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Project Toward No Tobacco Use (Project TNT) is a comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use in 5th through 10th grade youths (ages 10–15). 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 five-group, randomized, experimental block design was used to evaluate Project TNT. 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, while four were rural. In the control condition, eight schools were urban, and eight were rural. Conversely, 16 schools were assigned to a “standard” curriculum control condition. Students in the control condition received routine prevention activities provided directly by their school. These activities generally were limited to 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, and 7,219 students provided 2-year follow-up data.
Project Toward No Tobacco Use appears to promote decreases in substance use along with other types of outcomes. For instance, students in Project TNT reduced initiation of cigarette smoking by about 26 percent over the control group when 1- and 2-year follow-up outcomes were averaged together. Initiation of smokeless tobacco use was reduced by about 30 percent. Weekly or more frequent cigarette smoking by students in the Project Toward No Tobacco Use group was reduced by about 60 percent, and weekly or more frequent smokeless tobacco use was eliminated. Other outcomes include the students’ ability to describe the course of tobacco addiction and related diseases; demonstrate effective communication, refusal, and cognitive coping skills; identify how the media and advertisers influence youth to use tobacco products; and identify methods for building their self-esteem.
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.
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, C.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.
Steve Sussman, Ph.D., FAAHB
Institute for Health Promotion and Disease Prevention
1000 South Fremont Avenue, Unit 8, Building A–4, Room 6129
Department of Preventive Medicine, University of Southern California
Alhambra, CA 91803
Phone: (626) 457-6635
Fax: (626) 457-4012
E-mail: ssussma@usc.edu
Stephen Hauk
Institute for Health Promotion and Disease Prevention
Department of Preventive Medicine, University of Southern California
1000 South Fremont Avenue, Unit 8, Building A–4, Room 6129
Alhambra, CA 91803
Phone: (626) 457-4045
Fax: (626) 457-4012
E-mail: Hauk@usc.edu
