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 effective. 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 study. 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.
