Tobacco Use
Conditions
Keywords
e-cigarettes, prevention, middle school, smoking
Brief summary
The goal of this study is to modify a smoking prevention program for 5th and 6th grade students to also target vaping e-cigarettes. Aims were to modify the program along with associated materials and to conduct a trial with 5th grade students in the school setting to see how well the updated program worked. Students either participated in the four-week computer based program or continued with their usual tobacco prevention curriculum. This study showed that students who received the computer program reduced their intentions and willingness to use e-cigarettes or smoke in the future more than did students who used their usual tobacco curriculum.
Detailed description
Given the increase in prevalence of e-cigarette use among youth, investigators modified a smoking prevention program to not only target smoking but also vaping e-cigarettes. Investigators conducted a pragmatic randomized trial with 5th grade students in schools across Arizona and Oregon to evaluate the effectiveness of the updated program in a real-world setting. Forty-five schools were randomized to the intervention condition, wherein students used the updated version of Click City®: Tobacco, or the control condition, wherein students were taught their usual tobacco prevention curriculum. Students in the intervention schools decreased their intentions and willingness to use e-cigarettes and cigarettes significantly, as compared to students in control schools. The intervention also significantly changed all etiological mechanisms. The effects on all outcomes of the intervention were similar as a function of state (Arizona vs Oregon), gender, ethnicity (Hispanic vs not Hispanic), and historical timing (prior to school closures in 2020 vs after schools re-opened in 2022). The intervention was also more effective for at-risk students, as defined by student's previous tobacco use, current family use and/or high in sensation seeking. Close to 90% of the students completed the entire program, and most completed it in 3 to 4 weeks, the expected time frame. The effectiveness of the updated Click City®: Tobacco was demonstrated in a real world setting and findings suggested that all students can potentially benefit from the program.
Interventions
OTHERClick City®: Tobacco
A computer-based program assigned to students designed to prevent subsequent tobacco use. Students complete one 15 to 20 minute lesson two times a week for four weeks.
OTHERUsual Tobacco Curriculum
Students complete their usual curriculum designed to prevent tobacco use.
Sponsors
National Institute on Drug Abuse (NIDA)
Oregon Research Behavioral Intervention Strategies, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Schools were stratified by state, size of school (small, medium, large) and desired start date and randomized to intervention or control. Intervention and control schools were yoked for the timing of assessments (baseline and follow-up assessments).
Eligibility
Sex/Gender
ALL
Age
9 Years to 12 Years
Healthy volunteers
Yes
Inclusion criteria
* A 5th grade student in one of the recruited schools * Student speaks English as a first or second language * Passive parental consent to participate
Exclusion criteria
* Special needs students identified by the classroom teacher as a student who would not understand the questionnaire or the program * Teacher indicates that they cannot comprehend English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Behavioral Intentions to Vape E-cigarettes | baseline; six months | Measured by two items, assessing the student's intentions regarding vaping e-cigarettes as a teen or as a grown-up. Responses were on a five-point scale ranging from definitely not (1) to definitely will (5). The scale was created by summing the two items with potential range from 2 to 10. A higher score means a worse outcome. |
| Change in Behavioral Intentions to Smoke Cigarettes | baseline; six weeks | Measured by two items assessing the student's intentions to smoke cigarettes as a teen or as a grown-up. Responses were on a five-point scale ranging from definitely not (1) to definitely will (5). The scale was created by summing the two items with a potential range from 2 to 10. A higher score means a worse outcome. |
| Change in Willingness to Vape E-cigarettes | baseline; six weeks | Measured by four items, assessing the student's willingness to vape e-cigarettes if the opportunity presented itself (with a group of kids with e-cigaretes available and with kids who are vaping and you want to be a part of the group. Willingness to vape was assessed for two levels, try a few vapes and try vaping several times in a row. Responses were on a five point scale, not at all willing (1) to very willing (5) and were summed for the two scenarios and two levels, yielding a scale from 4 to 20. A higher score means a worse outcome. |
| Change in Willingness to Smoke Cigarettes | baseline; six weeks | Measured by four items, assessing the student's willingness to smoke cigarettes if the opportunity presented itself (with a group of kids with cigarettes available and with kids who are smoking and you want to be a part of the group. Willingness to smoke was assessed for two levels, try a few puffs and smoking the whole cigarette. Responses were on a five point scale, not at all willing (1) to very willing (5) and were summed for the two scenarios and two levels, yielding a scale from 4 to 20. A higher score means a worse outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Perception of Friends Approval of Smoking | baseline; six weeks | Students indicated their perception of friends' approval of their smoking of each of three levels of cigarettes, trying, smoking a few, and smoking a few a day. Responses to each item ranged from yes (1) to no (3). Summing the three levels ranged from 3 to 9, with a higher score means a better outcome. |
| Change in Perception of Friends Approval of Vaping | baseline; six weeks | Students indicated their perception of friends' approval of their vaping of each of three levels of cigarettes, trying, vaping a few, and vaping a few a day. Responses to each item ranged from yes (1) to no (3). Summing the three levels ranged from 3 to 9, with a higher score indicating a better outcome. |
| Change in Perception of Risk of Second-hand Smoke Exposure | baseline; six weeks | Perception of the risk of getting four diseases (breathing problems, asthma, ear infections heart disease, and lung disease or cancer) as a result of being often around someone who smokes. Responses for each disease are on a five point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of five items ranged from 4 to 20. A higher score means a better outcome. |
