The investigators propose a five year school based project that meets the criteria for a cutting edge prevention with high risk, rural youth. In contrast to the comparison group, these youth will consume more foods that reflect low fat and high fiber choices as well as choose not to initiate tobacco use. The innovative and interactive cancer prevention program that the investigators propose to use is based in theory and research and builds upon an existing life skills program -- Going for the Goal (GOAL). GOAL is an interactive, school-based life skills program taught by high school students to middle school student; it is designed to increase the ability of sixth graders to make choices that promote their long term health. The skills taught include how to identify positive life goals; how to identify and engage in health promoting behaviors that can facilitate goal attainment; how to identify and avoid health compromising behaviors that can impede goal attainment; how to construct step- by-step plans to reach goals; how to create and utilize social support; and how to transfer these skills from one life context to another. By focusing specifically on diet and tobacco use in the enhanced GOAL Program, the sixth graders will learn how to make life choices and goals for health. Twenty-two schools in rural Virginia and New York will be randomly assigned to either intervention or control groups. The key behaviors (as well as relevant attitudes and knowledge) of diet and tobacco use will be assessed both prior to and following the intervention (immediately post, and one- and two-year follow- ups). The intervention program will consist of (1) twelve peer- led classroom sessions based on the GOAL Program and implemented during the sixth grade; (2) six teacher-led classroom sessions based on a social influence smoking prevention program in the seventh grade; and (3) six teacher-led classroom sessions based on GOAL in the seventh grade, as well. Several different evaluations strategies will be used to investigate the impact of the intervention on eating and tobacco behaviors, as well as the behavioral, attitudinal, cognitive and environmental factors influenced by the intervention. The impact of the intervention will be assessed by observed food choices in the cafeteria, several carefully crafted self reported measures of dietary intake and self- and parent-reported tobacco use. This project will contribute to the ability to prevent cancer in rural populations by creating a non-intrusive cancer prevention program based on life skills that not only impacts cancer-related behaviors, but extends to other health behaviors as well. This program can be delivered in the future with minimal support from sources outside the school.
