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Program Profile: Project Toward No Tobacco Use (Project TNT)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 15, 2011

Program Summary

A comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use in fifth through ninth grade youths. The program is rated Promising. At a 2-year follow-up, participants reported lower trial and weekly use of cigarettes.

Program Description

Program Goals
Project Toward No Tobacco Use (Project TNT) is a comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use. It is devised to counteract several different risk factors for tobacco use simultaneously, because the behavior is associated with multiple risk factors.

Target Population
Project TNT targets a wide variety of youths who may have different risk factors influencing their tobacco use. It is designed for fifth through ninth grade youths (ages 10–14).

Program Components
Project TNT teaches awareness of misleading social information, develops skills that counteract social pressure to use tobacco, and provides information about the physical consequences of tobacco use, such as addiction.

Implementing Project TNT involves the following activities:
  • A comprehensive, 10-day, classroom-based, social-influences program—plus two booster sessions—that examines media, celebrity, and peer portrayal of tobacco use
  • Training in active listening, effective communication, and general assertiveness development, along with methods for building self-esteem
  • Education on the course of tobacco-related addiction and diseases; correction of inflated tobacco-use prevalence estimates
  • Education on tobacco-specific, cognitive coping skills, and assertive refusal techniques; practicing ways to counteract media portrayals of tobacco use, including social-activism letter-writing to make a public commitment to not using tobacco products
  • Use of homework assignments, a classroom competition (i.e., the “TNT Game”), and a two-lesson booster program
  • Longitudinal assessment material
Key Personnel
Trained teachers in a classroom setting deliver Project TNT to standard class sizes.

Evaluation Outcomes

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Study 1

Substance Use

Results from immediate posttest to 1-year follow-up for the five groups were as follows:

  • For both trial and weekly use of cigarettes, the informational social influence group, physical consequences, and combined groups were superior to the normative and control groups.

  • For trial of smokeless tobacco, two of the three intervention groups were superior to the informational social influence and control groups.

  • For weekly use of smokeless tobacco, the combined condition was superior to all other conditions.

A 2-year follow-up (Dent and colleagues 1995) analyzed data for subjects when they were ninth graders and reported maintenance of initial intervention effects (lower trial and weekly use of cigarettes) in the combined and physical consequences groups and lower weekly use of smokeless tobacco for the combined condition.

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Evaluation Methodology

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Study 1

Sussman, Dent, and colleagues (1993) used a five-group, randomized, experimental block design. Forty-eight schools from 27 Southern California school districts were randomly assigned within blocks defined by region (urban, rural), school type (middle school with sixth through eighth grades, junior high with only seventh through eighth grades), and a composite variable. Eight schools were assigned to each of the four program conditions. Three of these curricula were designed to counteract the effects of separate (single) program components (normative social influence, informational social influence, or physical consequences), whereas a fourth (comprehensive curriculum Project TNT) was designed to counteract all three effects. In each of the four program conditions, four schools were urban and four rural. The control condition, eight urban and eight rural schools) were assigned to a “standard” curriculum control condition in which students received routine prevention activities provided directly by their school. These activities included assemblies that presented values clarification material, long-term physical consequences information, or simple “just say no to drugs” messages. Control schools did not provide programming specifically for tobacco-use prevention.

 

To determine outcomes, data was captured for both groups through an in-class, 20-page, self-report questionnaire. A total of 6,716 seventh grade students provided posttest data on the school day immediately after they completed a 10-day curriculum. Fifty percent of the students were male. Regarding ethnic composition, 60 percent were white, 27 percent Hispanic, 7 percent African American, and 6 percent Asian American or other. A total of 7,052 students provided 1-year follow-up data. Two-year follow-up data collected from 7,219 ninth grade students was reported by Dent and colleagues (1995).  All data was aggregated to the school as the unit of analysis at each time point.

 

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Cost

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Information on material and training costs can be found on the University of Southern California’s Project Toward No Tobacco Use Web site under the Cost & Order page (Project Toward No Tobacco Use, N.d.). See the Additional References section for Web site details.
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Implementation Information

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Project Toward No Tobacco Use is implemented in ten 40- to 50-minute lessons delivered in a two to four-week period with two additional booster sessions one year later.

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Sussman Steven Y., Clyde W. Dent, Alan W. Stacy, Ping Sun, Sande Craig, Thomas R. Simon, Dee Burton, and Brian R. Flay. 1993. “Project Toward No Tobacco Use: 1-Year Behavior Outcomes.” American Journal of Public Health 83:1245–50.
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Additional References

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These sources were used in the development of the program profile:

Dent, Clyde W., Steven Y. Sussman, Alan W. Stacy, Sande Craig, Dee Burton, and Brian R. Flay. 1995. “Two-Year Behavior Outcomes of Project Toward No Tobacco Use.” Journal of Consulting and Clinical Psychology 63(4):676–77.

