Nadine Carter, director of the smoking cessation program at the Tulalip Health Clinic, knows that one of the best ways to prevent the problems caused by tobacco is through education.

"If we can get the message out early, before young people decide to try tobacco, we have a better chance of preventing its use," said Carter.

Through a partnership with the Marysville School District, Carter works to deliver that message at all grade levels, being careful to customize her presentations for the students' ages.

Recently, students at Totem Middle School were invited to take part in activities aimed at stopping tobacco use by teens, including creating posters or essays with an anti-smoking message. Participants were treated to a pizza party and prizes of gift cards courtesy of the health clinic.

"The contest was open to all students in 6th, 7th and 8th grade," explained Sandra Olson, intervention specialist for Totem and Marysville middle schools. "We had winners from all three grade levels, although most of the students who participated were 8th graders."

Olson continued, "The students completed an essay assignment as part of teacher's Andrea Chapman's Language Arts class. Another eighth grade teacher, Mia Cauley, submitted her own essay about how tobacco has affected her family. Most of the other entries were posters encouraged by our art teacher, Sandy Chapin."

The essays and posters were the result of a concerted effort begun by Carter in February, when the health clinic sponsored a visit to the school by "The Organ Lady," registered nurse Kathy Ketchum. Ketchum offers a graphic presentation, guaranteed to make even middle schoolers squeamish, featuring human organs that were damaged by tobacco, drugs or alcohol.

Thanks to the Tulalip Health Clinic sponsorship, Ketchum also presented her eye-opening display at Marysville-Pilchuck High School and Marysville Mountain View High School this school year.

"The key is repetition," said Carter. "Maybe one time you see a message and it doesn't catch you, but next time it comes your way, it might be the right time for you."

Working with kids is a natural choice for Carter's program.

"If we are successful, maybe these kids will never pick up a cigarette," said Carter. "We are starting at the ground level to help them build the foundation for a healthier life."

Carter's smoking cessation program at the clinic is free and open to all. It's based on the three-tier approach of education, support and nicotine replacement.

Olson knows the anti-smoking message is good for the students.

"I feel all positive messages, including living a tobacco-free life style, support our students and the district goals," said the intervention specialist. "This message encourages students to make positive, healthy choices, to be aware and understand the consequences of their behaviors, to stand up for their beliefs and not give into peer pressure."

This year, due to budget cuts, a school-based group called Teens Against Tobacco Use (TATU) combined with Marysville Kids Matter, an initiative funded by United Way. The combined group participated in community and school activities spreading the positive message that kids matter and make a difference.

Totem students' posters and essays will be featured in a series of ads and public service announcements running in North County Outlook over the next few months.