We propose to develop, adapt, and pilot test a school-based tobacco use
prevention intervention for rural school children in which, as part of
an interscholastic competition, the children themselves develop tobacco-
use prevention messages and communicate them to their peers and adult
community members. In addressing the problems for this competition,
groups of 8 students will select a target audience, develop a prevention
message by researching tobacco use behavior with the help of a physician-
medical student mentorship team, and communicate the message back to the
target audience. The intervention will entail a competition between
schools to provide incentive for the students to perform at their highest
level and to offer a structure and incentive for widespread adoption of
the intervention by multiple districts. This approach will affect large
numbers of rural children over an extended period.
Our hypothesis is that the intervention will result in lower rates of
tobacco use in grades 4-10 students in comparison to students in control
schools. In this feasibility study, however, we wish to refine the
intervention and to perform a process evaluation of its acceptance in the
community. We will also measure intermediate markers of intention to
smoke as a means of assessing whether the intervention is likely to be
For the initial phase of this project, three predominantly-white, rural,
Vermont K-12 schools will participate, two in the competition and one as
a control school. We will survey tobacco use attitudes, intentions, and
behavior in grades 4-12 at the three sites in each of the 2 intervention
years and one year thereafter. To evaluate the feasibility of the
intervention, we will conduct focus groups among students, teachers, and
parents prior to and during the first competition year. Based on the
results of this process evaluation we will modify the intervention, and
implement it and evaluate its acceptance in years 3-4 in two rural North
Carolina schools in which a large proportion of students are African
American. At the end of the intervention period we will assess changes
in measures of intention to smoke among participants in both states based
on analyses of standardized questionnaires administered throughout the
Our ultimate goal is to use the results of this pilot study to design and
conduct a randomized study using a sufficiently large and diverse sample
of schools and a longer follow up period to assess whether tobacco use
is actually reduced by the intervention.
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