Tobacco and Literacy Education Project

Transcription

1 Tobacco and Literacy Education Project Pilot Test of Three Tobacco Education Lessons Evaluation Report July, 2008 Prepared by JSI Research & Training Institute, Inc.

2 Purpose of the Evaluation This evaluation had two main aspects: formative and summative. The purpose of the formative was to collect information from the teachers and students that would help the team to make decisions about how to improve the Tobacco Education lessons and materials. The purpose of the summative (or outcome) aspect of the evaluation was to collect information from the teachers and students about how the Tobacco Education lessons affected them, in order to make a judgment about the value of the lessons. Specifically, the evaluation provided us with information about whether the following pilot project goals were met: Objective One: 85% of participating teachers will indicate their intention to use the lessons again in future adult education classes. Objective Two: At least 85% of adult students will increase their knowledge of the health effects and other impacts of tobacco use and cessation resources. Objective Three: At least 75% of students will rate the lessons as useful for learning about tobacco use and improving reading/writing. Methodology We conducted a mixed method evaluation, using qualitative data from teachers and students to make decisions about how to revise the Tobacco Education curriculum, and using a combination of qualitative and quantitative data to make a judgment about the value of the lessons in meeting the key objectives of the project. In addition to the four teachers who taught the pilot lessons, and the adult students who participated in their classes, we also collected questionnaire data from a small comparison group of adult students in another program who did not participate in the Tobacco Education lessons. Formative Evaluation We used a combination of individual written feedback, focus groups and interviews to collect information from the teachers about their suggestions for improving the lessons and materials. We used student focus groups to get information from students about their ideas for improving the lessons and materials. 2

3 To get input from teachers about what they liked or would change in the lessons, we asked teachers to provide specific comments about each lesson as and after they taught it. We also gave them feedback forms with which to provide suggestions about each lesson, including recording in detail the particular activities they designed to introduce the lesson to their students. Specifically, we asked teachers to write their answers to each of the following questions about each lesson: Preparation: How did you prepare yourself to teach the lesson (activity)? Did you feel prepared? What additional background materials would have helped? Implementation: How did you introduce the lessons (activity)? What steps did you take to implement the lesson? Did you do all the activities in one session or over multiple sessions? Describe. Student Response: How did students respond to the lesson as a whole? How did they respond to the tobacco content? Was the basic skills challenge of the lesson appropriate? Teacher Suggestions: What worked well? What would you do differently next time? What changes would you suggest? We collected these from the four teachers, collated all the information lesson by lesson, and analyzed them as a team. We also questioned teachers during interviews and focus groups, after they conducted the lessons, to hear their verbal comments about the lessons. In these interviews and focus groups, we led the teachers through a discussion of each activity in all of the lessons, asking them how they facilitated the activity, what was good about the activity, and what they would improve about the activity. To get input from students about what they liked or would change about the materials, we conducted student focus groups. Their comments provided additional information to support the teachers suggestions for improving the lessons and materials. Specifically, the focus group asked students to get into pairs and talk about what they liked and what they might improve about each of the lessons. We then went around the group and asked each pair to share, lesson by lesson, what was good and what suggestions they had, and we wrote all of their comments on newsprint as they are reported. We then generated a set of recommendations that we shared with the advisory group (consisting of teacher, student, and adult basic education program representatives) for further input. We used this information to make changes in the format and content of each lesson. For example, in the final version of the materials, we included teachers comments and suggested activities for each lesson. 3

4 Summative Evaluation The pre and post lesson questionnaires, interviews, and teacher and student focus groups gave us information about whether and how much the Tobacco Education lessons contributed to teachers intentions to use the lessons in their future adult basic education classes. In the teachers focus groups and interviews, we asked teachers to rate the overall quality of the lessons by answering the following questions (using a scale of 1 to 5, with #1 representing not very much and #5 representing extremely or to a great extent ): To what extent do you think the lessons had an impact on the learners knowledge of and attitudes towards tobacco use? Why or why not? To what extent do you think the lessons had an impact on the learners knowledge of cessation resources? Why or why not? To what extent do you intend to use the lessons again in future classes? Why and why not? In what manner would you use them? To what extent do you think the lessons had an impact on the learners literacy skills? To what extent do you think the lessons had an impact on the students math skills? To what extent do you think the lessons had an impact on the learners other skills (problem solving, critical thinking?) Why or why not? We also wanted to know how the lessons had affected adult students knowledge about and attitudes towards tobacco use and cessation. Specifically, we wanted to know if the lessons had helped adult students to: Estimate the dollar amount a smoker spends on cigarettes weekly, monthly and yearly. Recognize that the cost of cigarettes can represent a significant percentage of one s income. Understand that quitting smoking has immediate monetary benefits, and that the savings from quitting can be used to buy desired goods and services. Define secondhand smoke, and identify three harmful ingredients in it State the health effects of exposure to secondhand smoke on nonsmoking adults Describe how exposure to secondhand smoke harms young children List three ways to reduce people s exposure to secondhand smoke Describe the services of the New Hampshire Smokers Helpline available to all NH residents Identify two resources that can help people quit smoking List three websites that provide information about tobacco and health topics, and how to quit smoking The pre and post lesson questionnaires were our main method for collecting information about what knowledge and attitudes the adult students might have gained. The teachers, after being trained by the project staff, administered the pre lesson questionnaire during their classes before starting any of the tobacco education lessons. They then administered the postlesson questionnaire during class immediately after completing the last lesson in the 4

5 curriculum. They then forwarded these questionnaires to project staff, who input the data into SPSS and ran descriptive analyses. In addition, we used the student focus groups to collect students opinions about the usefulness of the lessons. We used a live Likert scale activity, wherein we put up around the room (on the wall) five half sheets of newsprint, each with a number from 1 5 on it. The newsprint with #1 on it also said not very much and the newsprint with #5 on it said extremely or a lot. We then read off the following questions (also posted on newsprint and uncovered one by one) and asked students to move around the room to the number that corresponded to their feeling about the question. How little or how much do you think the lessons increased what you know about tobacco use? How little or how much do you think the lessons changed what you think about tobacco use? How little or how much do you think the lessons changed what you know about help that is available to quit smoking? Why or why not? How little or how much do you think you will or would share information you learned from these lessons with friends or family? Why and why not? Then, we asked students to discuss why they chose to stand in front of that number. We documented their choices and comments about each statement. Finally, at the end of the focus group, we asked each participant, individually, to take a minute or two to make any final comments about their opinion of the Tobacco Education curriculum, and we recorded their comments verbatim. The project staff and evaluator conducted the interviews/focus groups of both teachers and adult students within one two weeks of the final lessons. Findings The Adult Student Sample We have usable data about 51 adult students, as follows: Characteristic Number (n=51) Percent of sample Gender Male Female % 69% Age % 20% 20% 5

6 % Program/Group Dover am Portsmouth Exeter Dover pm Comparison Ever smoked cigarettes Yes No Missing (comparison group) Now smoke cigarettes Yes No Anyone in house now smoke cigarettes Yes No Attended tobacco education lessons Attended 0 lessons (only the comparison group) Attended 1 3 lesson/activities Attended 4 7 lesson/activities Attended 8 10 lesson/activities % 12% 20% 27% 23% 61% 16% 24% 49% 51% 69% 31% 24% 19% 39% 18% Twenty nine (57%) of the pilot students were aged 25 or below. Of these, 5 were from the comparison group. Of the critical under 25 group, 16 now smoked cigarettes, while 13 did not. There was no correlation between age and the number of tobacco education lessons attended. Formative Evaluation Findings From the teachers written comments and from their interviews/focus groups, we learned the following information for revising the Tobacco Education lessons. The layout of the lessons was clear and easy to prepare. Teachers prepared and used numerous innovative approaches to introducing and conducting the activities; for example: o Sample bar graphs, using a non related activity about eye color of the students 6

