Unbound



Online Smoking Cessation Program for College Level Students

Judith L. Francis

New Jersey City University

Overview

Smoking is one of the leading causes of preventable deaths. It can harm the heart, lungs, blood vessels, mouth, reproductive organs, skin, eyes, and bone which can lead to disease and disability (Centers for Disease Control, 2012). The disease and disabilities, such as lung cancer, coronary heart disease, and emphysema, are not only caused by smoking but causes many of the serious long-term health conditions (National Heart Lung and Blood Institute, 2010). The numerous health problems that are attributed to smoking can rob a person’s quality of life. It can make is virtually impossible for a person to breathe, play, attend, work and school.

One of the serious problems revolving around tobacco use is the nicotine addiction, which can lead to longer tobacco use as teens get older. Evidence-based research from the American Cancer Society, shows that over time nicotine harms the brain development in teenagers. This also includes the use of e-cigarettes, such as vapes, which also contain nicotine (American Cancer Society, n.d.). The use of e-cigarettes has increased in use among the teenage populations mainly because this population does not see the severity in the health effects from smoking. Younger smokers view vaping as a safer alternative to smoking cigarettes. In a study conducted by the American Cancer Society (2016), the use of e-cigarettes by teenager is strongly associated to daily use of cigarettes and other harmful tobacco products.

To improve the health and wellbeing of college students nationally, universities are creating 100% smoke and tobacco free campuses. Implementing a smoke-free, tobacco-free policy will not only help to reduce smoking rates but will limit or eradicate second-hand smoke exposure. These policy effects also assist in fostering smokers to consider quitting. Working to decrease smoking use in the collegiate populations is very important because 99% of smokers start smoking before the age of 26 (The Truth Initiative, 2017). Although nationally, smoking rates among students age 18-25 have gone down, it is still an area of concern due to the popularity of e-cigarettes.

Currently, there are 2,342 US College campuses that are 100% smoke-free; and out of this number there are 1,945 campuses prohibit e-cigarettes use (American Non-Smoking Rights Foundation, 2018). College campuses across the board are recognizing the need to go 100% smoke and tobacco free. The ban will cover all property pertaining to the university. Smoke free-tobacco free means the use of tobacco related products. It will also eliminate the use of herbal substitutes and vaping that will be forbidden to be used on campus. One study evaluated the results from a national survey conducted on youth related smoking habits (Messer, Trinidad, Al-Delaimy, & Pierce, 2008). The research indicated that smoke-free places such as schools, restaurants, and recreational places like arcades, are linked to significantly lower statistics related to adolescent smoking (Messer, et al., 2008).

Over the past few years, there has been a dramatic increase in the number of smoke-free and tobacco-free universities nationally and internationally. Smoke-free universities prohibit use of tobacco products like cigarettes, while tobacco free involves the use of cigarettes but includes chewing tobacco products and e-cigarettes anywhere on campus. Although a number of these policies are increasing on campuses nationally, faculty, staff, and students are not always compliant. Some of the reasons for noncompliance has been not being fully aware of policy boundaries, inconvenience of going off-campus to smoke, and intentionally violating policy because it is believed to intrude on personal preference (Seitz, Kabir, Greiner, Davoren, & McIntryre, 2018).

It is important for smokers to realize the sooner they quit, the lower their chances of getting other diseases as well as cancer. According the Centers of Disease Control (CDC) (2009), tobacco use can not only lead to dependency and serious health problems, quitting smoking decreases those risks of developing smoking related diseases. In a report from the New York State Department of Health Bureau, it states that smoke-free campus policies result in social norm change with respect tobacco use (2011). Smoke and tobacco free norms also eliminate exposure to environmental tobacco smoke (DeTormes & Laschober, 2013). Reported benefits from long- and short-term smoking use include a decrease in heart and blood pressure rates, and a return to normal carbon monoxide levels return. Additionally, overall circulation of heart and lung function increases, coughing and shortness of breath decreases, and risk of getting cancer of the throat esophagus and bladder reduces (American Cancer Society, n.d.).

