Hands Off Tobacco: A School-based Tobacco Control Programming for Deaf and Hard of Hearing Youth

“Hands Off Tobacco: A School-based Tobacco Control Programming for Deaf and Hard of Hearing Youth”

Barbara A. Berman, Ph.D.
Debra Guthmann, Ed.D.
Cynthia Sternfeld, Ed.S.

Abstract

The Tobacco Related Diseases Research Program (TRDRP) and the California Department of Education provided funding to the University of California at Los Angeles Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center and the California School for the Deaf, Fremont (CSD) to develop a tobacco prevention curriculum specifically tailored for Deaf students. Funding was also provided to develop a DVD that could be used in conjunction with the curriculum or separately. This article will describe risk factors related to tobacco use for deaf and hearing adolescents, as well as the key components included in the curriculum and DVD that was developed.

        Both deaf and hearing people are at risk for tobacco use. Today about one out of five adults in this country smokes cigarettes. Experimentation most often begins in the teen age years – nearly all first use begins before high school graduation -- and, because of the addictive properties of the nicotine in tobacco, rapidly moves on to regular smoking for many young people. Many tobacco users, including more than half of high school smokers, want to stop smoking. Some succeed. But many find that when they try to quit they fail. Only three out of one hundred high school smokers think they will be smoking in five years. But studies show that sixty out of one hundred will still be smoking seven to nine years later. Each day, more than 4,000 teens try their first cigarette and another 2,000 become regular, daily smokers. Despite the gains made in reducing tobacco use in this country, in 2005, Monitoring the Future, a national survey, reported that nearly a quarter (21.6%) of high school seniors had smoked in the prior month, and 12.2% were daily smokers.
        This use of tobacco has many profound health consequences at all ages, not only for those who smoke or use chewing tobacco, but for those who are exposed to second hand smoke, as well. It harms unborn babies, infants, children, adolescents and seniors. Among young people it is also linked to other high risk behaviors: teen smoking has been identified as a “gateway” drug when it comes to alcohol and illegal drugs. Over 400,000 deaths are linked to tobacco use, the single most preventable cause of mortality in the United States, and cigarette smoking is a growing plague worldwide.
        In light of the difficulties faced when it comes to cessation for many tobacco users, including young smokers, it is clear that prevention – not starting tobacco use in the first place – is the most effective tobacco control approach. But this is not easy to achieve. Children and teens are easy targets for the tobacco industry. They are heavily influenced by television, movies, advertising, and by what their friends do and say. They don't think much about the future. Parents and other adults who work with children can help by warning young people of the risks of smoking. They can also set a good example by not smoking themselves.
        But prevention is more complex than just sharing information about the dangers of smoking. Today, comprehensive tobacco prevention programs have many elements designed to decrease the appeal of tobacco use. Some reach all people, for example, higher taxes to increase the cost of cigarettes, or rules that make it difficult to smoke in public places. But, unfortunately, some aspects of our nation’s prevention efforts don’t reach everyone, and there are young people that have been left out.
        This is certainly the case when it comes to Deaf youth. Prevention materials and messages that reach hearing youngsters are often inaccessible for Deaf children and teenagers. Most anti-tobacco public service announcements and educational videos are not captioned or available in American Sign Language (ASL). There are also significant barriers to the delivery of anti-tobacco messages for all Deaf people – including Deaf youth -- in clinical setting. Until now, there have been no school-based educational programs specifically designed for Deaf young people. This is particularly troubling because Deaf young people experience some important gaps when it comes to knowing the health effects of tobacco use. Just as important, they often struggle with issues of social acceptance and self-esteem, experience communication barriers, and face difficulties related to school performance, that are particularly recognized as risk factors for tobacco use.
        With this in mind, the Tobacco Related Diseases Research Program (TRDRP) and the California Department of Education provided funding to the University of California at Los Angeles Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center and the California School for the Deaf, Fremont (CSD) to develop a tobacco prevention curriculum specifically tailored for Deaf students. Funding was also provided to develop a DVD that could be used in conjunction with the curriculum or separately.
        The curriculum, “Hands Off Tobacco!” takes into account what is known about effective school based tobacco prevention education. We know that programs need to be implemented at all grade levels but particularly by middle school and should continue throughout the high school years. Beginning in high school is too late. Guest speakers and special events can offer enrichment and enhance learning, but are not a substitute for repeated, intensive, focused classroom programming. The health consequences of tobacco use need to be included, but there needs to be a focus on life skills, on making good decisions, on recognizing and resisting peer pressure.
        When developing the curriculum, the need to take into account the language and cultural requirements of Deaf youth was kept in mind. The tobacco prevention curriculum that was developed features a social influences and resistance model approach, emphasizes simplicity and repetition, uses visual elements, graphic design, “hands-on” activities, and images of Deaf and hard of hearing youth, and draws on examples from the lives of these young people. The program can be used in residential schools for Deaf students as well as mainstream settings. There are lessons that can be delivered as part of a health or physical education curriculum, as a stand-alone program, or introduced through a variety of school subjects including math, science, or social studies.
        There are seven lessons at each grade level and the program features key elements that are repeated each subsequent year, introducing specific content as appropriate for children and teenagers as they get older. The elements of the curriculum include: the health effects of tobacco use; the addiction cycle; the influence of tobacco industry marketing; anti-tobacco efforts and social action; self-esteem and self-concept; the influence of friends and peers and decision making.
        The goal was to create a curriculum that was user-friendly for educators at various grade levels, and that could be easily adapted to the range of students in the class. To do this, lessons include vocabulary words, assignments, examples, suggestions for discussion, and clear content. Cover sheets are provided for each grade to give teachers an indication of materials they would likely want to have on hand. Worksheets and visual images are available on an accompanying CD for use in a PowerPoint presentation or for distribution. Homework assignments can be used as classroom activities. In the last year of the grant, funds were used to expand the curriculum to include material for use in among 5th and 6th grade students. Assessment of the program is still in progress but teachers who used the curriculum gave feedback that is very promising, indicating they thought the curriculum was appropriate to use with Deaf youth and that they found it to be very user friendly.
        Deaf educators are aware that many students learn best when materials are very visual. Recognized that there were no tobacco prevention DVDs or Videos geared specifically for Deaf youth, the decision was made at the California School for the Deaf Fremont to develop a DVD that featured Deaf students, and that could be used separately or as an educational tool along with the Hands off Tobacco curriculum. The DVD was completed using American Sign Language and is voiced and captioned. It consists of six different chapters, each focusing on a different aspect of tobacco prevention. An accompanying teacher’s guide was developed that has vocabulary from each chapter as well as a variety of activities and topics for class discussion. The DVD chapters include the following information: Chapter 1 - Everyone Has a Reason gives a number of statistics including when individuals first start smoking and how many young people smoke. Chapter 2 -The Truth about Smoking discusses the advertising used by tobacco companies to try and makes smoking appealing to youth. Chapter 3 - Worth the Price gives examples of ways young people can respond to the pressure to smoke or use tobacco. Chapter 4 - Self Esteem talks about the benefits of having good healthy, positive self esteem. Chapter 5 – Be True to Yourself gives a scenario of a teenager, who used smoking to try and look older, and the important lessons she learned. Chapter 6 – Deaf People and Smoking interviews six Deaf people who have been affected by smoking in some way.
        If you are interested in more information on this topic or are interested in receiving a copy of the curriculum or the DVD, contact Deb Guthmann at Dguthmann@aol.com or Barbara Berman at BBerman@ucla.edu.

