Spit It Out Running head: Spit It Out

American Cancer Society Smokeless Tobacco Campaign: Spit It Out Cydney Cooper, Alexandra Fenwick, Meg Gillies, Liz Jordan, Ally Staszesky The Pennsylvania State University

Spit It Out 2 American Cancer Society Smokeless Tobacco Campaign: Spit It Out Executive Summary The American Cancer Society wants to better address the issue of smokeless tobacco use in youth and teenagers. The most effective way to target youth about this topic is through the school district in a previously established learning environment. To enforce this, a 10-week curriculum was created or the target audience ages 13-16. Primary research proved there is not enough focus on smokeless tobacco use in comparison to cigarettes and alcohol use. To better assess the needs and objectives for the curriculum a survey was created and distributed to the State College High School 9th grade health class. The 31 responses are a small-scale example of how students lack knowledge of what smokeless tobacco is and the dangers of using smokeless tobacco. The research and survey conducted led us to these five objectives: teach students about smokeless tobacco and raise awareness of these students enrolled in the curriculum by 10 percent; educate students with the knowledge necessary to combat peer pressure from their friends who use smokeless tobacco; to increase the number of students who believe smokeless tobacco is dangerous even when you try it once by 15 percent; at increasing the amount of parents who teach their children about the dangers of smokeless tobacco, in addition to smoking and alcohol; and promote the American Cancer Society and their involvement in actively reducing the use of smokeless tobacco. The combination of behavioral, informational and attitudinal objectives will lead the campaign to a successful outcome. Keeping these objectives in mind our key publics to target are (1) students, (2) teachers, and (3) parents. In targeting these three specific groups the most effective messages tactics can be employed. The main messages to be stressed throughout the campaign are that smokeless

Spit It Out 3 tobacco is not a safe substitute for smoking cigarettes. In addition, smokeless tobacco is dangerous even after just one use. To disseminate these messages and gain publicity for the American Cancer Society as well as the 10-week curriculum twitter will be utilized. In addition, a kick off event will start the program creating the opportunity for press and media placements. The speaker who is apart of the program (week 6) will also create an opportunity for media coverage. The schedule of the curriculum is easy to follow because it is laid out and planned to last a specified time, 10 weeks. This will make it easier to teach for educators and easier for students to stay involved. The budget for the entire campaign remains relatively low, under five thousand dollars. We will work with many local venues, as well as loyal partners to help sponsor the Spit It Out Campaign to get that number down. Our main expenses include printing and event planning. We plan to distribute around one thousand brochures and newsletters. As well as plan a kick off carnival at the hosting school to begin the campaign, as well as create a concluding ceremony at the end. To evaluate the success of the overall campaign we will conduct a post-survey to evaluate how much the students learned. We will also hold one focus group for parents and teachers and one focus group for students to determine whether we achieved our objectives. Research After collecting our drop-off surveys and carefully analyzing them, we are confident that despite the low number of responses (31) that we received, they were still a strong enough representation of our target audience and that the results would be useful and applicable. Ideally, we would have liked to get 50-75 responses, however, we learned very quickly that asking teachers to add another component into their lesson plan was easier said than done. However, we

Spit It Out 4 were more satisfied with 31 responses from the Centre Country Region rather than having to reach out to other students in varying counties. After all of our research was conducted we are still confident that a survey questionnaire was the most useful research method for our campaign. Often times when asking youth about drug abuse or illegal actions, they give false responses with the fear that they will get in trouble. This is why we felt that one-on-one interviews would have been inefficient and the results ineffective. With anonymous drop-off surveys we felt that students would be honest with their responses knowing that they could not get into any kind of legal trouble. All in all, we are pleased with how our research went and feel that we have developed a strong curriculum based off of our results. Objectives The first and most important objective of the smokeless tobacco curriculum is to teach students about smokeless tobacco and raise awareness of these students enrolled in the curriculum by 10 percent. This informational objective is key to the campaign because research collected from our survey proved that 73% (24 of 31) of students polled had little to no knowledge of smokeless tobacco and only 5% (2 of 31) were fully aware of the drug and its health effects. The next and second informational objective is to educate students with the knowledge necessary to combat peer pressure from their friends who use smokeless tobacco. A majority of students surveyed, 55 percent, said they know of friends who use or have tried smokeless tobacco. The amount is so overwhelming that to keep more adolescents away from smokeless tobacco an aggressive stance towards equipping youth with tools to combat peer pressure needs to be put into action.

