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Intervention Summary

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Project Towards No Tobacco Use

Project Towards No Tobacco Use (Project TNT) is a classroom-based curriculum that aims to prevent and reduce tobacco use, primarily among 6th- to 8th-grade students. The intervention was developed for a universal audience and has served students with a wide variety of risk factors. Designed to counteract multiple causes of tobacco use simultaneously, Project TNT is based on the theory that youth will be better able to resist tobacco use if they are aware of misleading information that facilitates tobacco use (e.g., pro-tobacco advertising, inflated estimates of the prevalence of tobacco use), have skills that counteract the social pressures to obtain approval by using tobacco, and appreciate the physical consequences of tobacco use.

Project TNT comprises 10 core lessons and 2 booster lessons, all 40-50 minutes in duration. The core lessons are designed to be taught over a 2-week period but may be spread out over as long as 4 weeks. Booster lessons, which are taught 1 year afterward, are intended to be delivered over 2 consecutive days but may be taught 1 week apart. The curriculum uses a wide variety of activities to encourage student involvement and participation. Activities include games, videos, role-plays, large and small group discussion, use of student worksheets, homework assignments, activism letter writing, and a videotaping project. The two-lesson booster program summarizes previously learned material and discusses how this material might be used in daily living.

Descriptive Information

Areas of Interest Substance abuse prevention
Substance abuse treatment
Outcomes Review Date: September 2007
1: Tobacco use
2: Cost-effectiveness
Outcome Categories Cost
Tobacco
Ages 6-12 (Childhood)
13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Project TNT has reached approximately 50,000 students involved in experimental trials and other implementations. The developer has conducted at least 88 evaluations of independent Project TNT implementations and estimates that approximately 20 additional evaluations have been conducted. The longest continuous implementation of Project TNT is at least 4 years.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: September 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Dent, C. W., Sussman, S., Stacy, A. W., Craig, S., Burton, D., & Flay, B. R. (1995). Two-year behavior outcomes of Project Towards No Tobacco Use. Journal of Clinical and Consulting Psychology, 63(4), 676-677.  Pub Med icon

Sussman, S., Dent, C. W., Burton, D., Stacy, A. W., & Flay, B. R. (1994). Developing school-based tobacco use prevention and cessation programs. Thousand Oaks, CA: Sage.

Sussman, S., Dent, C. W., Stacy, A. W., Hodgson, C. S., Burton, D., & Flay, B. R. (1993). Project Towards No Tobacco Use: Implementation, process and post-test knowledge evaluation. Health Education Research, 8(1), 109-123.  Pub Med icon

Sussman, S., Dent, C. W., Stacy, A. W., Sun, P., Craig, S., Simon, T. R., et al. (1993). Project Towards No Tobacco Use: 1-year behavior outcomes. American Journal of Public Health, 83(9), 1245-1250.  Pub Med icon

Wang, L. Y., Crossett, L. S., Lowry, R., Sussman, S., & Dent, C. W. (2001). Cost-effectiveness of a school-based tobacco-use prevention program. Archives of Pediatrics and Adolescent Medicine, 155(9), 1043-1050.  Pub Med icon

Supplementary Materials

Meshack, A. F., Hu, S., Pallonen, U. E., McAlister, A. L., Gottlieb, N., & Huang, P. (2004). Texas Tobacco Prevention Pilot Initiative: Processes and effects. Health Education Research, 19(6), 657-668.  Pub Med icon

Project TNT, University of Southern California. (1998). Project Towards No Tobacco Use student workbook. Santa Cruz, CA: ETR Associates.

Outcomes

Outcome 1: Tobacco use
Description of Measures Tobacco use was measured using a self-report questionnaire assessing lifetime tobacco use and frequency of use.
Key Findings The study assigned 48 junior high schools to one of four Project TNT treatment conditions or a usual care control condition. One Project TNT treatment condition exposed students to the full Project TNT curriculum. The other treatment conditions tested independent implementations of three Project TNT curriculum components targeting factors that influence tobacco use: normative social influence (e.g., peer offers to use tobacco as a form of acceptance), informational social influence (e.g., advertising or pro-tobacco-use statements by peers), and knowledge of the physical consequences of tobacco use. Students in the usual care control condition were exposed to the typically occurring antitobacco efforts implemented in their schools.