References
Centers for Disease Control and Prevention (CDC). Healthy Youth. Available at: http://apps.nccd.cdc.gov/yrbss/CategoryQuestions.asp?Cat=2&desc=Tobacco%20Use. Accessed September 15, 2006.
Centers for Disease Control and Prevention (CDC). Preventing Tobacco Use Among Young People, A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 1994.
Centers for Disease Control and Prevention (CDC). You(th) and Tobacco. Available at: www.cdc.gov/tobacco/educational_materials/yuthfax1.htm#Parents. Accessed September 13, 2006.
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U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

Barbara A. Berman, Ph.D., is Adjunct Associate Professor, UCLA Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center. She has conducted cancer prevention and control research for over 20 years and has partnered with the Deaf community to address unmet cancer prevention and control needs, focusing on tobacco use among deaf and hard-of-hearing youth and, more recently, the need for breast cancer educational programming among deaf adults

Debra Guthmann, Ed.D., is the Director of Pupil Personnel Services at the California School for the Deaf, Fremont where she oversees all clinical services as well as admissions, IEP’s and due process issues. She is the founding Director of the Minnesota Chemical Dependency Program for Deaf and Hard of Hearing Individuals which is one of the first inpatient treatment programs for Deaf and Hard of Hearing Individuals in the country and has done trainings nationally and internationally on substance abuse and ethics.

Cynthia Sternfeld, Ed.S., is a Licensed Professional Counselor and has worked at the New Jersey’s Katzenbach School for the Deaf since 1985. She has developed multiple curricula for Deaf and hard of hearing students related to HIV, Substance Abuse and Independent Living. She also teaches a Drug Addiction course at The College of New Jersey and provides continuing education training to professionals on areas related to counseling, deafness, addictions and other topics.