Rationale

The researcher is a faculty member in a public health department at a NJ university. The university has a smoke-free campus initiative currently underway. The smoke-free campus policy will be implemented January 1, 2020. To support enforcement efforts, a team comprised of 20 university employees will oversee the enforcement and promotion of the new anti-tobacco campus-wide policy. The team will consist of wellness counselors, faculty, staff, and students appointed by the President of the University who will come together to propose new policy ideas, revise and delete standards that are no longer applicable, and recommend changes to the existing policies regarding campus tobacco use.

The implementation of this program will occur during the 2020 Spring term. The current policy prohibits smoking in campus related building and vehicles only. The new policy will prohibit smoking and tobacco use on all campus grounds. Faculty, staff, counselors, and students are encouraged to abide by the policy as well as to enforce policies by informing others about the university’s effort to promote a smoke-free and tobacco free environment (Gatto et al.,2019). Campus police and security will give documented verbal warnings. Students who continue to violate policy will be reported to the Dean of Students for disciplinary actions. Through posters, emails, and text messages students have been notified of the new changes of the campus becoming 100% smoke-free by January 1, 2020.

Beyond enforcement, promoting cessation and reduction of tobacco use are the main component of the university's efforts. From a public health perspective, encouraging and assisting smokers to quit is the fastest approach in the reduction of tobacco-related diseases. Using nicotine-based products can contribute to absenteeism, sickness, and may result in death (Essa-Hadad, Linn, & Rafaeli, 2015). Although quitting smoking at any age is advisable, smokers who quit by 35 to 44 years old avoid a great part of the risk of dying from a smoking-related disease (Cessation Intervention, 2014).

The researcher’s university has been chosen for this implementation plan as the university’s smoke-free campus initiative seeks to enforce policies across campus systems and within all university environments. However, while the university has created a means for enforcing the policies systemically, it does not have a plan in place to assist smokers, who must abide by the policies, with a means to quit using tobacco products. Therefore, the researcher believes implementing a smoking cessation course as an elective will provide a much-needed resource to aid students in their quest to be tobacco-free (Seitz et al, 2018). Offering online cessation class not only makes it convenient for the smoker to quit, but also it makes provisions for student smokers to quit in response to these smoke-free campus initiatives.

University students have increased levels of tobacco related use, yet this population is unlikely to seek traditional approach to quitting (Gulliver, 2015). Technology focused interventions are very relevant to college students as the scientific evidence demonstrates that the most effective public health education campaigns use multiple resources to reach their target audience. Martinez, et al, (2017) note that online smoking cessation programs have a greater participation rate than face-to-face classroom instruction. Online cessation programs provide students greater accessibility and convenience (Martinez et al., 2017). Another study found that smoker's who participated were more engaged in the format and learning activities and were more likely to quit (The Truth Initiative, 2017).

Systems-Based Proposal for Implementation

Population-wide cessation efforts in policy, systems, or environment are most effective in reaching many people (Riordan, 2018). A systems change in health involves the integration of a tobacco dependence treatment program. The goal of this systems-based proposal is to provide an on-campus resource for students to quit tobacco product use and to ensure that the university meets the needs of the students. In order to prepare students for the implementation of the new tobacco–free policy, an online smoking cessation course will be developed and implemented by the researcher. This systems-based implementation proposal will provide numerous opportunities for motivating and helping smoker quit. Administering an online smoking cessation course will create further opportunities to educate students about hazards of tobacco use and the highlight the benefits of quitting.

