Kentucky Adolescent Tobacco Prevention Project

In the area of tobacco prevention, a high-risk group that has not been widely studied is youth who live in tobacco-raising areas. Rural youth, youth residing in tobacco-raising households, and young people who personally raise tobacco are at elevated risk for tobacco use. Because these young people begin tobacco use very early, they have high usage rates, and will be major contributors to increased future morbidity and mortality due to tobacco use. Programs effective in preventing tobacco use among this group are sorely needed.

The program aims to prevent tobacco use among adolescents living in high tobacco production areas through a social-influences intervention. The Kentucky Adolescent Prevention Project is a 6-session program that includes: skills training (learning to recognize types of peer pressure, refusal skills, and assertiveness); recognizing and countering advertising appeals; and use of trained peer leaders. In the program, students pledge not to use tobacco and they learn about the negative consequences for using tobacco, including immediate physical consequences. Special attention is given to such undesirable social consequences as stained teeth, bad breath, and holes burned in clothes. The program also includes three booster sessions to reinforce earlier concepts.

Each of the six sessions lasts 45 to 50 minutes.

Participants were middle school youth from 19 rural schools in Kentucky residing in counties that produce an average of 7.7 million pounds of tobacco annually. The average age of the participants was 12.4 years; 92% of the sample was White and 6% were Black.

This intervention is suitable for a school setting.

The Kentucky Adolescent Tobacco Prevention Project curriculum, with six sessions for delivery in Grade 7 and three booster sessions for delivery in Grade 8, is required. The training outline for teachers and the Peer Leader Manual is also required.

Three videotapes were used in the original intervention and are not required for its implementation. If desired, the videos may be acquired from the following sources:

• "If I'm Lying, I'm Dying (A Program About Smoking)" from Disney Educational Productions (no longer available)
• "Big Dipper" from InterVision Media: 1-800-678-3455. $59.95 +$7.50 s/h. Shipped UPS ground. www.intervisionmedia.com
• "Stand Up for Yourself - Peer Pressure and Drugs" from SVE: 1-800-829-1900. Cost: $79.95 + $5.60 s/h. Shipped FedEx Ground. www.svemedia.com

For the intervention study, 19 schools were randomly assigned to receive the educational intervention, Kentucky Adolescent Tobacco Prevention Project, or health education classes as usual. Participants in the intervention group received six sessions of social-influences program in the seventh grade and three booster sessions in the eighth grade. The seventh grade sessions were delivered by trained classroom teachers, and the booster sessions were delivered by trained educators who were part of the research staff. In addition to youths' self-reports on smokeless tobacco and cigarette use, samples of expired air were tested for carbon monoxide.

Results indicated:

• One year after delivery of the booster sessions, youth in the intervention group had lower 24-hour, 7-day, and 30-day smoking, compared to youth in the control group.
  
• Among the subset of youth directly involved in raising tobacco, intervention effects were even stronger for 24-hour, 7-day, and 30-rates. Differences between the treatment and control groups were 23%, 21%, and 23% respectively for 24-hour, 7-day, and 30-day smoking. For youth involved in tobacco raising, these differences increased to 30%, 25%, and 29%, respectively.
• No program effects were seen for smokeless tobacco.