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School tobacco program and policy trial

Institution: University of Southern California
Investigator(s): Mary Ann Pentz, Ph.D.
Award Cycle: 1997 (Cycle 6) Grant #: 6RT-0184 Award: $1,162,877
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
Cigarette smoking among California youth continues to rise despite required school prevention programs and no-use policies for students. A major question is what strategies can be used to enhance the potential of school policy to effectively prevent and decrease student use. The proposed project aims to develop and evaluate an intervention comprised of six components to enhance the effects of school policy (review of student policy and enforcement, review of staff policy, staff education about modeling influences and quitting resources, parent education about school policy, addition of policy awareness and cueing, social norms and consequences lessons to each school's prevention program, staged policy dissemination) on middle school student tobacco use. The components are designed to be readily adopted by schools if the intervention is effective. The study addresses at least two of the TRDRP research priorities: prevention programs/interventions and reduced use/addiction intervention.

The major hypothesis is that the proposed intervention, compared to a program and policy as usual control group, will increase support. enforcement, and compliance with policy and subsequently reduce student smoking in 16 California middle schools representing a mix of Latino, Asian, and White students. The subjects are 2400 7th grade students who are measured two years to evaluate effects of intervention. The impact of existing school district/community policies and youth access to tobacco in stores near schools will also be assessed. Results should be generalizable to most schools in California. The intervention, designed as a low cost adjunct to existing prevention programs and policy, should be a cost-effective way for schools to increase the potential of school policy to produce changes in adolescent tobacco use behavior. Materials developed as part of the intervention will be produced as an easy-to-follow manual that all California schools can use in their program and policy planning.

Final Report
Cigarette smoking among California youth has not declined appreciably despite use by schools of evidence-based prevention programs. A major question is whether school tobacco policy could be improved to help decrease smoking among youth. This project developed and evaluated a tobacco policy intervention to enhance the effects of school policy on youth smoking. Year 1 included development and piloting. Year 2 included intervention and 2 measurements. Year 3 included the final follow-up collection and analyses, and training of control group schools. A no-cost extension was used to refine the curriculum and policy resource manuals, and to prepare publications. The intervention had four components: a 3 session curriculum, a policy presentation for faculty, an administrative staff policy workshop, and a parent teacher association workshop. The research design was a 2 group design, with 19 schools in 3 districts randomly assigned to the intervention or a policy as usual control group. A total of 2617 entering 7t' grade students with active parental permission were surveyed at least once (85% response rate); 2053 had complete merged data across three waves of measurement (baseline, 6 month follow-up, 12 month follow-up; 41% white; 30% Latino; 17% Asian; 2%African American; 10% Other). Seven measures were used: student survey of tobacco use, and policy attitudes and behaviors, principal policy interview; staff surveys of student and staff policy; written district and school policy; school infraction records. Analyses included structural equation modeling of tobacco use-policy relationships; regression analyses of policy intervention effects, controlling for gender, ethnicity, and baseline values of variables; and content analyses of written policies and principal interviews. Results of structural equation modeling showed that the major mediators of change in tobacco use were changes in perceived social norms for tobacco use and support of policy (CFI>.93). Results of regression analyses showed significant program effects on policy support, encouragement of friends not to smoke, perceived social norms for tobacco use, intentions to use, and lifetime and monthly smoking prevalence by 6 months; and maintenance of most effects by 1 year. There were few ethnic or ethnic x program differences: Latino students showed the highest pro-smoking environment (norms), and Asian students the lowest. Written policies showed no variation among schools or districts. Three categories of policy enforcement were generated from principal interviews (punishment, punishment + counseling, counseling + support); program schools showed more adoption of counseling + support enforcement after intervention. This project has thus far produced 12 conference presentations and published abstracts, 2 peer reviewed publications and one chapter, a doctoral fellowship grant, and 2 educational products (curriculum, resource manual). With the short timeline of this project, preparation of publications and extended analyses are expected to continue for another year on both doctoral fellowship funding and on nonfunded efforts from supervised research credits.
Publications

The conflict between least harm and no-use tobacco policy for youth: ethical and policy implications
Periodical: Addiction Index Medicus:
Authors: Pentz MA, Sussman S, Newman T ART
Yr: 1997 Vol: 92 Nbr: 9 Abs: Pg: 1165-1173

The interface of school tobacco policy and programs
Periodical: Proceedings of the TRDRP Annual Investigator's Meeting Index Medicus:
Authors: Pentz MA, Pentz CA, Newman TL ABS
Yr: 1997 Vol: Nbr: Abs: Pg:

Effective prevention programs for tobacco use
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Pentz MA ART
Yr: 1999 Vol: 1 Supp 2 Nbr: Abs: Pg: 99-107

Institutionalizing community-based prevention through policy change
Periodical: Journal of Community Prevention Index Medicus:
Authors: Pentz ART
Yr: 2000 Vol: Spec CSAP Nbr: 28(3) Abs: Pg: 257-270

School tobacco program and policy trial
Periodical: TRDRP Annual Report to the State of California Legislature Index Medicus:
Authors: Pentz MA, Kumar CA, Ross L ABS
Yr: 1998 Vol: Nbr: Abs: Pg: 127-128

Early effects of a tobacco policy prevention trial
Periodical: TRDRP Annual Report to the State of California Legislature Index Medicus:
Authors: Pentz MA ABS
Yr: 1999 Vol: Nbr: Abs: Pg:

Patterns and predictors for adolescent nicotinee addiction
Periodical: Addiction Index Medicus:
Authors: Li C, Pentz MA, Pentz CA ABS
Yr: 2000 Vol: 1 Nbr: Abs: 17 Pg:

Relationship of school tobacco policy on adolescent smoking susceptibility
Periodical: American Journal of Health Behavior Index Medicus:
Authors: Pentz MA ABS
Yr: 2000 Vol: 25 Nbr: 3 Abs: Pg:

Effects of a multi-component policy on adolescent smoking susceptibility
Periodical: American Journal of Health Behavior Index Medicus:
Authors: McClure M, Pentz MA, Huang T, Pentz CA ABS
Yr: 2001 Vol: 25 Nbr: 3 Abs: Pg: