Assessing the Pragmatic Effectiveness and Implementation of Click City: Tobacco: A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use
Abstract
Introduction: Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use.
Methods: To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th-grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum.
Results: Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (before COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 1,346 participants or records.
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