The Preventing Tobacco Use Across Culture Study will develop and test culturally relevant tobacco use prevention programs for middle and high school youth of the largest and highest risk immigrant populations in California. Study 1 starts with a trial already underway to assess a middle school smoking prevention program designed for California's largest immigrant youth population, those from the Pacific Rim cultures of Mexico, Central and South American, China, and the Philippines. The study proposed here will add a fifth group, youth of Pacific Island cultures who have the highest rate of smoking among youth in California. This study will also add interventions to prevent progression to regular and addictive use at the high school level, and prevent uptake among those who reached high school without smoking. The study will track tobacco use uptake and progression through grade 11 using a variety of questionnaire and bio-marker measures, and relate uptake and program effectiveness to various dimensions of culture and acculturation. Study 2 is a trial in Wuhan, China to assess in a relatively homogenous indigenous population a program found to be effective in preventing smoking among American youth. Because of the strong pro-smoking norms in China together with relatively low levels of western influence in the culture, this trial will provide a rigorous test of the cultural university of a western-based prevention program. The measures are the same, and the study mirrors the experimental design of study 1. Together these studies will inform program development of cultural associations with smoking in both heterogeneous and homogeneous settings, and test the cultural limitations of a state of the art program developed largely from a Western perspective for California's largest and highest risk immigrant/resident populations.
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