Both cigarette and smokeless tobacco use are popular among youth, with the use of smokeless tobacco increasing dramatically in recent years. Both types of tobacco use are serious public health problems. Smoking prevention programs have proven to be effective with youth, but few have been conducted with youth who are at high risk for tobacco use. Furthermore, these smoking prevention programs have included little or no emphasis on smokeless tobacco. It is not known whether methods effective for smoking prevention would be effective for smokeless tobacco prevention as well. The proposed research program will (1) investigate the efficacy of tobacco prevention methods with youth residing in a high tobacco production area who have high rates of tobacco usage, (2) examine the effectiveness of smoking prevention methods when these methods are applied to the prevention of smokeless tobacco, and (3) determine how the implementation of a smoking-only prevention educational unit affects smokeless tobacco use. It is possible that teaching smoking prevention with little mention of smokeless tobacco may encourage youth to switch to smokeless tobacco. The long-term goal of this project is to identify effective smoking and smokeless tobacco prevention methods and ultimately to reduce the usage of both types of tobacco among central Kentucky youth. This study will be implemented in a high tobacco-production area where youth are at high risk for tobacco use. An NCI study found that 90% of non metro high school boys in this area had tried one or more smokeless tobacco products and 33% had used at least one of these products in the last 6 days. A survey will be administered to all 7th grade students (N=3,326) in 12 central Kentucky counties. Saliva samples will be collected and a portion of these will be analyzed for cotinine and thiocyanate to validate students' self-reported tobacco usage. The 12 counties will be divided into four strata of 3 counties each using baseline levels of tobacco usage. Treatments will be randomly assigned to one county within each stratum. Treatment groups will be (1) health education as usual control, (2) smoking-only intervention unit, and (3) smoking and smokeless tobacco intervention unit. Follow-up surveys and saliva samples will be repeated in all counties immediately following the intervention and at 6 and 18 month post intervention.