Course Goals and Objectives

There are two goals of the course: 1) To provide anti- tobacco education and assist collegiate level smokers to quit through the incorporation of an online smoking cessation program; and 2) To increase students smoking cessation efforts through knowledge, attitudes, and quitting efforts. These goals will be met through the students being able to accomplish the following objectives:

a. Student will be able to describe in writing what nicotine and tobacco do to the body.

b. Student will be able to Identify 5 Morbidity and Mortality Rates related to tobacco use.

c. Student will be able to Explain through discussion board post the reasons why some students do not smoke.

d. Student will be able to recite the realities of what tobacco can and cannot do to their bodies.

e. Student will be able to Describe in writing the immediate and long-term effects of smoking.

f. Student will be able to list at least 5 benefits of quitting smoking or tobacco related products.

g. Student will be able to demonstrate through the use of podcasts and other visual aids, 6 stress relaxation techniques.

h. Student will be able to identify their method to quit using tobacco products.

i. Student will be able to find a minimum of two technology resources that will assist them in their quitting efforts. such as "smart text" and "Quitline".

Course Logistics

The course will be available for those students who are interested in quitting smoking. Registration will take place during the Fall 2019 semester registration process. This will be a two-credit elective course. The content for the online course will be delivered using the online platform, Blackboard. Students are familiar with utilizing this tool from previous classes and Blackboard supports the workload of higher education institutions. Mobile phone use will also be an optional added feature to the class. Mobile use will enable students to receive positive text messages to keep them on track of their quitting. This is an optional feature because various cellular plans may charge additional cost for text messaging services.

This course will be conducted in a synchronous and asynchronous learning format. Asynchronous learning through use of online technology allowing students to have the flexibility in completing assignment without scheduling conflicts. Synchronous learning will allow for students to schedule times for group discussions, lectures, online tests, and presentations. The online learning format implemented within this course will further instruct in core learning objects and evaluate students’ understanding of course materials (Gatto et al., 2019).

Course Features and Delivery

The course will feature in-depth online discussion chats, weekly assignments, quitting exercises, video and podcast viewing, online quizzes and exams, interactive web-based activities and games, weekly homework assignments, and designated online meeting times (Appendix A). It will also feature a pre-test and a post-test (Appendix B). Once the student is registered and enrolled in the course, they will complete an online survey using Qualtrics. This will serve as a pre-test. The survey will consist of 10 questions that will evaluate their smoking use and gauge their success and determination to quit.

Evaluation Plan

Technology-based interventions for smoking cessation show interest in the college level populations groups. As technology is advancing additional improvements for smartphone, Twitter, and Facebook will be incorporated into the program to reinforce the curriculum. This evaluation plan will serve as an effective way to measure outcomes and conclusions. It can also serve to promote and disseminate information. The online tools that was used in the course should show a promising relationship between college students and their increased understanding of health promotion and disease prevention through smoking cessation (Geckle, 2016). To ensure successful implementation of the lesson, evaluation exercises will be done after each session. Evaluation of lesson will be done through post-tests, course evaluation provided by the University, quiz grades, and participation feedback from students.

Additionally, the evaluation process will be organized using outcomes, registration data, vignettes, scenarios, discussion board questions and lesson tests. This process will consist of measured outcomes from class participation and responses from interactive activities. Some suggestions to further the education of the course will be to offer continuing education credits to faculty and staff who may want to quit smoking. Possible areas of training in smoking cessation techniques will be available to all levels of the campus workforce. Online cessation program offer education through the evaluative process it might be the remedy as a way of providing evidence-based treatment for tobacco dependence (Martinez, 2017). Evaluation will be ongoing to increase the knowledge, perceptions and attitudes in tobacco cessation.

Reflection

Benjamin Bloom’s Taxonomy of Educational Objectives provides a useful framework for identifying and measuring skills for students to accomplish. It best relates to this curriculum because it builds on the different levels of obtaining knowledge through learning objectives. This structure has been utilized as an applied teaching tool for elementary, secondary, and post-secondary education. According to Armstrong (2001), there are three taxonomies that an individual must master the lower levels before they move up to the higher levels. The first taxonomy is knowledge based, which deals with students learning and understanding different concepts and specific elements. The second is skill based or "how to do something" by way of creating, demonstrating or using something. The third is affective based, which consists of students’ attitudes, interests, and values. The advantages of using Bloom’s Taxonomy is that it helps to develop critical thinking skills in a ranking order. This order helps teachers to classify lesson plans for their students as well as help them design and implement curriculum based on student goals and outcomes. Additionally, it can assist in identifying a student’s capacity to work on a critical thinking level.