Spit It Out 5 The third objective is to increase the number of students who believe smokeless tobacco is dangerous even when you try it once by 15 percent. A majority of students said that smokeless tobacco is dangerous but not when you try it just once, but research has proven otherwise. Smokeless tobacco is just as addictive as cigarettes and smoking once can lead to lifelong habits of use. I will be vital to the success of the campaign to change the attitudes of students and make them realize the dangerous of smokeless tobacco and its addictive nature. Parents are also a target of the smokeless tobacco curriculum and campaign and this fourth objective is aimed at increasing the amount of parents who teach their children about the dangers of smokeless tobacco, in addition to smoking and alcohol. Research provided from Center County High Schools proved that while parents talk to their children about issues such as smoking cigarettes and drinking alcohol they neglect to teach them about smokeless tobacco. This could be due to a generational gap and the evolving industry and market of smokeless tobacco. Big tobacco companies are now marketing specifically to teenagers, something not many adults are aware of. The campaign aims to educate parents to change their behavior and motivate them to speak more to their children about these issues. Finally, the last objective is to promote the American Cancer Society and their involvement in actively reducing the use of smokeless tobacco. The American Cancer Society deserves credit and recognition for tackling tough issues and bettering the health our nation. The more media exposure the American Cancer Society can gain through non-profit programs such as these can potentially help the overall image, sponsorship and funding for the society.

Key Publics After distributing and analyzing the data, the key publics that will be targeted are middle school children, their teachers and their parents. The first and most important key public is the

Spit It Out 6 children attending middle school. By targeting this group, they will become educated and aware at a younger age. This way we work on prevention. The children are young and still impressionable whose minds will be easier to change then someone who is rooted in their habits. The second group of people that are being targeted are middle school teachers. The middle school teachers are the people that the students spend most of their time with during the day. They can have a serious impact on the children that they teach and can help curve bad health choices. The last key public is the childrens parents. Their parents are one of the biggest influences in their lives and can explain to them on a personal level why they should steer away from harmful choices. If their parents are educated and talk to their kids about smokeless tobacco they should be less likely to use it. Strategies/Messages Through the research, we found that the main issue that needed to be addressed was the students lack of knowledge about the dangers of smokeless tobacco. Out of 31 respondents to the survey, only five stated that their knowledge on smokeless tobacco was a nine or ten. Therefore, our goal is to dramatically increase this number. The primary goal of the Spit it Out Campaign is to increase the number of Center County students ages 13-16 who know about the dangers of smokeless tobacco from 13 percent to 40 percent at the end of the 10-week curriculum. In order to achieve this goal, as well as our five objectives we want to create the message that smokeless tobacco is not a safe substitute for cigarette smoke and is dangerous even after one use. In addition, we want those parents that come in contact with our campaign to remember to talk about smokeless tobacco with their children in the same ways the talk about alcohol and drugs.

Spit It Out Our strategy for presenting this messages is the creation of the Spit it Out campaign. This campaign is a 10-week long curriculum in which the educator takes an hour our of their lesson plan every week in order to provide the students with the information they need to make the right choice when it comes to smokeless tobacco- spitting it out. Each week will focus on a different topic, as well the information will be presented in a

different media. The first week will an introduction and a kick off event. The hosting school will open up their gymnasium, or even parking lot if it is nice outside to have a mini carnival getting the students excited for the next 10 weeks. Local venues will sponsor some food, as well as have other health organizations, especially the American Cancer Society have a booth giving out information. The second week, and first real lesson in the classroom will consist of an overview of smokeless tobacco. The demographics of those that use smokeless tobacco the most, as well as outlining what exactly it is. Through the research, when students were given the opportunity to fill in what they believe smokeless tobacco is, most only replied chewing. However, there are many other types in which this lesson hopes to relay to the target audience. The third week, will go in to detail the hidden dangers of smokeless tobacco. It will entitled SmokeLESS does not equal CancerLESS. The educator will provide statistics, provided by the American Cancer Society, as well as graphic pictures detailing the harmful effects of smokeless tobacco. The fourth week will be a 20-minute movie entitled Smokeless Tobacco. The movie is a documentary that contains testimonies of individuals that have been negatively effected by smokeless tobacco. Students will then be given the rest of the class period to reflect on the movie by answering some open-ended questions.

