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Evaluation of the Tobacco Prevention Toolkit

Institution: Stanford University
Investigator(s): Bonnie Halpern-Felsher, Ph.D.
Award Cycle: 2018 (Cycle 27) Grant #: 27IR-0043 Award: $1,175,996
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Research Project Award

Initial Award Abstract

Tobacco-use prevention among adolescents is critical, especially since most addicted adult smokers began using before age 18. The way in which tobacco use occurs, however, has changed over the past decade, with rates of cigarette use decreasing or remaining stable, and use of novel tobacco products such as electronic cigarettes, little cigars, hookah, and smokeless tobacco increasing. Moreover, adolescents harbor numerous misperceptions about these non-cigarette products, perpetuated by a lack of understanding about their harms and addictive properties. Schools have historically provided a key venue in which to implement tobacco prevention programs.  However, most school-based tobacco prevention programs focus on conventional cigarette smoking only, have had mixed results, and have had several gaps in their educational content.  To date, no comprehensive prevention program focusing on prevention of all tobacco products has been developed, tested, or widely disseminated throughout California or the U.S.  To fill these and other gaps identified by our school partners and stakeholders across California, we received previous funding from TRDRP, through the Pilot and Full SARA mechanisms, to develop and disseminate The Tobacco Prevention Toolkit Curriculum (, a 10-session Curriculum that includes resources, activities, worksheets, PowerPoint presentations, and other tools, aimed at changing adolescents’ attitudes towards and misperceptions about tobacco, increasing their resistance skills, and decreasing intentions and actual use of all tobacco products.  Aligning with the NIH Stage Model for Behavioral Intervention Development, we have addressed 3 of the 6 stages to develop, evaluate, and refine our Curriculum, including conducting basic formative research to identify curriculum topics and develop the lessons (Stage 0); developing, refining, and pilot testing the Curriculum (Stage I); and initial efficacy testing including confirming feasibility and acceptability in a classroom setting and some early pre-post evaluations (Stage II). Our next step is to conduct an evaluation to determine the real world efficacy and effectiveness of the Curriculum (Stages III-IV) and to further implement and disseminate the Curriculum (Stage V).  As such, the Specific Aims of this project are to determine: (1) whether the Curriculum is effective in changing middle and high school students’ resistance to using tobacco as well as knowledge of, attitudes towards, and intentions to use different tobacco products; and (2) whether the Curriculum is effective in changing middle and high school students’ actual use of tobacco in the short-term. To address our aims, we will employ a group/cluster-randomized, parallel design/sampling framework, with 14 middle and 14 high schools in California. Schools will be randomized to either the treatment (curriculum) or control (standard health education) arm, and we will administer baseline, post-curriculum, and follow-up surveys and interviews with students and teachers. The timing of this proposed research is extremely important, as we have outstanding momentum, have established an extensive team of school partners, have numerous schools already interested in and using the Curriculum, and have garnered tremendous support from the California Department of Education.