Youth Engagement in Peer-Led Health Education Via Teens Against Tobacco Use

Teens Against Tobacco Use (TATU) empowers youth to serve as both educators and health policy advocates. In the El Paso Independent School District, the program operates as an after school activity, where high school and middle school youth are trained to develop and deliver anti-tobacco presentations to younger students. TATU members also engage in tobacco control advocacy activities including tobacco retailer compliance checks, the creation and dissemination of anti-tobacco videos via social media, and letter writing policy campaigns.

Central to youth engagement in TATU is the youth-adult partnership approach, where a teacher serves as an advisor focused on developing youth leadership while addressing logistical issues youth are poorly positioned to navigate. Advisors help to ensure productive meetings by collaborating with youth to create an agenda and ensure important issues are addressed. Advisors also pose guided questions to raise appropriate issues, provide intermediate structure that breaks down task to a manageable level, and interjects clarifying questions that challenge youth to discuss the feasibility and productivity of their ideas.

Youth work in small groups to develop anti-tobacco presentations where they share tobacco-related personal experience narratives and facilitate activities that encourage participants to share their own tobacco-related narratives. This approach is conceptually grounded in social cognitive theory, as the older youth are credible role models that promote observational learning. Narrative research also suggests: a) youth engagement with narratives reduces counterarguing; b) identification with the storyteller promotes credibility; c) emotional arousal enhances recall. These factors combine to promote the lasting adoption of outcome expectations, normative beliefs, and intentions that help prevent tobacco use.

Evidence – We randomly assigned 639 students at two low-income, predominantly Latino middle schools to receive either two TATU presentations or nutrition instruction from their physical education teacher. Our primary outcome was tobacco susceptibility, measured via survey at the beginning and end of the school year, before and after TATU presentations. Tobacco susceptibility captures future tobacco use risk based on Likert scale items that assess tobacco knowledge, outcome expectations, normative beliefs, and intentions. Intent-to-treat analyses indicate a small but significant reduction in tobacco susceptibility among intervention youth.

Conclusions – TATU is a compelling youth engagement strategy that has the potential to provide quality health education on a population level while building a cohort of experienced tobacco control advocates that can garner substantial media attention in policy change efforts.