Using this taxonomy helps students understand the "Why" in the curriculum. That is, they can respond to questions: “Why do should I consider quitting smoking?” and “Why is enrolling in a smoking cessation course beneficial to my health?” Students enrolled in the course were able to meet or exceed these objectives through the hierarchical structure of cognitive skills outlined in Bloom’s Taxonomy. The cognitive skills have been applied as follows:

1. Recall: remembering important facts and defining concepts.

2. Application: Students applying knowledge to operate technology features on the internet to access various digital modules within the course.

3. Understanding: describing and discussing the material through discussion board forums, memorizing facts for multiple choice tests. Understanding ideas and concepts for essays. creating and recalling information.

4. Analyzing: relating and comparing information, asking questions, taking tests. Students had to analyze the information from the Biofeedback experiment and compare pulse rates before and after smoking.

5. Evaluation: support or defending decisions, support of the 100% smoke free policy on campus. Making a stand not be a smoker.

6. Create: creating a new smoke-free lifestyle. Synthetizing, putting together all of the lesson to create an educational resources database which can be used a reference.

Incorporating a 2-credit online course to implement at the university was a genius idea. This served as a great method for student to earn additional college credits and gain a second chance on obtaining better health through living a non-smoking lifestyle. The structure of the course guides the students to explore various areas of addressing their nicotine addiction. Each week ,students are challenged on concepts that will contributes to their overall student learning. The materials in the course builds on previous knowledge that require and measure active student learning. Weekly discussion board topics allow students to expand on different perspectives of tobacco use. It also helps them improve on their problem-solving skills when it comes to making decisions regarding their tobacco use.

References

American Cancer Society (n.d). Health Risks of Smoking Tobacco. Retrieved from

American Non- Smoking Rights Foundation.(2018). Smoke-free and Tobacco- Free U.S . and Tribal College and Universities. content/uploads/pdf/smokefreecollegesuniversities.pdf

Armstrong, P, (2001), A Taxonomy of Learning, Teaching , and Accessing: Revision of Bloom;s Taxonomy of Educational objectives.Center for Disease Control, (2012).Preventing Tobacco Use Among Youth and Young Adults, A Report of the Surgeon General. use

Cessation Interventions,(2014.) Best Practices for Comprehensive Tobacco control Programs.

Essa-Hadad, J.; Linn,S.; Rafaelli, S. (2015). A Web- Based Program to Increase Knowledge and Reduce Cigarette and Nargila Smoking Among Arab University Students in Israel:Mixed Methods Study to Test Acceptability. Journal of Medical Research. Vol 17(2):e39.

Gatto, A.; Powell,S.; Walters,E.; Zamani,S.; Sales,L; Debate,R.; (2019). A Mixed- Methods Assessment of a Peer-Enforced Tobacco and Smoke-Free Policy at a Large Urban University. Journal of Community Health. Vol.44, Issue 2, pp 365-376. University of South Florida, Tampa, USA

Gulliver,A,; Farrer, L., Chan, J.; Tait, R. Bennett, K.; Calear, A.; Griffiths,K. (2015,) Addiction Science and Clinical Practice, DOI 10.1186/s/137722-015-0027-4.

Jeopardy Game -Rules of Jeopardy game.

Martinez, C.; Gullen, O.; Margalet, M.; Arrien, MA.; Sanchez, C.; Caceres de Leon, P.; Fernandez, E.; Group of Hospital Coordinators in the Fruitful project. (2017). Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish Speaking Latin American Countries: Protocol of the Fruitful study.JMIR Res Protoc, 2017, 6(1):e7

Messer, K.; Dennis, R.; Trinidad, K.; Delaimy, A.; Pierce, J.; (2008) Smoking Cessation Rates in the United States: A comparison of Young Adult and Older Smokers. American Journal of Public Health. Vol 98. No.2.

Riordan, M.(2018). Public Education Campaigns Reduce Tobacco Use. Campaign for Tobacco- Free Kids.

