2. "Death in the West" Is Comingl-Chart. On a large piece of butcher paper, print in bold letters across the top: "Death in the West" Is Coming! Hang the chart in a prominent area of the room where it can remain for the week. THE ACTIVITY 1. Becoming Experts on Cigareltes. Ask the class to define expert. Explain that an expert is someone who knows more about something than almost everyone. Ask how someone becomes an expert. Highlight those ideas that involve gathering and analyzing information. Explain that most experts have to find out a lot on their own. Explain to the class that they will now have the chance to become experts on a subject that most people know very little about: cigarettes. 2. Interviewing a Smoker. As a first step in becoming a cigarette expert, explain that we will have to gather evidence about what it's like to be a smoker. Ask how this might be done. Explain that a good way to find out what smoking is like--without actually being hurt by smokingmis to talk to people who have smoked for a while. Ask each student to interview an adult who smokes, using the Smoker's Interview you now distribute. Explain that by interviewing adults who smoke, the students will learn how the adults got started with the habit, what effects it has had on them, and how they feel about it now. Have each student complete this interview and bring it to class for the next activity. 3. Introducing "Addiction." Introduce the term addiction. Explain that addiction means needing to do something so much that you can no longer choose for yourself whether or not you will do it. We call this "getting hooked." Explain that when you get hooked on cigarettes you can no longer make decisions about if you will or if you will not smoke. Once you are hooked, you have lost control of yourself in regard to smoking; you are not in controlmthe cigarettes are in con- trol. Ask the students what happens when you cannot decide things for yourself anymore. Relate getting hooked to losing the ability to control things for yourself. A good example of losing control might be this common situa- tion: You are talking with a brother or sister, parent, teacher, or friend when the. person says something that makes you so angry that you forgot what you were going to say next and simply start to scream. Here, your anger has control of you because you can't remem- ber what you were going to say. Ask if the students have had this experience, or other experiences that illustrate losing control.

Encourage students to give examples of losing control. 4. Introducing the "Death in the West" Is Coming! Chart. Explain that a very important TV show will be on TV (or shown in class) this week: "Death in the West." The film is especially interesting because no one in this country was ever supposed to know that it was made! Explain that a very powerful cigarette com- pany helped make the documentary, but then decided that nobody should see it and tried to keep it secret. Explain that this week everyone will have a chance to see this film. Draw the class' attention to th~e,'Death in the West" Is Coming! Chart. Explain that to pre- pare for the show, the class will have to collect cigarette ads. Instruct the students to bring in as many cigarette ads with pictures as they can each day and tape them to the Chart. Tape the ads you have to the Chart. Remind the class regularly until the entire Chart is filled with ads. SUMMARY * You introduce the term expert and invite the class to become experts on cigarettes. * You introduce and assign the Smoker's Inter- view. * You introduce and discuss addiction and relate it to being out of control. • The students begin the collection of cigarette advertisements.

DAY 2: CIGARETTES WILL MESS YOU UP (Estimated time required: 45 minutes) PURPOSE This activity is intended to teach that: I. Addiction ("getting hooked") reduces the ability to make personal decisions; 2. Anyone who smokes cigarettes can get hooked; 3. Cigarettes have control over people who are hooked; 4. Almost all current smokers have tried to quit but find it very difficult; :5. Cigarette smoke contains many tiny particles, including tar, carbon monoxide and nicotine; 6. Anybody who smokes gets tar in their lungs, whether or not they use filter cigarettes; ?. Tar begins to build up in the lungs with the first cigarette; and, 8. Cigarette tar remains in human lungs for a very long time and has a negative effect on breathing and health. MATERIALS Students' Completed Smoker's Interviews Smoking Machine Demonstration Materials: 2 cotton balls ~ 1 squeeze bottle 1 large, clear plastic soft-drink bottle and cap masking tape 1 piece of clean, white paper 1 tweezer (optional) 1 pack of matches 1 or 2 filter-tip cigarettes (If possible, use Marlboro cigarettes because they are the biggest seller among teenagers and are the focus of the final activity.) GETTING READY 1. Preparing the Smoking Machine Demonstration. Collect and prepare all materials needed for the Smoking Machine Demonstration as listed under the "Materials" section. Cut off just enough of the squeeze bottle's nozzle so that a cigarette can fit snugly in it. Do not assemble the Smoking Machine yet. THE ACTIVITY 1. Introducing the Scientific Exploration of Cigarettes. Explain that we hear many different things about cigarettes. For example, some people say that cigarettes are dangerous and other people say that they are not so bad. Ask the students about other things they have heard about ciga- rettes. Explain that it can be very difficult to decide which statement is correct without having any evidence to examine. Tell the stu- dents that as a part of their investigation of smoking, today they will collect some of the evidence needed to make more accurate state- ments about cigarettes. 2. Discussing the Interviews of Adult Smokers. Beginning with the first question, ask the stu- dents to present their interview findings. As you proceed, have the class use their data to answer the following questions: • Do people remember their first cigarette? How old were ihey when they tried their first cigarette? • Did the.people interviewed enjoy their first cigarette? • How much did they smoke at first? • How much do they smoke now? • How much do they spend on cigarettes each month? How much do they spend on cigar- ettes each year? 4

