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Evaluating Mechanisms of Change in a Smoking Intervention

Institution: RAND Corporation
Investigator(s): Harold Green, Ph.D.
Award Cycle: 2008 (Cycle 17) Grant #: 17IT-0007H Award: $219,376
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Inno Dev & Exp Awards (IDEAS)

Initial Award Abstract
Rates of smoking among young people remain high. School-based smoking prevention programs are a popular way to reach adolescents because they provide services in a setting with few barriers. Project CHOICE, the first voluntary after-school prevention program for middle-school students, is a new approach to smoking prevention. A pilot study in two schools found that with 13% of students participating in this after school program, rates of smoking among all students in the Project CHOICE treatment school (regardless of participation) were significantly lower compared to students in the other school. This IDEA-funded research addresses the TRDRP primary funding area ‘Tobacco-Related Health Disparities among California’s Diverse Populations’ by investigating how Project CHOICE affects tobacco use, including whether there are differences across gender and racial/ethnic groups.

The research aims to provide important new information by applying new statistical methods to investigate how a voluntary school-based prevention program has individual- and school-level effects on smoking-related attitudes and behaviors over a one-year period. The project adds a new component to a larger-scale evaluation of Project CHOICE currently underway by collecting additional information on student friendship networks and then modeling how smoking attitudes and behaviors and friendship networks change over time. The large and diverse population of students participating in the evaluation will allow us to examine whether and how peer selection and peer influence mechanisms associated with smoking-related attitudes and behaviors differ by gender and race/ethnicity. This research is crucial as it will significantly expand our understanding of smoking behavior and smoking prevention among younger adolescents and thus help design more powerful prevention approaches. Further, the study will provide data that could lead to the development of a new evaluation approach for prevention programs.

The study will occur in two pairs of schools in Los Angeles and Torrance. The proposed project will build on existing Project CHOICE survey activities but will gather additional friendship nomination data. Students will be asked to nominate their friends, their current romantic partner, and their family members who attend the same school. After nominations are collected from students, researchers will match names against a confidential survey respondent/ID list. These data will be combined with other survey responses regarding smoking behaviors and attitudes. This will allow us to investigate the effects of the intervention on decreasing smoking behavior and pro-smoking behaviors through either peer selection or peer influence.

This IDEA project represents a significant, innovative extension of the Project CHOICE evaluation. Collecting friendship network data with the support of the IDEA grant will enable us to better understand how peer selection and influence may act as mechanisms of change in the context of youth cigarette smoking and cessation. Understanding how school-wide effects of a voluntary program such as Project CHOICE may extend to the rest of the student body will allow intervention designers to maximize an intervention’s impact. We anticipate producing two papers from this project: one focusing on the impact of peer influence and selection mechanisms on smoking cessation and prevention and the other focusing on the utility of SNA methodologies for evaluating smoking prevention interventions. The proposed project will be the first to examine this important issue in such detail using the newest, most sophisticated statistical analysis techniques.

Substance use among Middle School Students: Associations with self-rated and peer-nominated popularity.
Periodical: Journal of Adolescence Index Medicus:
Authors: Tucker, J; Green, H; Zhou, A; Miles, JNV; Shih, R; D'Amico, EJ ART
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