The Truth Initiative( 2017) Interested in Quitting Smoking?Retreived from

Appendix A

Course Elective PBHL 1234-20 The Biggest Quitter- 2 credit course.

Course meets once a week for 1.5 hours. All work is to be submitted through Blackboard,

Tentative Sample Curriculum

|Class Session- Lecture Topics | Discussion board Assignments |Homework- Assignment are to be answered |

| |Make sure that you log in on time to |completed and submitted via Blackboard. |

| |participate in the discussion forum. Remember | |

| |these are timed sessions. If you log in more | |

| |than twice, it will result in an absence. | |

|1. Welcome/Instructions |Icebreaker - Name that Cigarette. |After hearing today's lecture reflect on your |

|Explain in detail the following: | |smoking situation. |

|2. Smoke- free policies | |Write a one- page reaction paper regarding how |

|a) Smoke- Free Campus | |you plan on implementing the 100% smoke- free |

|b) Enforcement of policy | |policy and your thoughts regarding secondhand |

|c)Penalties for not following policy. | |and sidestream smoke. |

| | | |

|Interactive Lecture using Prezi Topic: | | |

|Addiction vs. Habit | | |

|What is Nicotine? What is Tobacco? Secondhand | | |

|smoke, sidestream smoke. | | |

|2.Interactive Lecture using Powerpoint. |Anatomy of a cigarette. Deconstruct the |1-page reaction paper of what unexpected |

|Topic: Morbidity and mortality rates of smokers |cigarette to find out some of the hidden |ingredients were you surprised to find out that|

|ages 18-25 years old. |ingredients. |was in a cigarette? What do you think you will|

|Smoking and Biofeedback |Materials- Fill in the blank worksheet . Use of|find in cigars, or chewing tobacco? |

| |laptop or smartphone. |1 page reaction to "Smoking and Biofeedback |

| | |lesson" How are you planning on changing your |

| | |biofeedback? |

|3. Interactive Lecture using Prezi. |Discuss and Identify the stage that you |Create an action plan on how you plan to quit. |

|Topic: Transtheoretical Model (Stages of Change) |currently are in with your smoking habit. | |

|Quiz #1 | | |

| |Answer question within group. How do you plan | |

| |on moving out of that stage? | |

|4. The Biggest Quitter! |What method do you plan to use to quit? What is|Log onto Smoke Choose an online |

|Topic: Methods on Quitting Smoking. Bring in |your quit plan? What is your Quit Date? |cessation resource tool to help with your |

|visual samples of Nicotine Replacement products. | |journey to quit. Online resources provide 24/7 |

|-Nicotine gum |Open discussion for those who wish to verbal |support |

|- Patch |share their methods. |A) Smoke text |

|-Lozenge | |B) Quitnow. |

|- nasal spray |. | |

|Methods; Tapering, Cold Turkey, brand switching, | | |

|5. Benefits of quitting |Jeopardy game: Methods of quitting |Discussion Board- Free discussion on the |

|Quiz #2 | |quitting process. How has it been for you? Is |

| | |this process easier or harder than you thought?|

|6. Interactive Lecture |Deal or No deal. Open Discussion question: How |Develop 5 Quit tips that will help you stick |

|Powerpoint- Withdrawal symptoms. Is this a normal |long can you go without a smoking a tobacco |to your commitment to becoming a non- smoker. |

|process? What symptoms am I expected to feel? |product? | |

| |How did it make you feel? | |

|Quiz #3 |Name some reason why you continue to smoke? | |

|7. Nutrition- Interactive lecture |Create a mindful eating plate using the MYPLATE|Keep a food diary of 2 day eating using the |

|-Mindful vs. mindless eating |plate and food models |MYPLATE method. Log onto for |

|-weight management | |additional resources. |

|-Trigger Foods | | |

|- Role of sugar in smoking cessation. | | |

|- snacking | | |

|- MYPLATE | | |

|Quiz #4 | | |

|8. Pod cast presentation. |Open Discussion : Q&A. |Schedule a visit to your local Shoprite to |