| Change in Perception of Risk of Second-hand Vape Exposure | baseline; six weeks | Perception of the risk of getting each of four diseases (breathing problems, asthma, ear infections , and lung disease or cancer) as a result of being often around someone who vapes. Responses for each disease are on a five point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of four items ranged from 4 to 20. The follow-up measure was subtracted from the baseline measure, with a higher score indicating a favorable outcome. |
| Change in Perception of Risk of Cumulative Consequences of Smoking | baseline; six weeks | Perception of risk of getting three diseases (lung cancer, serious breathing diseases, and heart disease) as a result of three levels of cigarettes, one, a few cigarettes a day for two years, a pack of cigarettes a day for two years. Responses for each disease and each level ranged from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of nine items ranged from 9 to 45. A higher score means a better outcome. |
| Change in Perception of Risk of Cumulative Consequences of Vaping | baseline; six weeks | Perception of risk of getting three diseases (lung cancer, serious breathing diseases, and heart disease) as a result of three levels of e-cigarettes, one time, a few times a day for two years, Twenty or more times a day for two years'. Responses for each disease and each level ranged from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of nine items ranged from 9 to 45. A higher score means a better outcome. |
| Change in Perception of Risk of Smoking Each Cigarette | baseline; six weeks | Risk of smoking each cigarette was measured by two items indicating what would happen to a 12 year old who started smoking, every cigarette smoked hurts them a bit and The very next cigarette probably won't hurt their bodies. The response scale was a five-point scale ranging from strongly agree (1) to strongly disagree (5). The scale consisted of summing both items with the former item reversed scored. Scale scores ranged from 2 to 10. A higher score indicated a more favorable outcome. |
| Change in Favorable Social Images of Smokers | baseline; six weeks | Students rate what they think kids who smoke are like using a three-point rating scale from not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score goes from 3 to 9. A higher score means a worse outcome. |
| Change in Perception of Risk of Addiction From Smoking | baseline; six weeks | Change in perception of risk of getting addicted to smoking as a result of five levels of smoking, ranging from one time to a a pack of cigarettes a day for five years. Responses for each level were on a five-point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of the five items ranged from 5 to 25. A higher score means a better outcome. |
| Change in Perception of Risk of Addiction From Vaping | baseline; six weeks | Perception of risk of getting addicted to vaping as a result of vaping five levels of increasing quantities of e-cigarettes, ranging from one time to a 20 times a day for 5 years. Responses for each level were on a five-point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score means a better outcome. |
| Change in Perception of Control Over Quitting Smoking | baseline; six weeks | Students answered how much control do you think you would have over quitting smoking using a four-point response scale ranging from no control (1) to total control (4). Perception of control was indicated within four levels of increasing quantities of cigarettes, ranging from tried a cigarette to a pack a day for five years. The four Items were summed to form a scale with the total scale ranging from 4 to 16. A higher score means a worse outcome. |
| Change in Perception of Control Over Vaping | baseline; six weeks | Students answered how much control do you think you would have over quitting vaping e-cigarettes using a four-point response scale ranging from no control (1) to total control (4). Students indicated thier perception of control within each of four levels of increasing quantities of e-cigarettes, ranging from tried vaping to 20 times a day for five years. The four Items were summed to form a scale with the total scale ranging from 4 to 16. A lower score indicated a better outcome. |
| Change in Perception of Risk of Difficulty Quitting Smoking | baseline; six weeks | Perception of risk of difficulty quitting smoking as a result of vaping five levels of increasing quantities of cigarettes smoked, ranging from one cigarette to a a pack of cigarettes a day for 5 years. Responses for each level were on a five-point scale ranging from Very easy (1) to Very difficult (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score meant a better outcome. |
| Change in Perception of Risk of Difficulty Quitting Vaping | baseline; six weeks | Perception of risk of difficulty of quitting vaping as a result of vaping five levels of increasing quantities of e-cigarettes vaped, ranging from one time to a 20 times a day for 5 years. Responses for each level were on a five-point scale ranging from Very easy (1) to Very difficult (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score means a better outcome. |
| Change in Perception of Risk of Vaping Each E-cigarette | baseline; six weeks | Risk of vaping each e-cigarette was measured by two items indicating what would happen to a 12 year old who started vaping, every e-cigarette vaped hurts them a bit and the very next e-cigarette probably won't hurt their bodies. The response scale was a five-point scale ranging from strongly agree (1) to strongly disagree (5). The scale consisted of summing both items with the former item reversed scored. Scale scores ranged from 2 to 10. A higher score indicated a more better outcome. |
| Change in Favorable Social Images of E-cigarette Vapers | baseline; six weeks | Students rate what they think kids who vape e-carettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome. |
| Change in Normative Social Images of Smokers | baseline; six weeks | Students rate what they think other 5th grade kids think kids who smoke cigarettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome. |
| Change in Normative Social Images of Vapers | baseline; six weeks | Students rate what they think other 5th grade kids think kids who vape e-cigarettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome. |
Countries
United States
Participant flow
Recruitment details
The study took place in the schools from January 6, 2020 through June 10, 2022. Within 43 recruited schools, 2906 5th grade students were initially eligible for participation. Among these students, 111 had parents who actively declined their participation, resulting in 2795 students within randomized schools, as eligible for enrollment. Among these, 2673 were enrolled in the study, as defined by completing the baseline and/or follow-up assessment.