Spit It Out 8 The half-way point at five weeks will focus on one of the newest developments in the smokeless tobacco field, marketing. The marketing and packaging of the smokeless tobacco is becoming increasingly more focused on children. The packaging of the products are often full of color and containing cartoon figures. They are also shaped like many mints and candies that are popular with the younger demographic. This lesson will hopefully educate the students to look out for these tactics and to always remember to spit it out. The sixth week we will contact a speaker that has been negatively effected by smokeless tobacco. The person will spend the first half of the class telling his or her story. Then the second half will be spent as a question and answer period. The seventh week will feature a lesson on all of the different types of smokeless tobacco. Though it was addressed in the overview, this week will spend a large amount of time going through the dangers of each. The educator will be given samples of each to show the students, and alarm them to stay away from them. The eighth week will feature lessons on how to stay away from smokeless tobacco even when your friends offer it to you. Not one out of the 31 respondents admitted to every using smokeless tobacco, however 55 percent of the same students sais that their friends so. Therefore, this lesson will engage students on ways to say no. The ninth week will be a reflection lesson. The teacher will spend most of the period answering any question that the students may still have, as well as provide them an opportunity to talk about what they like and didnt like about the course. This week a post-survey will be administrated to see the progress of the students, as well as evaluate whether or not the goal was achieved.

Spit It Out 9 The final week will be a concluding ceremony within the classroom, in which parents will be invited to join. There will be three speakers at the event: a student, the teacher, and a representative of the American Cancer Society. Students will then be asked to sign a pledge that states they will never use smokeless tobacco. Finally, they will receive a certificate stating their completion of the program. Tactics Launch a twitter for middle school and high school aged. The page will include daily facts about tobacco use, links to the American Cancer Society website and links to websites of other antitobacco groups. Twitter will also be utilized to promote the Smokeless Tobacco: Spit It Out curriculum kickoff event which will take place at the beginning of the semester prior to implementation in the host school. Rationale: The consensus approach will be utilized. When more students follow and interact with the Smokeless Tobacco: Spit It Out curriculum twitter page, the more popular the page will become as well as the websites of other groups such as The American Cancer Society. Tools: Social media, Twitter, Twitter networking

Launch a kickoff event for middle school and high school aged students at the host school prior to the implementation of the curriculum. The event will take place at the host school and will include food, educational games and booths for students to learn more about the dangers of tobacco use. The event will also introduce the curriculum and give students a glimpse into some of the lessons and activities they will be engaging in during the next 10 weeks.

Spit It Out 10 Rationale: The principle of commitment under Ciadinis ethical influence will be used to influence students to get enthusiastic about and commit to engaging in the Smokeless Tobacco: Spit It Out curriculum. Tools: Special event

Establish a 10-week curriculum educating students from the ages of 13-16 on the dangers of smokeless tobacco. Each week will feature a different lesson, presented to the educator bound along with an activity book. The weeks will also features different mediums to keep the children engaged. Rationale: Under Maslows Hierarchy of Needs, Safety needs is very important. Educating children about the dangers of smokeless tobacco will force them to realize all of the data and scientific evidence that states it is detrimental to their health. We have also chosen to present the information through the school because our primary research found that only 39 percent of parents talk about it with their children. Tools: Curriculum, Activity Book Schedule The schedule will be based on a 10-week curriculum with no exact dates, to give the administrations and educators flexibility on when they want to implement their program. One unpaid, press release detailing the kickoff event and new curriculum in The Centre Daily Times. The press release will also be distributed to local radio stations Froggy 101 and B94.5. Week 1: Draft and distribute press release, The Centre Daily Times Draft and distribute press release, Froggy 101 radio station Draft and distribute press release, B94.5 radio station Distribute curriculum, host school Draft and distribute flyers and brochure to host school for flyering around the facility and community

