Initial Evaluation of the Tobacco Prevention Toolkit, a New Online and Free Theory-Based and Evidence-Informed Curriculum

Introduction: We are assessing the effectiveness of The Tobacco Prevention Toolkit, a new online and free theory-based and evidence-informed curriculum aimed at preventing middle and high school students’ use of cigarettes, cigars/cigarillos, chew, hookah, marijuana, and electronic cigarettes. The Toolkit (tobaccopreventiontoolkit.stanford.edu) contains information, slide presentations, worksheets, activities, and fun quizzes on the history of and trends in tobacco use, immediate and long-term health risks of tobacco, effects of nicotine and nicotine addiction including its impact on the developing adolescent brain, the appeal of tobacco including marketing and flavors, and ways to resist using tobacco. The Toolkit also includes resources and information on Positive Youth Development, and resources for parents.

Methods: We are conducting the initial outcomes evaluation of the Toolkit using a pre-post design. The Toolkit is being implemented among adolescents aged 11 - 18 (grades 6-12) from middle schools, high schools, and youth-serving organizations in California and throughout the country. Data collection is ongoing and by Spring 2018 we will have data to present from at least 10 schools and organizations in addition to the data from the five high schools reported below. The ultimate effect of the intervention will be evaluated using random effects generalized linear mixed modeling and difference-in-differences estimation.

Preliminary Results: In 2016-17, five high schools completed the pre-program survey (n=375 students), participated in the Toolkit curriculum, and then completed the post-program survey (n=330 students). Preliminary results showed that past 30-day use of cigarettes decreased 7.6% (from 6.5% to 6%); vaping decreased 6.8% (from 19.1% to 17.8%); and snuff/chew decreased 53% (from 5.8% to 2.7%). The proportion reporting perceived risk for harming themselves, physically or in other ways, by using e-cigarettes or other vapor-emitting devices increased by 2.1% and for cigarettes by 2.5%. The percentage of students reporting knowledge of health effects of tobacco use increased by 32.8% (from 50.9% to 67.6%) and knowledge of environmental effects of tobacco use increased by 15% (from 67.2% to 77.3%).

Conclusions: Preliminary evidence suggests the Toolkit is effective in changing high school students’ knowledge of, attitudes towards, and current use of different tobacco products including e-cigarettes. Additional data will provide further information on which aspects of knowledge, attitudes, intentions and behavior are changing. These findings suggest that the Toolkit is an effective curriculum for use in middle and high schools.