• Hadthe person you interviewed tried to quit? • Why do people who smoke want to quit? • Why can't smokers quit? Highlight the fact that people who smoke often get hooked on cigarettes and that almost every- one who smokes has tried to quit but most can- not. Ask the students how this fact relates to addiction and loss of personal control. The following points should be made follow- ing the discussion of the interviews: • Getting addicted is a process; • Anybody can get hooked on cigarettes--all you have to do is smoke them; • Although you won't get hooked by smoking one cigarette, you start the addiction process with your very first cigarette; • Once you're hooked, you lose power to con- trol yourself: the cigarette is in control once you are hooked; • It is very difficult to get unhooked because cigarette addiction is very powerful; • Once you're hooked--even if you get un- hooked-you are never quite the same beo cause of the tar that's stuck in your lungs and the lingering effects of being hooked; and, • Nearly everyone who has gotten hooked on cigarettes has tried to quit. What does this tell you about smoking cigarettes? 3. Introducing the Smoking Machine Demonstration. Explain that today the students will begin to find out for themselves what is in cigarette smoke. Ask the students to watch very carefully. 4. Assembling the Smoking Machine. As you perform the following steps, explain to the class what you are doing. See Figure I for assistance. a. Remove the top of the squeeze bottle. b. Take the two cotton balls and have several students examine them closely. Have them describe the cotton balls' properties, especially color and texture (softness). 1 Squeeze Bottle T~pe Cotton Ball & Paper Clip Cigarette (Remove base if possible) ~oft Drink Bottle Inside View of Nozzle Clip Cotton FIGURE 1 5

c. Ask the class to select one of the cotton balls for the demonstration. Insert it in the lid of the squeeze bottle and secure it with the paper clip. (Note: when taping the paper clip to the underside of the lid, be careful not to cover the hole with the tape._) d. Insert and tape a cigarette to the nozzle. e. Screw the lid onto the squeeze bottle. L Light the cigarette. (Note: several soft squeeze of the bottle will be necessary to light the cigarette). g. Carefully insert the cigarette into the soft- drink bottle. (Note: the plastic will melt if touched by the burning end of the cigarette. h. Tape the bottles together securely. 5. The Demonstration, Part One. "Smoke" the cigarette by squeezing the smal- ler bottle. As the larger bottle fills with smoke, explain that it is about the size of an adult human lung. Continue until the cigarette has burnt down close to the filter. Explain the following points during this part of the demonstration: • Cigarette smoke has many things in it; ask the class if the three most important substances can be named. • The smoke has tar, carbon monoxide, and nicotine in it. • Ask if anyone knows where carbon monoxide can be found; explain that the exhaust from cars and busses has carbon monoxide in it. Ask how many of the students like to stand directly behind a bus as it pulls away from the curb and take a deep breath of the exhaust. Explain that carbon monoxide is a poison: it can kill people. • Explain that nicotine is in cigarette smoke and it also is a poison. As a matter of fact, nicotine was once used by farmers as a pesticide. But it was too strong: people got sick from eating the food sprayed with nicotine. It was barred by the U.S. Govern- ment. Explain that if two cigarettes are broken into ajar of water, the nicotine would dissolve in the water and make it a poison! (See Additional Activities) 6. The Demonstration, Part Two. Carefully dismantle the machine. Losing as little smoke as possible, quickly screw the cap on the large bottle and stand it upright. Using the tweezer, remove the cotton ball and place it on the clean piece of paper with the"unsmoked" cotton ball. Allow the students to inspect the two balls closely. Ask them to compare the appearance of the "smoked" and clean cotton balls. Ask the class what they think is on the smoked cotton ball. When tar is mentioned, ask what this implies about the effectiveness of the cigarette filter. Ask the class where the substance on the cotton would have gone if someone had actually smoked the cigarette (mouth, throat, and lungs). Ask the class about the smoke that leaves the burning end of the cigarette without going through the filter--the smoke that others near the cigarette breathe. Emphasize that cigarette tar is very similar to the tar on roofs: both are dark, sticky and gooey and neither will wash off your fingers easily. Because we can't wash our lungs, once tar gets in them it will stay there for a very long time/Make clear that tar begins to build up in the lungs the first time a cigarette is smoked. 7. The Demonstration, Part Three. Return the students' attention to the smoke- filled bottle. Remind the class that the bottle is roughly the size of an adult human lung. Ask what we can expect smoking to do to a human lung. Remove the cap and allow the students to smell the contents of the bottle. Ask how smoking can affect someone's breath. 8. Summing Up. Review the general findings of the Smoking Machine Demonstration. Be certain to empha- size the following: 1. Even though we can't feel them, cigarette smoke contains many tiny particles; 2. Tar is one of the particles in cigarette smoke; 3. The tar in cigarettes is very much like the tar on roofs: it is dark, sticky and gooey; 4. Cigarette filters do not catch all of the tar in cigarette smoke;