Spit It Out 11 Week 2: Teacher preparation curriculum preparation time Draft and distribute parent newsletter to host school Week 3: (Week 1 of Curriculum) Introduction Week, host school Kickoff event, host school Week 4: (Week 2 of Curriculum) Smokeless Tobacco Overview lesson, host school Week 5: (Week 3 of Curriculum) SmokeLESS does not equal CancerLESS lesson, host school Week 6: (Week 4 of Curriculum) Movie Day, host school Week 7: (Week 5 of Curriculum) Marketing of Smokeless Tobacco Week 8: (Week 6 of Curriculum) Guest Speaker presentation, host school Week 9: (Week 7 of Curriculum) Types of Smokeless Tobacco, host school Week 10: (Week 8 of Curriculum) How to Avoid Peer Pressure, host school Week 11: (Week 9 of Curriculum) Friends Dont Let Friends Use Smokeless Tobacco, host school Week 12: (Week 10 of Curriculum) Concluding Ceremony and Pledge Sign, host school Budget For this campaign, a large budget is not needed. Through totaling all of the expenses, the total was $3229.50. That total may even decrease with the possibility of attaining local sponsors. The root of the campaign is the curriculum that will be distributed to teachers in their schools. The main expense is to have the curriculums printed and worksheets/quizzes to be distributed to the students. The curriculums would also need to be bound for easy use for the teachers. This

Spit It Out 12 could be accomplished with a budget of $1,500 when being printed at Kinkos. Another main expense of the campaign is the kick-off and concluding events that bookend the 10-week curriculum. Advertising Center Daily Times Free Distribute news releases, fact sheets, and pitch feature stories of the campaign implementation, as well as the kick-off event Froggy 101 Radio Free Release PSA containing the information about the curriculum by the American Cancer Society, as well as the kick-off and concluding events. B94.5 Radio Free Release PSA containing the information about the curriculum by the American Cancer Society, as well as the kick-off and concluding events. School Newsletter Free Distribute the details of the curriculum to the parents at home, informing them of the program that their children will be going through. Printing Brochures $787.50 750 color copy, double-sided, standard sized, tri-fold brochures printed by Kinkos at $1.05 each. Curriculum $1,500 500 bound curriculums on white, standard size paper at Kinkos for $3.00 each.

Spit It Out 13 Flyers $500 1,000 color copy, single-sided flyers to be printed on white, standard size paper by Kinkos at $0.50 each. Fact Sheets, Press Releases, Feature Stories, and PSAs $100 1,000 single-sided fact sheets, press releases, feature stories and PSAs printed on white, standard size paper by Kinkos at $0.10 each. Events Kick-Off Spit it Out Free The American Cancer Society will work closely with their sponsors, as well as provide other opportunities to raise money for the event, and get some food donated. Concluding Ceremony $100-200 Light refreshments will be provided, as well as printing for the Pledge and Certificate of Graduation from the Program will have to be factored in. Postage Distribution of Brochures, Flyers, Newsletters $242 Non-for-Profit Organizations receive postage at a discounted rate. When entering information in the Business Price Calculator, the American Cancer Society can send 1000 pieces of mail of 3.5 ounces or less at the discounted rate of $0.24 per piece. Evaluation

Spit It Out 14 The campaign will be evaluated during following the 10-week campaign. In order to successfully gauge the success of the campaign, the individual objectives will be measured based on their type: information, attitudinal and behavioral. The following informational objectives will be evaluated: Teach students about smokeless tobacco and raise awareness of students enrolled in the curriculum by 10 percent. Educate students with the knowledge necessary to combat peer pressure Promote the American Cancer Society and their involvement in actively reducing the use of smokeless tobacco The informational objectives will be measured by comparing the pre-campaign and postcampaign surveys. These surveys will remain identical to measure the students knowledge on the dangers of smokeless tobacco, as well as the effectiveness of the campaign curriculum. Particular attention will be paid to questions gauging students individual knowledge on the dangers of smokeless tobacco to measure whether any change has occurred. Results from both of these surveys will be analyzed in association with one another to calculate the progress. The following attitudinal objectives will be evaluated: Increase the number of students who believe smokeless tobacco is dangerous even when you try it once by 15% The attitudinal objectives will be measured through similar tactics as the informational objectives. Once again, it is important to look at the pre-campaign and post-campaign survey, paying particular attention to the questions in which students were asked to gauge how dangerous smokeless tobacco is, even if they only try it once. To better understand the supposed attitude changes it is important to create a focus group of students once they complete the