7 o Having the students create their own crossword from an internet format. o Vocabulary games using slips of paper and definitions o Calling the NH hotline and having a class conversation with a counselor there. The teachers felt the reading lessons were well received. There were two versions (a short and a long version) of the reading about tobacco use and secondhand smoke. All teachers used the long version of the reading, so they suggested that the short version be omitted. There were multiple suggestions about the formatting of the reading selection itself (such as using consistent bolded subtitles, etc.) that the project team took into account when revising the reading activity. The activities were geared to different levels, but were less applicable at the higher level (GED). The crossword, vocabulary, and word search activities were well liked by the students, although one teacher felt that the word search activity would be confusing for low level learning disabled students. The teachers felt that the activities for writing needed to be revised. Specifically, they felt that the pilot writing activity was repetitive, just asking students to essentially rewrite the facts in the text. A better activity, as some teachers used and suggested, was an assignment that asks learners to argue a point or opinion, such as Why do you think it is so hard to quit smoking? or Considering the dangers of secondhand smoke, should it be banned in all public places? This type of writing exercise would engage the students more and would be a closer fit with the type of GED essay or opinion piece that students will be likely to encounter on the test or in further education. Teachers perceived that not all students were interested in searching the internet, although it certainly was beneficial and enjoyable to those students who did want to further their computer skills. The research activity, asking for students to research an opinion about smoking, did not lend itself to the type of internet searching that suited the students levels. Instead, the teachers suggested that the research activity have students focus on finding resources about smoking and smoking cessation and on searching for facts from a wide range of sources (not just the internet). In particular, teachers felt the research lessons should highlight the local helpline FIRST. For an internet search activity, the task should be more like a scavenger hunt, where students search for particular facts or places, rather than searching for opinions, to familiarize them with the variety of information online. The math lesson problems, in particular, were not difficult enough for students at the GED level. While they served as a review, we needed to add some higher skill questions. Also, the prompts for the math lesson (such as the charts and graphs) needed to be improved, teachers felt, so that they used the type of question prompts that students would see on a GED test. Some of the teachers thought that an additional science lesson (on chemicals in smoke, or the biology of health) might be helpful to draw on in the future, particularly for GED level students. The information collected from the student focus groups supported much of what the teachers reported about improving the lessons. Overall, the students liked the innovative activities the teachers developed to introduce the Tobacco Education lessons. They liked most the activities 7

8 for reading (vocabulary, crossword puzzle) and math but less so the activities for research. The research activity on smoking cessation needed to highlight the hotline, and give other choices (looking in phone books, calling 800 numbers, collecting brochures from hospitals and programs) besides just looking on the internet, because some learners were not interested in the internet or didn t see it as a viable source of information from home. Summative Evaluation Findings What did the students know about tobacco use before participating in the lessons? Using the pre tests of all participants and comparison group (n=51), we find that: Only 43% of students knew that a carcinogen was something that caused cancer. 24% thought it caused teeth to yellow; 18% thought that it caused heart attacks; and 12% thought it caused asthma. Only 28% of students thought that buying a pack a day, starting at age 17, would costs someone more than $50,000 during their lifetime. 39% thought it would cost over $500,000, while 28% thought it would cost $25,000, and 4% thought it would cost only $5, % of students correctly thought that cardiovascular disease affects the heart and blood vessels. 61% thought it affects the lung and breathing passages; while only 4% thought it affected either the liver and kidneys or the brain and spinal cord. A little more than half 55% could correctly state what secondhand smoke is. One third 33% gave an incorrect answer, and 12% left it blank. Only 18% could name two illnesses that children exposed to secondhand smoke can get (colds, earaches, respiratory problems, pneumonia, and asthma). 47% could name one illness, while 28% couldn t name any and 8% gave two incorrect answers (emphysema, lung cancer). Almost 2/3 (63%) of students could not name one website that would provide information about how to stop smoking. 10% could name two sites (or at least the sponsor of the website), and 26% could name one. 55% of the students could not say where they would advise friends who smoked to go if they wanted information about how to quit. 22% said they would advise them to go to their doctor/hospital/clinic/cessation program, and 18% said they would advise them to go to a website. 8

9 65% of students left blank a question about two ways that a program or quitline could help someone quit (motivation, advice, support and encouragement, where to get the patch, etc.). 71% of students agreed that secondhand smoke would raise a baby s risk of SIDS, while 29% said that was false. What did students learn about tobacco use and cessation? We had 23 participating students with both a pre test and post test, who ranged in age from 17 to 56; 1/3 are 19 or younger, half are 24 or younger. 10 were male and 18 female. 11 currently smoked, while 12 did not currently smoke. 18 had smoked at some point in their lives, while 5 had never smoked. Finally, 16 lived with people who smoked, while 7 did not have a smoker in their household. Comparing the 23 students for whom we have post tests and who attended at least some of the tobacco education lessons with the 51 students for whom we have pre test data, we found that the number of adult students who correctly answered questions increased as follows: 73% knew that a carcinogen was something that caused cancer (as compared to the 43% of all students who knew on the pre test). 65% knew that spending on cigarettes over a lifetime would be more than $50,000 (as compared to the 28% of all students who knew on the pre test). 95% could correctly define secondhand smoke (as opposed to the 55% who knew on the pre test). 65% knew that cardiovascular disease affects the heart and blood vessels (as opposed to the 35% of all students who knew on the pre test). 91% could name at least one illness children exposed to secondhand smoke get more often (as opposed to the 65% who could name at least one illness on the pre test). 91% of students agreed that secondhand smoke could raise the risk of SIDS (as opposed to 71% who agreed on the pre test). 74% could name at least one website (or sponsor) that contained information about how to quit smoking (as opposed to 36% who could name at least one website on the pre test). 22% named the helpline as a place they would advise their smoker friends to get information about how to quit (as opposed to 0% who named the helpline on the pretest), and 44% named a hospital/clinic/doctor/cessation program (as opposed to 22% who would advised that on the pre test) 9

10 61% left blank how a quit smoking program or helpline could help someone who wanted to quit (as opposed to 65% on the pre test). When looking at overall scores on the pre and post tests (on which there were 15 possible correct answers), we found that the mean on pre test was 6.22 (n=23, sd=2.56), ranging from a minimum score of 3 to a maximum of12. The mean on post test was 9.74 (n=23, sd=2.137), ranging from a minimum of 6 to a maximum of 13. The average jump in score between pre and post was 3.7 (n=23, sd=2.7). The difference between pre and post test scores was significant at p=.000. There was no significant relationship between jump in score and total lessons attended, attending some reading lessons, attending some math lessons, attending some research lessons, age, program in which they were enrolled or teacher who taught them, gender, or whether they had ever smoked or whether they now smoked (although those who didn t smoke had a higher jump: 4.42 jump vs jump for those who smoke). What did the students say about the tobacco education lessons? In the post lesson questionnaire, we asked them four evaluative questions about the Tobacco Education lessons as a whole. The questions, which used a Likert scale of 1 5 (1 being disagree strongly and 5 being agree strongly ), and the students responses to them, are as follows: I learned more about how expensive smoking is: Mean response was 4.96, sd=1.3, n=23. I learned more about the effects of smoking on nonsmokers: Mean response was 4.78 (out of 5), sd=1.2, n=23. I learned more about the types of services that quit smoking programs, telephone quitlines and websites provide to people who want to quit: Mean response was 4.70, sd=1.4, n=23. I learned more about the quit smoking programs and quitlines in my local area: Mean response was 4.5, sd=1.5, n=22. Overall, the students strongly agreed that the Tobacco Education lessons helped them learn the most about the expense and the effects of smoking. They also felt they learned a considerable amount about quit smoking programs. From the focus groups, the tally of live Likert scale responses for all four student focus groups is presented in the table below. The total possible n=32, but not all students responded to each question. Question 1 (not very much) How little or how much do you think the lessons (extremely) Mean

11 increased what you know about tobacco use? (n=30) How little or how much do you think the lessons changed what you think about tobacco use? (n=31) How little or how much do you think the lessons changed what you know about help that is available to quit smoking? Why or why not? (n=32) How little or how much do you think you will share information? (n=32) Overall, the students felt that learned a good deal about tobacco use, and the majority students had shared this information with others (family, friends). The comments from the students indicate that, overall, students enjoyed the lessons: This was more fun than anything I have ever done in class. Their comments also indicated that adult students, particularly younger students, didn t know much about secondhand smoke or hadn t thought about the cost before the lessons. The lessons helped them realize the dangers of secondhand smoke and expense of cigarettes. While it didn t have as great an effect on their attitudes towards smoking, the change in attitudes seemed to vary according to whether or not the student was a smoker: those who were not smokers said it didn t change their attitude because they had always opposed smoking; those who were smokers said it motivated them to stop smoking but that quitting was difficult. In general, students learned some, but not as much, about where to go for smoking cessation help. Perhaps the most impressive outcome of the evaluation was the extent to which students reported sharing information they learned in the Tobacco Education lessons with others outside of the class. Almost all learners shared information they learned with others (in their family, friends). We concluded that the lessons would have a more far reaching impact if we provided learners with information they could take home, and that this information should provide facts about tobacco use; several students mentioned that it would be good to have lots of arguments (to share with others), not just say it s [smoking] bad. Finally, from the teacher focus groups and interviews, we learned that all four teachers said they would use the lessons again, but would do so intermittently (not in order, and not within 3 weeks), mostly when skills focused on in class matched the skills in the lessons (charts, math, writing, and reading). 11