Gingiss, Phyllis M., Melynda Boerm, and Cynthia Roberts–Gray. 2006. “Follow-Up Comparisons of Intervention and Comparison Schools in a State Tobacco Prevention and Control Initiative.” Journal of School Health 76:98–103.

Guilamo–Ramos, Vincent, James Jaccard, Patricia Dittus, Bernardo Gonzalez, Alida Bouris, and Stephen Banspach. 2010. “The Linking Lives Health Education Program: A Randomized Clinical Trial of a Parent-Based Tobacco Use Prevention Program for African American and Latino Youths.” American Journal of Public Health 100(9):1641–47.

Meshack, Angela F., Shaohua Hu, Unto E. Pallonen, Alfred L. McAlister, N. Gottlieb, and Philip P. Huang. 2004. “Texas Tobacco Prevention Pilot Initiative: Processes and Effects.” Health Education Research 19(6):657–68. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)

Metz, Arnold E. Jr., Bernard F. Fuemmeler, and Ronald T. Brown. 2006. “Implementation and Assessment of an Empirically Validated Intervention Program to Prevent Tobacco Use Among African American Middle-School Youth.” Journal of Clinical Psychology in Medical Settings 13:229–38.

Rice, Virginia Hill, Linda S. Weglicki, Thomas N. Templin, Hikmet Jamil, and Adnan Hammad. 2010. “Intervention Effects on Tobacco Use in Arab and Non–Arab American Adolescents.” Addictive Behaviors 35(1):46–4.

Sussman, Steven Y. (ed.). 2001. Handbook of Program Development in Health Behavior Research and Practice. Thousand Oaks, Calif.: Sage Publications.

Sussman, Steven Y., Clyde W. Dent, Alan W. Stacy, Dee Burton, and Brian R. Flay. 1995. Developing School-Based Tobacco Use Prevention and Cessation Programs. Thousand Oaks, Calif.: Sage Publications.

Sussman, Steven Y., Clyde W. Dent, Alan W. Stacy, Carol S. Hodgson, Dee Burton, and Brian R. Flay. 1993. “Project Toward No Tobacco Use: Implementation, Process, and Posttest Knowledge Evaluation.” Health Education Research Theory and Practice 8(1):109–23.

Sussman, Steven Y., Alan W. Stacy, Clyde W. Dent, Dee Burton, and Brian R. Flay. 1993. “Refusal Assertion Versus Conversational Skill Role-Play Competence: Relevance to Prevention of Tobacco Use.” Statistics in Medicine 12:365–76.

Tengs, Tammy O., Nathaniel D. Osgood, and Laurie L. Chen. 2001. “The Cost-Effectiveness of Intensive National School-Based Antitobacco Education: Results From the Tobacco Policy Model.” Preventive Medicine 33:558–70.

University of Texas, Houston, School of Public Health. 2001. Texas Tobacco Prevention Initiative Media Campaign and Community Program Effects Among Children and Adults. Report to the Texas Legislature prepared by the Center for Health Promotion and Prevention Research at the University of Texas, School of Public Health, and the Center for Chronic Disease Prevention at the Baylor College of Medicine in collaboration with the Texas Tobacco Prevention Initiative Research Consortium.
http://www.dshs.state.tx.us/tobacco/reports/uthsc/Rep2.pdf

Wang, Li Yan, Linda S. Crossett, Richard Lowry, Steven Y. Sussman, and Clyde W. Dent. 2001. “Cost-Effectiveness of a School-Based Tobacco-Use Prevention Program.” Archives of Pediatrics and Adolescent Medicine 155:1043–50.

Project Toward No Tobacco Use. N.d. “Cost & Order.”
http://tnd.usc.edu/tnt/order.php
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Program Snapshot

Age: 10 - 14

Gender: Both

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White

Geography: Rural, Suburban, Urban

Setting (Delivery): School

Program Type: Classroom Curricula, Alcohol and Drug Prevention

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices, What Works Clearinghouse, Guide to Community Preventive Services

Program Developer:
Steve Sussman
Professor of Preventive Medicine and Psychology
University of Southern California, Institute for Health Promotion and Disease Prevention Research
Soto Street Building, Room 302, 2001 N. Soto Street
Los Angeles CA 90032
Phone: 323.442.8220
Fax: 323.442.8201
Website
Email

Training and TA Provider:
Leah Meza
Program Manaager
University of Southern California, Institute for Health Promotion and Disease Prevention Research
Soto Street Building, Room 302, 2001 N. Soto Street
Los Angeles CA 90032
Phone: 1.800.400.8461
Fax: 323.442.8201
Website
Email

Training and TA Provider:
ETR Associates
4 Carbonero Way
Scotts Valley CA 95066
Phone: 1.800.321.4407
Fax: 800.435.8433
Website