Spit It Out 15 curriculum to allow them a forum to voice individual attitude changes that may not be able to be measured by a survey. The following behavioral objectives will be evaluated: Increase the amount of parents who teach their children about the dangers of smokeless tobacco, in addition to smoking and alcohol. The behavioral objectives will be evaluated by obtaining data from the percentage of State College high school that use smokeless tobacco, divided by demographics, and comparing them to the numbers before the campaign occurred. It is also important to have one-on-one sessions with students after the campaign, as well as focus groups. We will also hold a meeting and conference with parents to evaluate their perceptions on the program, as well as use this as another venue to persuade them to talk to their children. The final evaluation method will to collect and tally all media placements for the American Cancer Society in relation to Spit it Out campaign. It is important to determine how many impressions the Spit It Out campaign collected and look at the coverage as either positive or negative. This will help the program improve from year to year, if the American Cancer Society should want to continue it. Conclusion The American Cancer Society has provided assistance, information, and research for those persons and families that face cancer for almost 100 years. In their tenure, they have established many programs to provide patient services for those that have cancer, as well as implement information so that other can help prevent it. Locally, the American Cancer Society, the Centre Unit has aimed to provide middle school and high-school students with the knowledge on the dangers of smokeless tobacco.

Spit It Out 16 Primary research results indicate that need for the American Cancer Society to raise awareness about the dangers of smokeless tobacco to both the students of State College High School, as well as the need for their parents. The goal of the Smokeless Tobacco Campaign is to teach students about smokeless tobacco and the dangers it can cause on their health, as well as providing information to both parents and educators to be the intervening audience. These goals will be achieved through the creation of a curriculum to be implemented in the school district over a 10-week span taught by an educator to the target audience of Center County middle school and high school students. The curriculum was individually designed according to the results from a survey distributed to State College High School. An emphasis will also be focused on parents to educate their children on the dangers of smokeless tobacco, just as most do for drugs and alcohol. Guided by a background analysis on the American Cancer Society, nationally and locally, research on the target audience, as well as research on smokeless tobacco, the campaign is composed on objectives, strategies and messages, tactics, a budget and an evaluation. All of these aspects of the campaign were centered on the goal of educating the targeted audience.

Spit It Out 17 Appendix

Fact Sheets for Educators

Fact Sheet For Educators: What is Smokeless Tobacco? The two main types of smokeless tobacco in the United States are chewing and snuff. Chewing tobacco comes in the form of loose leaf, plug or twist. While, snuff is finely grinded tobacco that can be dry, moist or in tea-like pouches, known as sachets. Snuff is usually absorbed into the bloodstream through sniffing or inhaling directly into the nose. Smokeless Tobacco is often known as spit or spitting tobacco because most users place the tobacco in their cheek or between their gum and cheek. They then suck on the tobacco and spit out all of the tobacco juices. High Risk Populations: High School o 8 percent of high school students are current smokeless tobacco users o Smokeless tobacco is more common among males at 13.6 percent than female high school students at 2.2 percent. Middle School o 3 percent of middle school students are current smokeless tobacco users o Smokeless tobacco is more common among males at 4 percent than female middle school students at 2 percent. Estimates by race/ethnicity: 10.2 white 5.1 Hispanic 1.7 African-American Chart of TypesChewing Tobacco: Form Loose Leaf

Plug

Description Cured tobacco strips typically sweetened and packaged in foil pouches. Cured tobacco leaves pressed together in a cake or plug form.

Use Pieces taken from pouch and placed between cheek and gums. Piece taken from pouch and placed between cheek and gums.

Market Share (2009) 22.2 %

.6%

Spit It Out 18 Twist (or roll) Cured tobacco leaves (often flavored) twisted together to resemble rope. Piece cut off from twist and placed between cheek and gums. .4%

Snuff Tobacco: Form Moist

Dry

Sachets

Description Cured and fermented tobacco processed into fine particles and often packaged in round cans. Fire-cured tobacco processed into a powder. Moist snuff packaged in ready-to-use pouches that resemble small tea bags.

Use Pinch or dip placed between cheek or lip and gums.

Market Share (2009) 75.3%

Pinch or powder is 1.4% taken orally or inhaled through nostrils. Sachet is placed Data unavailable. between cheek or teeth and gums.

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Fact Sheet for Educators Health Effects: Cancer Smokeless tobacco contains 28 cancer-causing agents. Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of oral cavity. Oral Health Smokeless tobacco is also strongly associated with luekoplakia- a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off. Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay. Smokeless tobacco can cause hairy tongue, as well. Reproductive Health Smokeless tobacco used during pregnancy increases the risk of premature birth, low birth weight, high blood pressure, swelling and fluid retention. Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells. Nicotine Addiction Smokeless tobacco use can lead to nicotine addiction and dependence. Adolescents who use smokeless tobacco are more likely to become cigarette smokers. Pictures To Show Class: