School-based Tobacco Prevention Research Articles

Bridge-It: A System for Predicting Implementation Fidelity for School-Based Tobacco Prevention Programs

Properly implemented school programs to prevent tobacco use and addiction can lower smoking prevalence up to 60%. However, numerous programs are not successful due to poor implementation. A system for estimating likelihood of future implementation fidelity of school-based prevention programs was tested using data collected at baseline and two year follow-up in 47 middle schools and high schools participating in the Texas Tobacco Prevention Initiative. The Bridge-It system includes an eight-factor, 36-item survey to analyze capacity for program implementation and a companion Bayesian model which provides estimations of likelihood of implementation fidelity several years after program initiation. The survey also asks about amount of implementing activity for each of the multiple components recommended in federal guidelines for school programs to prevent tobacco use. Criterion referenced cross-tabulations showed the system's forecast of implementation fidelity was correct in 74% of cases (p < .01). Model reliability was confirmed in regression analyses. Implementation fidelity at follow-up was predicted by the combination of the model's eight capacity factors at baseline. It includes program, implementation support, and non-program factors. Integration of the Bridge-It system, or comparable tools, into the dissemination and evaluation of school-based prevention programs can help to increase understanding of factors that influence implementation and provide guidance for capacity building. If administrators can identify at baseline schools likely to fall short of implementation goals, plans for resource allocation and provision of guidance, training, and technical assistance can be specifically tailored to identified needs.

Since school-based tobacco prevention programs do not work, what should we do?

Since school-based tobacco prevention programs do not work, what should we do?

Impact of the Life Skills Training Curriculum on Middle School Students Tobacco Use in Marion County, Indiana, 1997–2000

Evaluation of school-based tobacco prevention and control programs have yielded mixed results. This study assessed the impact of the Life Skills Training curriculum on Marion County, Ind., middle school students' knowledge, attitudes, and ability to make good lifestyle decisions. From 1997 to 2000, students in grades six to eight in the study schools received the Life Skills Training curriculum. Survey data (n = 1,598) were used to compare tobacco use behavior, attitudes, and knowledge of those exposed with those not exposed to the program. Of the students surveyed, 12.5% were currently smoking. There were significantly fewer current smokers, and more students exposed to the program indicated they intended to stay smoke-free. Fewer of those participating in the program "hung out" with smokers and more said they could easily refuse a cigarette if offered one. Students completing the Life Skills Training curriculum were more knowledgeable about the health effects of smoking. Program effects were different for male and female students as well as for White and Black students.

The Arizona CHAMPS Peer Project for Tobacco Use Prevention: Effects on Tobacco Use, Intentions to Use, and Knowledge

This study reports on CHAMPS, a youth tobacco education and prevention program intervention that focused on peer-led educational activities. Nineteen schools implemented a CHAMPS tobacco prevention program in grades 5, 6, and 7. Six schools served as nonintervention comparison sites. Baseline and follow-up questionnaires were completed by 1,412 students. The proportion of students reporting current cigarette use decreased significantly in the CHAMPS group but not in the comparison group. Intervention group students' knowledge about the harmful consequences of tobacco use increased significantly, whereas knowledge essentially stayed the same among comparison group students. Finally, the number of nonsmoking students who reported they would smoke a cigarette if one of their best friends offered it increased significantly in the comparison group but not in the intervention group. These results suggest that a well-planned and implemented peer-helping program represents an important potential resource that should be considered as a welcome adjunct to existing school-based tobacco education and prevention efforts.

An Assessment of the Relationship Between the Quality of School-Based Tobacco Prevention Programs and Youth Tobacco Use

SUMMARY This study presents data from an assessment of substance use prevention programs in 23 elementary and middle schools in northern and central Illinois. The quality of prevention programming was assessed based on program intensity, focus on tobacco, staff resources designated for prevention programs, and implementation of the Centers for Disease Control and Prevention recommendations for tobacco prevention. Data from these four dimensions were used to calculate a Quality Index Score. Multilevel logistic regression analysis was used to assess the relationship between individual level variables, school level variables and the outcomes of reported current tobacco use, intent to use tobacco in the coming year, and perceived efficacy of substance use prevention programs. No significant effects were found, indicating that exclusive use of even high quality school-based prevention programs may not be sufficient in changing youth behavior. However, school-based prevention programs may be an important component of a broader ecological approach that uses multiple, community-wide strategies to promote normative change.

E-mail communication between medical students and schoolchildren: A model for medical education.

To examine e-mail communication between student physicians and schoolchildren, in the context of a school-based tobacco prevention program, as a way to teach communication skills and model physician-patient interactions. Twenty medical students and pediatric residents were partnered with groups of children as part of HealthQuest, a tobacco prevention program implemented in 2 kindergarten through grade 12 Vermont schools. Medical students and residents acted as mentors for their group and provided support to the schoolchildren through e-mail and occasional site visits. E-mail messages were transmitted and stored in a Web server and monitored by preceptors. Content analysis of the messages was performed to identify emerging themes. During the 2-year intervention period, 1187 messages were exchanged between children, teachers, and the student physicians. Thirty-two percent (n = 383) of the messages involved tobacco, of which 54% addressed health effects; 23% were related to social influences of tobacco use, 15% to cessation by parents and others, and 7% to cessation by students. Other categories included nontobacco health issues (n = 135), personal questions (n = 294), and classroom information (n = 735). Many inquiries required medical students and residents to research their answers, and several required collaboration with preceptors, because the questions raised serious medical or psychosocial issues. With feedback, medical students and residents adjusted their responses so that they were appropriate for the developmental level of the children. The e-mail component of this program provided important learning opportunities for student physicians in tobacco control, child development, communication skills, and developing a physician-patient relationship. This model also offers potential benefits for medically underserved pediatric populations. Arch Pediatr Adolesc Med. 2000;154:1258-1262.

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents

To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility. An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues. The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age. The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.

Diffusion of CDC's Guidelines to Prevent Tobacco Use and Addiction.

The Center for Disease Control and Prevention's School Guidelines to Prevent Tobacco Use and Addiction were developed, in part, to assist state and local education agencies in adopting and implementing effective school-based tobacco prevention and cessation programs. This project assessed state education agency awareness of and reaction to the Guidelines, and documented efforts to disseminate the Guidelines to local schools. Key informants in 15 state education agencies were interviewed. Respondents reported a fairly high level of receptivity to the Guidelines, numerous benefits and few barriers, and high commitment. Levels of use for the Guidelines varied. Dissemination strategies such as mass mailing or teleconferences are not sufficient to influence the use and integration of Guidelines for school health. The diffusion process requires planned change over time through numerous communication channels and should be monitored at the national, state, and local levels to assess effectiveness and impact.

Diffusion of innovations in schools: a study of adoption and implementation of school-based tobacco prevention curricula.

The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process. The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions. The study was conducted in North Carolina. All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample. An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted. Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%. Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation. While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.

Effects of a Statewide Antismoking Campaign on Mass Media Messages and Smoking Beliefs

Background. In 1985, The Minnesota Legislature initiated a long-term and broad-based program to deter adolescent tobacco use. The initiative was funded by higher taxes on tobacco products and combined school-based programming, mass-media campaigns, and local community grants. The Minnesota-Wisconsin Adolescent Tobacco-Use Research Project was designed to evaluate this effort by monitoring adolescent tobacco use and related factors in Minnesota and Wisconsin from 1986 to 1990. The results presented in this paper indicate that the Minnesota initiative dramatically increased Minnesota schoolchildren′s reported exposure to the anti-smoking messages in the mass media but had little effect on smoking-related beliefs or smoking behaviors. Conclusions. These results, together with the findings from other recent studies, suggest that even dramatic increases in exposure to anti-tobacco messages in the mass-media, in the absence of a substantial and sustained school-based tobacco prevention measures, may be insufficient to generate reductions in adolescent tobacco use.