|Guest speaker - Nutrition | |dicuss healthy eating options to avoid trigger |

|Dietician from Shoprite Food stores.- Ms. Norma | |foods |

|Phat | |Or Schedule a meeting to a attend a Nicotine |

| | |anonymous meeting. Follow guidelines out lined |

|Guest Speaker- Mr. Nick A. Teen from Nicotine | |indicated on your handout. |

|Anonymous. | | |

|Quiz #4 | | |

|9. Vision Board Presentation |Open Discussion Q & A | |

|Topic; What would your life look like as a | | |

|nonsmoker. Follow guideline for incorporating the | | |

|Six dimension of Health. Physical, Social, | | |

|Intellecual, Environment, Spirtual, Emotions | | |

|10. Letter to the Cigarette. |What does being a non-smoker mean to you? |Compose a heartfelt letter to the cigarette. |

|Saying good-bye to something that has been with | |Highlighting years of use , age started smoking|

|you through good and bad times may be difficult to|What will be your reward? Can be tangible or |and reaction to not having it in your life any |

|process. |intangible |longer. |

|Topic: Grieving Process. Elizabeth Kubler - Ross | | |

| | | |

| | | |

Appendix B

Pre-test and Post-test Survey Questions

Pre-test

1) How long have you been smoking?

2) At what age did you start smoking?

3) Have you been diagnosed by a medical professional with chronic health issues?

4) Do you want to quit smoking for yourself?

5) Is quitting a number one priority for you?

6) Have you tried to quit before?

7) Do you feel smoking is dangerous to your health?

8) Are you committed to trying to quit even though it will be tough?

9) Do you have a personal reason for quitting?

10) Can you be patient with yourself if you relapse?

Post-test

1) How many cigarettes do you currently using any tobacco products?

2) What quit method worked best for you? Brand switching, tapering, nicotine replacements.

3) What did you enjoy most about the course? Explain?

4) What did you enjoy the least? Explain?

5) Did you experience any withdrawal symptoms? If yes, Describe.

6) Did you find quitting challenging? If Yes Explain?

Appendix C

Session One Lesson Plan: Smoking and Biofeedback

Session Goal

To teach students some of the immediate psychological and physiological effects of tobacco use.

Objectives

1. Students will be able to describe in writing the effects of elevated heart rate in the body.

2. Students will be able to identify situations that can change heart rates.

3. Student will be able to discuss the purpose and procedure of the pulse-meter and tremor test.

4. Student will be able to list 3 reasons for the difference in pulse rates before and after smoking a cigarette.

5. Student will be able to discuss the reasons for differences in hand steadiness before and after smoking a cigarette.

Materials Needed

Podcast of Smoking and Biofeedback

Introduction

In this lesson students will focus on the immediate physiological and psychological effects of tobacco use. These effects are illustrated through Skype and the online podcast. Students are to view the 3 experiments prior to the assigned discussion board time. These experiments will show the effects of smoking on carbon monoxide levels of the lungs, heart rate, and hand steadiness.

Immediate Effects of Cigarette Smoking

Review the long-term health effects of:

1) Heart disease

2) Lung cancer

3) Oral cancers

4) Chronic Obstructive Lung Disease ( COPD).Angina

Discussion of immediate effects will take place in forum.

1) Once the cigarette is smoked, how long does smoking take to affect your body.

2) What are some of short-term effects of smoking?

3) What immediate effect does smoking have on your heart?

4) Do smokers' have a faster heart rate?

5) Why does a smoking increase a person's heartrate.

Measuring heart rate

Students will view a 5-minute video on the importance your heartrate.

1) Counting your pulse rate is an indicator of how fast your heart is beating. The number of times your heart beats per minute is known as the heart rate.

2) Your pulse or heart rate changes as a response to the body's needs

3) Several things can cause the heart rate to go up, one is smoking. Nicotine is a stimulate that cause increase in heart rate.

Students will view tutorial on how to take a pulse.