12 Conclusion Were the objectives of this pilot tobacco education project met? Objective One: 85% of participating teachers will indicate their intention to use the lessons again in future adult education classes. This objective was met in that all teachers said they would use selected lessons again in their adult education classes. Objective Two: At least 85% of adult learners will increase their knowledge of the health effects and other impacts of tobacco use and cessation resources. This objective was met in that over half (20 out of 32 students) gave the lessons a rating of 4 or 5 (out of 5) in how much it had helped them increase what they know about tobacco use. Also, over 90% of the adult students, after the lessons, understood what secondhand smoke was, could name at least one illness that children get from being exposed to secondhand smoke, and knew that secondhand smoke raised the risk of infant SIDS. Objective Three: At least 75% of students will rate the lessons as useful for learning about tobacco use AND improving reading/writing. The objective related to knowledge of tobacco use was met. In addition, the majority of the students indicated that they had shared knowledge about the dangers of smoking with others. In terms of reading and writing, the response was that these lessons were only one of many that helped students gain skills and knowledge, and that one wouldn t expect these lessons alone to single handedly improve students reading and writing. However, teachers agreed that these lessons were useful in either reviewing necessary skills or building skills, particularly computer or internet skills for those students who are already interested in searching the net. 12

13 Evaluation Appendix Timeline for Data Collection Method Timing Process Attend orientation and training. All participating teachers in program and program administrator. Includes purpose of project, orientation to lessons, and instructions for delivering preand post surveys. Teach the three tobacco use and cessation lessons Administer pre survey to students Administer post survey to students Be interviewed by the evaluator Help organize a learner focus group in your program March 21 Between March 26 and April 13 Before the first lesson. After the last lesson. Between April 16 and April 30 Within one week of the last lesson (week of April 16) Evaluator and Curriculum Designer come to program and do orientation. Follow the lesson plans; keep notes and suggestions in margins. Hand out surveys to students. Read each question aloud; allow time for students to write their answers. Hand out surveys to students. Read each question aloud, one by one; allow time for students to write their answers. Interviewer will call you to arrange a phone interview Ask students to come to onehour focus group session (for which they will receive a gift card). Provide space for the focus group within the program. 13

14 Evaluation Appendix: Pre Lesson Questionnaire [To the Teacher: Please read the following aloud before handing out the survey.] I ve been asked by a local organization called the Community Health Institute to try out some new health and literacy lessons and activities in our class. These lessons should help you improve your reading, math and information gathering skills while also helping you learn more about an important health topic the costs and effects of smoking. The goal of these lessons is not to push anyone to quit smoking, but to learn about a health topic while also practicing language arts and math skills. Over the next three weeks, we will be trying these lessons and activities during our regular class time. The organization that designed these lessons wants to understand how much these lessons help you learn. They would like you to fill out a short survey before we start the first lesson and another short survey after the end of the last lesson. This first survey is to see what you already know; it is not a test and there is no grade. Neither my name nor your name will be used in any report written about this project, and no one but me and the project evaluator will see your answers on the survey. After we finish the lessons in mid April, the organization will also hold a short meeting called a focus group for learners to hear what you thought about the lessons and activities. That focus group will be held in Exeter on Monday, April 16 from 7 8 p.m. OR in Dover on Tuesday, April 17 from 7 8 p.m. If you are able to come at this time and want to participate in the focus group, you will receive a gift card to Target for your time and energy. Questions? [Hand out the Pre Lesson Survey and read the following aloud to the class:] This is the first survey, before we begin the tobacco lessons. I will read aloud the first question on the survey, give you some time to write the answer to the question, and then read the next question aloud. This is an individual activity, so it s important not to say the answers out loud. I will collect everyone s survey after we finish the last question. If you have any questions, don t hesitate to ask me at any time. Write your first name and last initial, and the date at the top. 14

15 Tobacco and Literacy Education Project Pre lesson Survey First Name and Last Initial: Date: 1. A carcinogen is something that: Causes heart attacks Causes asthma Causes cancer Causes teeth to turn yellow 2. If someone smoked a pack of cigarettes a day starting at the age of 17, they could easily spend more than buying cigarettes during their lifetime. $5,000 $25,000 $50,000 $500, What is secondhand smoke? (If you don t have an answer, leave it blank).. 4. Breathing secondhand smoke increases a person s chance of getting cardiovascular disease, which affects the: Liver and kidneys Heart and blood vessels Brain and spinal cord Lungs and breathing passages 15