From posttest to 1-year follow-up:

  • Although tobacco use generally increased in the sample, students in the physical consequences, informational social influence, and full curriculum conditions showed smaller increases in trial cigarette use (6.1%, 7.1%, and 7.3%, respectively) than students in the control and normative social influence conditions (9.3% and 10.2%, respectively) (p < .05).
  • Students in the full curriculum, physical consequences, and informational social influence conditions showed smaller increases in weekly cigarette use (2.0%, 2.6%, and 3.2%, respectively) than students in the normative social influence and control conditions (5.3% and 5.6%, respectively) (p < .05).
  • Students in the full curriculum, physical consequences, and normative social influence conditions showed smaller increases in trial smokeless tobacco use (1.7%, 2.4%, and 2.6%, respectively) than students in the informational social influence and control conditions (3.5% and 4.1%, respectively) (p < .05).
  • While students in the full curriculum condition showed a decrease in weekly smokeless tobacco use (0.4%), use increased among students in the normative social influence, informational social influence, control, and physical consequences conditions (0.3%, 0.5%, 0.5%, and 0.6%, respectively) (p < .05).
From posttest to 2-year follow-up:

  • Although tobacco use generally increased in the sample, students in the physical consequences, informational social influence, full curriculum, and normative social influence conditions showed smaller increases in trial cigarette use (13%, 15%, 16%, and 17%, respectively) than students in the control condition (23%) (p < .05).
  • Students in the full curriculum condition also showed smaller increases in weekly cigarette use (4%) than students in the control group (9%) (p < .05).
  • While students in the physical consequences condition showed no change in trial use and a decrease in weekly use (1%) of smokeless tobacco, students in the control condition showed an increase in use (7% and 1%, respectively) (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 2: Cost-effectiveness
Description of Measures Data were collected to estimate life years (LYs) saved, quality-adjusted life years (QALYs) saved, and lifetime medical costs saved, discounted 3% annually as recommended by the Panel on Cost-Effectiveness in Health and Medicine. Program costs incurred during the 2-year implementation of Project TNT were included as intervention costs. All costs were in 1990 dollars to correspond with the time of the intervention. The cost-effectiveness of Project TNT was compared with that of the control scenario and was assessed in terms of the cost per LY saved and the cost per QALY saved.
Key Findings The base-case analysis estimated that the intervention cost $16,403 ($13.29 per student) and that the full Project TNT intervention would prevent 34.9 students from becoming established smokers. As a result, society could expect to save $327,140 in medical care costs, with a total of 23.3 discounted LYs saved and a total of 36.6 discounted QALYs saved. These data translated into a cost savings of $13,316 per LY saved and $8,482 per QALY saved. When medical costs were excluded from the analysis, the estimated intervention cost was $703 per LY saved and $448 per QALY saved.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 6-12 (Childhood)
13-17 (Adolescent)
50% Female
50% Male
60% White
27% Hispanic or Latino
7% Black or African American
6% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Tobacco use 3.5 3.5 2.5 3.5 3.5 3.5 3.3
2: Cost-effectiveness 3.5 3.5 3.0 3.5 3.5 3.5 3.4

Study Strengths

The program makes use of a curriculum-based intervention model. Pilot study data were used to fine-tune the measures to ensure their relevance to the population. The cost-effectiveness analysis used a systematic process.

Study Weaknesses

Some of the schools in the study had other drug prevention programs in place during the time of the Project TNT intervention, which may have affected the findings. For the cost-effectiveness outcome, the estimates of tobacco use were based on staff estimates and pilot data.

Readiness for Dissemination
Review Date: September 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Evaluation forms:

  • Project TNT Implementation Evaluation
  • Project TNT Quality Assurance/Process Evaluation Measures
  • Project TNT School Staff Survey
  • Project TNT Session Evaluation Form: Teacher Self-Report
  • Project TNT Session Observation Form

Program Web site, http://tnd.usc.edu/tnt/

Sussman, S., Barovich, M., Hahn, G., Abrams, C., Selski, E., & Craig, S. (2004). Project Towards No Tobacco Use student workbook. Scotts Valley, CA: ETR Associates.

Sussman, S., Barovich, M., Hahn, G., Abrams, C., Selski, E., & Craig, S. (2004). Project Towards No Tobacco Use teachers guide. Scotts Valley, CA: ETR Associates.

SVE & Churchill Media. (1987). Stand up for yourself: Peer pressure and drugs [VHS]. Chicago, IL: Authors.

University of Southern California Institute for Prevention Research. (n.d.). Tobacco use social images [VHS]. Los Angeles: University of Southern California.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 4.0 4.0 4.0

Dissemination Strengths

Program materials are well organized and formatted for uncomplicated, real-time implementation. Training is offered by the developer in 1- and 2-day formats and can be arranged for delivery at either the program developer's or the implementer's site. The developer provides customized technical assistance and support to implementers. Process and outcome measures are provided with evaluation guidance to support quality assurance.

Dissemination Weaknesses

No weaknesses were identified by reviewers.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Teacher's guide $45 each Yes
Student workbook $19 for five Yes
Tobacco Use Social Images video $40 each No
Stand Up for Yourself: Peer Pressure and Drugs video $80 each No
Developing School-Based Tobacco Use Prevention and Cessation Programs (book) $61 each No
1-day, on-site training $1,100-$1,300 for up to 25 participants, plus travel expenses No
2-day, on-site training $1,800-$2,000 for up to 25 participants, plus travel expenses No
Student surveys Free No
Contact Information

To learn more about implementation, contact:
Leah Meza
(800) 400-8461
leahmedi@usc.edu

To learn more about research, contact:
Steve Sussman, Ph.D.
(323) 442-8220
ssussma@usc.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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