Students will record their numbers for resting and testing pulse.

Students will watch the following podcast " Cigarette Smoking Causes Accelerated Heart rates".

Students will answer following questions on discussion board

A) What did you observe regarding the difference between the first pulse and second pulse?

B) Why did it happen?

C) What would happen to your heart rate if you smoked all day.

D) What are alternate ways to develop a healthy heart.

E) What are some behavioral situation can increase your pulse?

Evaluation:

The evaluation process consisted of two online scenarios of successful implementation.

Scenario #1-A very lively discussion took place regarding the immediate and long-term effects of smoking. out of the 18 students enrolled in the course. 10 of them didn't realize how the heart and other body organs were dramatically affected by cigarette smoke. 8 of them didn't accurately know how to take a pulse. It was an added bonus to watch the video. Several students mentioned that they are going to start to keep track of their heart rate numbers after the smoke a cigarette. to see if smoking directly affects it. Many students didn't view cigarette smoking as doing drugs, but when another student mentioned that a lot of the addictive nature of cigarettes and going to withdrawal symptoms classifies it as being a drug.

A question in the discussion forum was expressed regarding the reality of long- and short-term effects of smoking. How it different for everyone. The advertisement for quitting seem to scare only younger child but not " committed smokers". Although television commercials are compelling, 7 out 18 did not believe that they cigarette smoking could do that much damage.

Another situation that was brought out on discussion board was that one of the students mentioned that his grandparents started smoking when they were 15 and they currently do not take any medication or have any chronic health condition.

Another student mentioned how when his grandparents started to smoke, tobacco was pure and didn't have all of the addictives. He went on to mention how lifestyles and the environment is vastly different from your grandparents’ time. Majority of the class had opinions regarding this subject. It was conveyed during the discussion board session that taking care of your overall health has great outcomes. The students were very interested in how smoking cigarettes had a direct impact on health.

The questions and comments went on for an hour in the discussion forum. Students began to realize that some of the health condition that they are experiencing such as frequent coughs and colds, bronchitis, shortness of breath , was not just attribute to the weather but had a direct link ot their smoking habit. Overall , the engagement of the students during the session and the questions gave the realization that the students understood the material and was able to apply it.

Scenario #2- online Jeopardy game. Normally this game is played in a classroom setting . Skype services was set up through the university to allow as many people from the class to participate.

Anti- Smoking Jeopardy was played similar to the "Jeopardy game show on T.V." The answer is the provide and you have to guess the question. When the question is given it is answered in the form of "What is"?

Rules of the Game: Games starts with revealing Six categories worth 100-400 points. Each team gets to choose a category. With the help of the team members, each participant gets a chance to give an answer. If the question is answered correctly , the team can accrue points. The team that has the most points wins the game.

Students really enjoyed this game. Teams were formed . Team were broken down into 2 groups of 5 members and 2 groups of 4 members for a total of 18 participants. Student were instructed to choose a non smoking team name . The names of the teams were 1) The Old Ports ( that group consisted of students who smoked Newport cigarette and where trying to quit). 2) The Quitters.3) No- Cigs. 4) Nickateam. . Students really got into the playing the game. So many of them are competitive. It was very entertaining and enlightening to see students work together to get the correct answer.

|Tobacco & Social Issues|College Students and |Smoke-free Policy |Withdrawal |Quitting |Nutrition |

|(Questions consists of |Tobacco Use |Questions consist of |Questions consist of |Questions consists of |Questions consist of |

|marketing, advertising,|Questions consists of |campus-based smoke |withdrawal symptoms |benefits from quitting |smart snacking , |

|Costs, health related |social smoking, stress,|/tobacco free policy | |Nicotine replacement, |avoiding trigger foods.|

|cost) |addiction Self esteem | | |staying quit. | |

| | | | | |Myplate |

|100 |100 |100 |100 |100 |100 |

|200 |200 |200 |200 |200 |200 |

|300 |300 |300 |300 |300 |300 |

|400 |400 |400 |400 |400 |400 |

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