Academic journal article American Journal of Health Education

The Smoking Milkshake

Academic journal article American Journal of Health Education

The Smoking Milkshake

Article excerpt


Objectives: This teaching idea is designed for students to learn about the ingredients in cigarettes and the potential short-term health consequences of these ingredients, as well as to learn about the general effects of smoking. Students will complete an activity to use this information in a hypothetical, but potentially, real-world situation. Target Audience: Middle school students.


In the United States from 1997-2001, cigarette smoking was estimated as responsible for over 400,000 annual deaths. (1) Because most adults begin their smoking habits while in adolescence, (2) it seems clear that tobacco use prevention and refusal strategies should be taught to students prior to entering high school. The U.S. Department of Health and Human Services made a primary goal in its Healthy People 2010 strategy to reduce smoking among adolescents to less than 16%. (3) The 2005 survey statistics from the Healthy People 2010 database indicate that approximately 23% of adolescents in grades 9-12 smoked cigarettes within the previous month. (4) Whereas this percentage represents a considerable decrease from the estimated 35% of the 1999 baseline measure of adolescent smoking, it is a slight increase from the 22% reported in 2004. (4) Although there does appear to be an overall downward trend in adolescent smoking prevalence, the lack of further improvement between 2004-05 indicates that reaching the Healthy People 2010 goal of 16% by 2010 could be a significant challenge.

In the United States, some type of tobacco prevention program is included in approximately 97% of schools. (5) Although it seems likely that teachers played a role in reducing the percentage of adolescent smokers in those programs, results from research conducted by the American Legacy Foundation indicated that fewer than one-third of U.S. schools utilize a multi-strategy prevention program. (5) The American Legacy Foundation reports that schools who incorporate a multi-strategy approach have a lower level of smoking prevalence among their students. (5) A multi-strategy tobacco prevention approach consists of using at least three of the four following components: (1) learning about the short-term health consequences of smoking, (2) correcting misperceptions, (3) identifying and discussing social influences, and (4) learning refusal skills. (5) The following lesson can be used as a part of a multi-strategy approach to address the first two multi-strategy components. This lesson also can be used to assist students in using and developing their critical thinking skills through candid conversations regarding the ingredients of cigarettes and the possible related consequences of these ingredients, as well as to learn about the general effects of smoking.


At the end of this teaching strategy, students should be able to:

1) Identify hazardous cigarette ingredients and apply that information to short-term health consequences that these ingredients and the general effects of smoking have on the body.

2) Assess a potential real-world situation (involving a friend's suggestion to try a cigarette) and develop a personal statement about the way this situation could be managed in a positive and effective manner using information learned in this lesson.


This activity is designed for middle school students. It is a strategy best used in a health or drug-related course.


* Empty cigarette pack (or image of one)

* Teacher Resources (Figure 1)

* Cigarette Ingredients Labeling Worksheet (Figure 2)

Figure 1. Teacher Resources

Why cigarettes don't have an ingredients label:

Because cigarettes are not considered a food, they are exempt from
having to comply with federal regulations requiring the ingredients
and nutrition labels with which people are familiar on the foods
they buy Cigarette packages have been required to carry the Surgeon
General's warning since the passage of the Public Health Cigarette
Smoking Act in 1970. … 
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