16 5. Which of the following statements is true? Breathing secondhand smoke doesn t harm children. Breathing secondhand smoke only causes children to cough. Breathing secondhand smoke causes children to get sick more often than children who don t breathe secondhand smoke. 6. Name two illnesses that children who breathe secondhand smoke can get. (If you don t have an answer, leave it blank). 7. True or False? Babies who breathe secondhand smoke have a greater risk of Sudden Infant Death Syndrome (SIDS). True False 8. True or False? Secondhand smoke can cause nonsmokers to die of lung cancer. True False 9. Which of the following is an effective way to prevent people from breathing secondhand smoke? No Smoking sections in restaurants Air filters and ventilation systems Not allowing smoking in cars, in the home or in the workplace All of the above 10. Name two Web sites that provide information about how to quit smoking. (If you don t know the full web address, just say who sponsors it. If you don t know any, leave it blank.) 16

17 11. If a friend or someone in your family wanted to quit smoking, where in your local area would you advise them to go for help or advice? (If you don t have an answer, leave it blank). 12. State two ways that a quit smoking program or telephone quitline can help someone who wants to stop smoking. (If you don t have an answer, leave it blank). 13. How much do you agree or disagree with the following statements? (Circle one number for each statement) Breathing secondhand smoke is dangerous for children. The money spent on cigarettes could be much better used for other things. Quit smoking programs can be very helpful to people who want to stop smoking. Smoking cigarettes only hurts the person who smokes. 14. Are you : (Check one) Male Female 17

18 15. What is your age? (Write in your age) 16. Have you ever smoked cigarettes? (Check one) Yes No 17. Do you now smoke cigarettes? (Check one) Yes No 18. Does anyone in your house now smoke cigarettes? (Check one) Yes No Thank you for filling out this survey. Please turn it in to your teacher. 18

19 Evaluation Appendix: Post lesson Questionnaire Tobacco and Literacy Education Project: Post lesson Survey First Name and Last Initial: Date: 1. A carcinogen is something that: Causes heart attacks Causes asthma Causes cancer Causes teeth to turn yellow 2. If someone smoked a pack of cigarettes a day starting at the age of 17, they could easily spend more than, buying cigarettes during their lifetime. $5,000 $25,000 $50,000 $500, What is secondhand smoke? (If you don t have an answer, leave it blank).. 4. Breathing secondhand smoke increases a person s chance of getting cardiovascular disease, which affects the: Liver and kidneys Heart and blood vessels Brain and spinal cord Lungs and breathing passages 19

20 5. Which of the following statements is true? Breathing secondhand smoke doesn t harm children. Breathing secondhand smoke only causes children to cough. Breathing secondhand smoke causes children to get sick more often than children who don t breathe secondhand smoke. 6. Name two illnesses that children who breathe secondhand smoke can get. (If you don t have an answer, leave it blank). 7. True or False? Babies who breathe secondhand smoke have a greater risk of Sudden Infant Death Syndrome (SIDS). True False 8. True or False? Secondhand smoke can cause nonsmokers to die of lung cancer. True False 9. Which of the following is an effective way to prevent people from breathing secondhand smoke? No Smoking sections in restaurants Air filters and ventilation systems Not allowing smoking in cars, in the home or in the workplace All of the above 20

21 10. Name two Web sites that provide information about how to quit smoking. (If you don t know the full web address, just say who sponsors it. If you don t know any, leave it blank.) 11. If a friend or someone in your family wanted to quit smoking, where in your local area would you advise them to go for help or advice? (If you don t have an answer, leave it blank). 12. State two ways that a tobacco cessation program or telephone quitline can help someone who wants to quit smoking. (If you don t have an answer, leave it blank). 13. How much do you agree or disagree with the following statements? (Circle one number for each statement) Breathing secondhand smoke is dangerous for children. The money spent on cigarettes could be much better used for other things. Programs to help people quit smoking can be very helpful. Smoking cigarettes only hurts the person who smokes. 21

22 14. How much do you agree or disagree with the following statements about the tobacco and literacy education lessons you had in this class? (Circle one number for each statement) I learned more about the effects of smoking on nonsmokers. I learned more about how expensive smoking is. I learned more about the types of services that quit smoking programs, telephone quitlines and websites provide to people who want to quit. I learned more about the quit smoking programs and quitlines in my local area. Thank you for filling out this survey. Please turn it in to your teacher. 22