Pre-assignment details
No events.
Participants by arm
| Arm | Count |
|---|---|
| Intervention Students in the intervention group were expected to complete Click City®: Tobacco, a computer-based program designed to prevent subsequent tobacco use. Students were expected to do a 15 to 20 minute lesson two times a week for four weeks. Participation also consisted of a baseline assessment one-week prior to starting the program, and a follow-up assessment one-week following completion of the program. | 1,233 |
| Control Students in control schools were expected to complete their usual tobacco curriculum, designed to prevent tobacco use. Students completed the baseline and follow-up assessments during the same week as students in their yoked intervention school. The expectation was that students would participate in the standard tobacco curriculum over the same period that students in the intervention group completed Click City®: Tobacco. | 1,215 |
| Total | 2,448 |
Baseline characteristics
| Characteristic | Intervention | Control | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 1233 Participants | 1215 Participants | 2448 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 370 Participants | 371 Participants | 741 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 863 Participants | 840 Participants | 1703 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 4 Participants | 4 Participants |
| Family members' current use of tobacco Family member does not use nicotine | 741 Participants | 689 Participants | 1430 Participants |
| Family members' current use of tobacco Family member uses nicotine | 489 Participants | 523 Participants | 1012 Participants |
| Family members' current use of tobacco Not reported | 3 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 16 Participants | 19 Participants | 35 Participants |
| Race (NIH/OMB) Asian | 29 Participants | 23 Participants | 52 Participants |
| Race (NIH/OMB) Black or African American | 29 Participants | 44 Participants | 73 Participants |
| Race (NIH/OMB) More than one race | 60 Participants | 56 Participants | 116 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 6 Participants | 2 Participants | 8 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 4 Participants | 4 Participants |
| Race (NIH/OMB) White | 1093 Participants | 1067 Participants | 2160 Participants |
| Sex/Gender, Customized Gender boy | 576 Participants | 545 Participants | 1121 Participants |
| Sex/Gender, Customized Gender girl | 594 Participants | 580 Participants | 1174 Participants |
| Sex/Gender, Customized Gender neither boy nor girl | 59 Participants | 44 Participants | 103 Participants |
| Sex/Gender, Customized Gender not reported (missing) | 4 Participants | 46 Participants | 50 Participants |
| Student's use of tobacco prior to the trial Not reported | 6 Participants | 2 Participants | 8 Participants |
| Student's use of tobacco prior to the trial Students did not use tobacco | 1145 Participants | 1091 Participants | 2236 Participants |
| Student's use of tobacco prior to the trial Students used tobacco | 82 Participants | 122 Participants | 204 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 1,346 | 0 / 1,327 |
| other Total, other adverse events | 0 / 1,346 | 0 / 1,327 |
| serious Total, serious adverse events | 0 / 1,346 | 0 / 1,327 |
Outcome results
Primary
Change in Behavioral Intentions to Smoke Cigarettes
Measured by two items assessing the student's intentions to smoke cigarettes as a teen or as a grown-up. Responses were on a five-point scale ranging from definitely not (1) to definitely will (5). The scale was created by summing the two items with a potential range from 2 to 10. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Behavioral Intentions to Smoke Cigarettes | -.12 score on a scale | Standard Deviation 1.026 |
| Control | Change in Behavioral Intentions to Smoke Cigarettes | .04 score on a scale | Standard Deviation 1.125 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within conditionp-value: =0Mixed Models Analysis
Primary
Change in Behavioral Intentions to Vape E-cigarettes
Measured by two items, assessing the student's intentions regarding vaping e-cigarettes as a teen or as a grown-up. Responses were on a five-point scale ranging from definitely not (1) to definitely will (5). The scale was created by summing the two items with potential range from 2 to 10. A higher score means a worse outcome.