5. Anybody who smokes gets tar in their lungs; 6. When it gets in the lungs, tar coats the surface of the lung and cuts down its ability to absorb oxygen into the bloodstream, thus making it hard to breathe; 7. Tar will stay in a human lung for a very long time because tar is sticky and we never wash our lungs; 8. Tar begins to build up in the lungs with the first cigarette; 9. Smoking gives people bad breath. 9. A Puzzle. Explain to the class that recent studies of people who have had heart attacks have shown that smokers have a 40% greater chance of dying during the attack. Ask why this might be so. Highlight those ideas that link cigarette tar clogging the lungs to the increased death rate. Explain that as tar coats the lung surface, the absorption of oxygen into the bloodstream becomes more difficult. During a heart attack, blood flow to the brain is reduced. If the brain does not get enough oxygen, death results. 10. Cigarette Ad Collection. Remind the students to continue collecting cigarette ads from newspapers and magazines and to tape them to the "Death in the West" Is Coming! Chart. SUMMARY • You introduce and begin the scientific exploration of cigarettesl • The students present their findings from the adult smokers they interviewed. • You do the Smoking Machine Demonstra- tion. • You discuss the poisonous nature of carbon monoxide and nicotine. • You discuss the demonstration, emphasizing the nature of tar and its effects on the lungs. _ • You challenge the class with a puzzle con--~-: cerning a recent finding about what happens - to smokers who have heart attacks. ADDITIONAL ACTIVITIES 1. The Smoking Machine apparatus can be used by interested students to compare: • filter vs~ non-filter cigarettes • "low" tar vs. regular cigarettes • menthol vs. unflavored cigarettes 2. What things make up a cigarette? What chemicals are added to tobacco? What is cig- arette paper made of? How are the filters constructed? What is menthol and why is it added to cigarettes? Interested students might research these questions. A good initial source is the World Book Encyclopedia. Have the students print their findings on large pieces of butcher paper and hang them in the class. Oral reports to the class are also suggested. 3. Poisonous Water can be made by breaking cigarettes into a small jar of water (a may- onnaise jar is ideal). After the cigarettes are in the water, put the top on securely and shake the jar. As the tobacco dissolves, the water will begin to change color. The brownish tint is a result of the tobacco and the coloring added to the tobacco. During this time, the nicotine in the tobacco will also dissolve in the water, making the contents poisonous. Warn the class that under no circumstances can anyone play or joke with this jar or the water because someone could get hurt seriously. Explain that nicotine is a poison and poisons kill people. Label the jar and let it sit overnight. The next day, allow students to smell the water. If a demonstration of the poisonous water is desired, place a small amount of the water on ants or other small bugs. The ants will not drown, they will be kined by the nicotine.

DAY 3: FACTS ABOUT CIGARETTES (Estimated time required: 30 minutes) PURPOSE This activity is intended to teach: 1. Twelve important facts about the physio- logical effects of cigarette smoking; 2. That cigarette makers might not want people to know these facts about smoking. MATERIALS Facts About Cigarettes Materials: playing board (or substitute) 24 3" x 5" cards 24 paper clips Statement and Answer Cards (to be cut out of this booklet) Answer Key GETTING READY 1. Making the Playing Board for Facts About Cigarettes. Before this activity, the Playing Board for Facts must be prepared. Facts is modeled after the popular game of "Concentration." The large Playing Board can be made by using a large piece of cardboard, posterboard, or other sturdy material. Tape only the top edge of 24 3" x 5" cards to the board in four rows of six cards. (Note: the cards must be able to be turned up.) Draw a dark line down the middle of the board and label the left side "Statements" and the right side "Answers." Starting at the top, left-hand side, number the cards from I to 24 in bold print. See the illustration for guidance. Cut out the 12 Statement and 12 Answer cards along the dividing lines (on pages 21, 23 and 25. To prepare the board for play, clip the State- ments and the Answers randomly to the numbered cards on the appropriate side of the board. Clip them so that when the card is turned up, the words can be read. The blackboard may also be used as the play- ing surface. Tape the numbered 3" x 5" cards to. the board in the same configuration shown in the illustration. Draw the dividing line on the board. Write the headings "Statements" and "Answers" as shown in the illustration. Clip the 12 Statement and 12 Answer cards to the numbered cards as described earlier. THE ACTIVITY 1. Introducing Facts About Cigarettes. Explain that there are many things about cigarettes and cigarette smoke that have been discovered in the last few years that very few people know. Ask what might happen to ciga- rette sales if everyone knew a lot more about the health effects of cigarettes. Highlight those ideas that suggest that cigarette sales might go down if people had more information about cigarettes. Ask if the makers of cigarettes want us to know a lot about cigarettes. Emphasize those ideas that suggest that cigarette makers probably do not want people to know the facts about cigarettes and may even be keeping infor- mation from us about the dangers of smoking. Explain that today the students will learn some important facts about smoking that cigarette makers would probably not want them to know. FACTS ABOUT CIGARETTFS! Statements Answers