Project Toward No Tobacco Use (OJJDP Model Program Guide)

Office of Justice Programs, Innovation - Partnerships – Safer Neighborhoods

Office of Juvenile Justice and Delinquency Prevention (OJJDP) Serving Children, Families and Communities

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Project Toward No Tobacco Use

Intervention:

Project Towards No Tobacco Use (Project TNT) is a comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use in 5th through 9th grade youths (ages 10–14). It is devised to counteract several different causes of tobacco use simultaneously, because the behavior is determined by multiple causes. Project TNT works well for a wide variety of youths who may have different risk factors influencing their tobacco use. It 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.

Virtually any school or school district can implement Project TNT. Trained teachers in a classroom setting deliver it to standard class sizes. 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

Evaluation Methodology:

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.

Evaluation Outcome:

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.

Other Information:

Costs: 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: http://tnd.usc.edu/tnt/order.php

In addition, Wang and colleagues (2001) determined the cost-effectiveness of Project Towards No Tobacco Use. Using data from the previously reported 2-year efficacy study of the Project Towards No Tobacco Use (TNT), they conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life years (LYs) saved, quality-adjusted life years (QALYs) saved, and medical care costs saved, discounted at 3 percent. The costs measured were program costs. They quantified TNT’s cost-effectiveness as cost per LY saved and cost per QALY saved. The efficacy evaluation was based on 770 ninth-grade students who participated in the program in the seventh and eighth grades and in both the baseline and the 2-year follow-up survey. Under base case assumptions, at an intervention cost of $16,403, TNT prevented an estimated 34.9 students from becoming established smokers. As a result, one could expect a savings of $13,316 per LY saved and a savings of $8,482 per QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates. TNT appeared to be highly cost effective compared with other widely accepted prevention interventions.

Tengs, Osgood, and Chen (2001) evaluated the cost-effectiveness of enhanced nationwide school-based antitobacco education relative to the status quo, using Project TNT as the model. To estimate cost effectiveness, they created the Tobacco Policy Model, a system dynamics computer–simulation model. The model relies on secondary data and is designed to calculate the expected costs and public health gains of any tobacco policy or intervention over any timeframe. Over 50 years, cost effectiveness was estimated to fall between $4,900 and $340,000 per QALY, depending on the degree and longevity of program effectiveness. Assuming a 30 percent effectiveness that dissipates in 4 years, cost-effectiveness is $20,000/QALY. Sensitivity analysis revealed that cost effectiveness varies with cost, survival, and quality-of-life estimates but cost effectiveness ratios, generally, remain favorable. Although not cost saving, a much more intensive school-based antitobacco educational effort would be an economically efficient investment for the Nation.

References:

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.

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.

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):46–48.

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., Clyde W. Dent, Alan W. Stacy, Ping Sun, Sande Craig, T.S. 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.

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.

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.

Program Specification:

New Rating:

Promising

Re-reviewed Date:

June 2011

Program Type:

Classroom Curricula

Ethnicity:

Asian

African American

Hispanic or Latino (of any race)

White

Gender:

Both

Age:

10 - 14

Target Settings:

Rural

Suburban

Urban

Problem Behaviors:

Alcohol,Tobacco and Other Drug Use

Risk & Protective Factors:

Risk

Community

Availability of alcohol and other drugs

Family

Family history of problem behavior / Parent criminality

Family management problems / Poor parental supervision and/or monitoring

Individual

Antisocial behavior and alienation / Delinquent beliefs / General delinquency involvement / Drug dealing

Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use

Poor refusal skills

Peer

Peer alcohol, tobacco, and/or other drug use

Peer rejection

Protective

Community

Prosocial opportunities for participation / Availability of neighborhood resources

Individual

Healthy / Conventional beliefs and clear standards

Positive / Resilient temperament

Self-efficacy

Social competencies and problem solving skills

Peer

Involvement with positive peer group activities

School

High quality schools / Clear standards and rules

Additional Information:

CDC

SAMHSA: NREPP

Department of Education

NIDA: Preventing Drug Abuse

Status:

Program is in operation at this time.

Performance Measures:

Suggested OJJDP Performance Measures for the Program Types(s):

Delinquency Prevention
Classroom Curricula
Logic Model: PDF
Performance Matrix:PDF
School Programs
Classroom Curricula
Logic Model: PDF
Performance Matrix:PDF

Contact Information:

Program Developer:
Steve Sussman, Ph.D., FAAHB
University of Southern California, Institute for Prevention Research
1000 South Fremont Avenue, Unit 8
Alhambra, CA 91803
Phone: 1.626.457.6635
Fax: 1.626.457.4012
Email: Click Here
Website: Click Here

Training & TA Provider:
ETR Associates
4 Carbonero Way
Scotts Valley, CA 95066
Phone: 1.800.321.4407
Fax: 1.800.435.8433
Email: Click Here
Website: Click Here

Leah Meza
University of Southern California, Institute for Prevention Research
1000 South Fremont Avenue, Unit 8
Alhambra, CA 91803
Phone: 1.800.400.8461
Fax: 1.626.457.5856
Email: Click Here
Website: Click Here

Program Locations:
Dr. Angela F. Meshack
Center for Health Promotion & Prevention Research
7000 Fannin Street
Houston, TX 77030–5400

Leslie Schmarlzried
Prevention Concepts, Inc.
909 E. Second Avenue, Suite G
Indianola, IA 50125