Talking Tobacco

When giving a classroom presentation on smoking, appeal to your young audience’s interests with real stories from your patients’ point of view. Props and graphic images also help drive home your message.

Cheryl L. Horn, AS, RRT

Your first instinct after being asked to give a talk on tobacco to a health class may be to compile a long list of smoking-related diseases and the latest statistics on deaths from emphysema. Students will appreciate it since they likely have had a long day and need a little mid-afternoon nap. This is not, however, why a teacher asks you into the classroom. Instead, I suggest that you gather all of the wisdom you have accumulated in your experience in respiratory care and share stories. Help these children imagine the suffering and emotions that we see every day.

Respiratory therapists are uniquely gifted to educate about tobacco and I encourage more practitioners to get involved. It is also a great way to let people know that, despite what they see on ER, there are health care professions available to them besides becoming a doctor or a nurse.

I have spoken to students about tobacco for 8 years, last year reaching more than 1,500 seventh through twelfth graders. Students filled out a short survey in the last few minutes of each session, and a follow-up survey about 1 month later; 25% of them reported that they were smokers, and 25% reported that 1 month later they had quit. By observing the reactions of the students whom I talk to, I am a little less boring, and fewer of my students are attending their next class unexpectedly refreshed.

Establish Credibility
The first task is to convince students that you are not exaggerating or just out to scare them. I start by letting them know that since medicine relies on science, I do not believe everything a salesman tells me when a new inhaler comes on the market. I ask for proof that what they tell me is true, and I do the same when I am going to tell them what tobacco does to the body. Besides what I see every day in the hospital, I let them know that I also read studies about the harmful effects of tobacco. An example is the study that tells me that a tobacco user has a 2.8 times higher risk of getting cancer of the penis. Then, to quell any suspicion that I am making things up, I put the study on an overhead. This also lets the student who dreaded hearing another talk on tobacco know that there is always something new to learn. I suggest discussing the body parts that matter to them. I do not discuss heart attacks. That is something that old people get when they are ready to die anyway. However, I do discuss tongue cancer, tracheotomies, breast cancer, impotence, and the way bladder cancer is diagnosed.

Tell a Story
Through the eyes of my patients, I describe the experience of learning how to live with a hole in their throat, suction their trachea, clean their tubing, and spend their waking hours contemplating mucus. I am answering such arguments as “I smoke because I’m bored.” Tracheostomy patients have plenty to keep them busy, but it is not how most teenagers would like to spend their time.

Another common argument is “I’m going to die anyway, so what difference does it make?” The impression teenagers get from television is that they will either fall over dead when they are very old or give an emotional speech to admiring family and friends before quietly slipping off into a nice sleep. Few teenagers have seen air hunger or watched a chronic obstructive pulmonary disease patient suffer for years using accessory muscles to pull in air—muscles that were never meant to be used for breathing. As you make the case that dying from lung cancer or emphysema is not pleasant or quick, you also can counter the argument that smoking is a great way to spend hours socializing with friends. I ask students how many of my patients they see out in public, making the case that smoking eventually isolates people. Patients end up unable to leave their homes and are bored and lonely. And no one wants to hang around and watch someone struggle to breathe during the last hours of dying from emphysema. Their smoking buddies will be long gone.

Patients express fears and regrets, so pass them on. I will never forget a woman who told me that if she knew how awful it would be to feel short of breath every day, she would have never picked up her first cigarette. I offered to take her message to my next group of students. She appreciated the opportunity to make a difference in the lives of young people and told me that at least she felt her suffering would serve a purpose. She wanted the boys to know how hungry she was for a hot dog, but that she could not eat one because all of her energy went into breathing. She wanted girls to know that smokers cough and eventually may wet their pants each time. She wanted them to imagine the humiliation of having to wear a diaper.

When talking to teenagers, focus some attention on tobacco’s effect on looks. I asked teen smokers in my cessation groups why they wanted to quit. The number one reason was health. New smokers feel the effect of vasoconstriction as their hands get cold as they smoke. You will be speaking to students that began smoking in the fourth or fifth grade. By the time they are in high school, they may have smoked for more than half of their lives, and be experiencing shortness of breath, coughing, and decreased stamina. The DNA damage from smoking begins immediately. They need to know that there is no time to lose when it comes to quitting, because some consequences are irreversible.

Ask for Evaluations
The first time I asked students to evaluate me, I told them that I needed their help to know how I was doing. I could spot the students taking speech classes; they commented on my use of props and pictures and told me which stories touched them the most. They love disgusting pictures and, even better, snippets of graphic videos. I used to think that maybe kids from Toledo were weird, but after watching CSI, I realized that their behavior is normal.

They also told me what they did not like. Students who do not smoke are tired of wasting their time hearing about those who do. Now I acknowledge nonsmoking students at the beginning and ask them to pass on the information that I give them to help other people quit. I also let them know that I will be asking them what happened on the next survey. Postsurveys have taught me that while teens can pressure others to smoke, they also can use peer pressure to get smokers to quit, and they do. Last year, 51% of the students said they used the information to help someone else.

You probably have a hundred stories about the suffering tobacco has caused for those you care for. Put your students in the shoes of those people. They will respond. It may be the most gratifying work you have ever done.

Cheryl L. Horn, AS, RRT, is a respiratory therapist in pulmonary rehabilitation at The Toledo Hospital, Ohio.