Long-term efficacy of click city(r): tobacco: a school-based tobacco prevention program.

ABSTRACT

INTRODUCTION: Click City (®) Tobacco is an innovative, computer-based tobacco prevention program designed to be implemented in 5th-grade classrooms with a booster in 6th grade. The program targets etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was empirically evaluated to assure that it changed its targeted mechanism. This paper describes long-term outcomes for students who participated in a randomized controlled efficacy trial of the program. METHODS: A total of 26 middle schools were stratified and randomly assigned to the Click City (®) Tobacco program or Usual Curriculum. The 47 elementary schools that fed into each middle school were assigned to the same condition as their respective middle school. In Click City (®) Tobacco schools, 1,168 students from 24 elementary schools and 13 middle schools participated. In Usual Curriculum schools, 1,154 students from 23 elementary schools and 13 middle schools participated. All participating students completed baseline, post-6th grade program, and 7th grade assessments. RESULTS: As compared to students in schools that continued with their usual curriculum, intentions and willingness to smoke increased less from baseline to 6th grade and from baseline to 7th grade, among students in schools that used the Click City (®) Tobacco curriculum. Changes in mechanisms were also in the expected direction. The program was particularly efficacious for at-risk students. CONCLUSIONS: Results provide evidence to support the long-term efficacy of Click City (®) Tobacco. Program development, based on an empirical evaluation of each component, most likely played a role in the success of the program.