Time frame: baseline; six months
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Behavioral Intentions to Vape E-cigarettes | -.14 score on a scale | Standard Deviation 1.325 |
| Control | Change in Behavioral Intentions to Vape E-cigarettes | 0.0 score on a scale | Standard Deviation 1.2 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: =0Mixed Models Analysis
Primary
Change in Willingness to Smoke Cigarettes
Measured by four items, assessing the student's willingness to smoke cigarettes if the opportunity presented itself (with a group of kids with cigarettes available and with kids who are smoking and you want to be a part of the group. Willingness to smoke was assessed for two levels, try a few puffs and smoking the whole cigarette. Responses were on a five point scale, not at all willing (1) to very willing (5) and were summed for the two scenarios and two levels, yielding a scale from 4 to 20. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students were nested within schools. Students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Willingness to Smoke Cigarettes | -.05 score on a scale | Standard Deviation 1.42 |
| Control | Change in Willingness to Smoke Cigarettes | .12 score on a scale | Standard Deviation 1.635 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: =0.033Mixed Models Analysis
Primary
Change in Willingness to Vape E-cigarettes
Measured by four items, assessing the student's willingness to vape e-cigarettes if the opportunity presented itself (with a group of kids with e-cigaretes available and with kids who are vaping and you want to be a part of the group. Willingness to vape was assessed for two levels, try a few vapes and try vaping several times in a row. Responses were on a five point scale, not at all willing (1) to very willing (5) and were summed for the two scenarios and two levels, yielding a scale from 4 to 20. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Willingness to Vape E-cigarettes | -.07 score on a scale | Standard Deviation 1.77 |
| Control | Change in Willingness to Vape E-cigarettes | .14 score on a scale | Standard Deviation 2 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: =0.044Mixed Models Analysis
Secondary
Change in Favorable Social Images of E-cigarette Vapers
Students rate what they think kids who vape e-carettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools and schools are randomly assigned to condition.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Favorable Social Images of E-cigarette Vapers | -.87 score on a scale | Standard Deviation 1.255 |
| Control | Change in Favorable Social Images of E-cigarette Vapers | -.17 score on a scale | Standard Deviation 1.635 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Favorable Social Images of Smokers
Students rate what they think kids who smoke are like using a three-point rating scale from not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score goes from 3 to 9. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Schools were randomly assigned to an arm.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Favorable Social Images of Smokers | -.87 score on a scale | Standard Deviation 1.175 |
| Control | Change in Favorable Social Images of Smokers | -.16 score on a scale | Standard Deviation 1.53 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Normative Social Images of Smokers
Students rate what they think other 5th grade kids think kids who smoke cigarettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Normative Social Images of Smokers | -.56 score on a scale | Standard Deviation 1.015 |
| Control | Change in Normative Social Images of Smokers | -.16 score on a scale | Standard Deviation 1.315 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Normative Social Images of Vapers
Students rate what they think other 5th grade kids think kids who vape e-cigarettes are like using a three-point rating scale using not at all like this (1) to very much like this (3) to rate three attributes, popular, cool or neat and exciting. The three attributes are summed and the potential score ranges from 3 to 9. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Normative Social Images of Vapers | -.62 score on a scale | Standard Deviation 1.08 |
| Control | Change in Normative Social Images of Vapers | -.19 score on a scale | Standard Deviation 1.445 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Control Over Quitting Smoking
Students answered how much control do you think you would have over quitting smoking using a four-point response scale ranging from no control (1) to total control (4). Perception of control was indicated within four levels of increasing quantities of cigarettes, ranging from tried a cigarette to a pack a day for five years. The four Items were summed to form a scale with the total scale ranging from 4 to 16. A higher score means a worse outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Control Over Quitting Smoking | -8.53 score on a scale | Standard Deviation 13.265 |
| Control | Change in Perception of Control Over Quitting Smoking | -1.90 score on a scale | Standard Deviation 14.605 |
Comparison: Data were anlyzed using a general linear model mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Control Over Vaping
Students answered how much control do you think you would have over quitting vaping e-cigarettes using a four-point response scale ranging from no control (1) to total control (4). Students indicated thier perception of control within each of four levels of increasing quantities of e-cigarettes, ranging from tried vaping to 20 times a day for five years. The four Items were summed to form a scale with the total scale ranging from 4 to 16. A lower score indicated a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Control Over Vaping | -7.93 score on a scale | Standard Deviation 13.6 |
| Control | Change in Perception of Control Over Vaping | -1.99 score on a scale | Standard Deviation 14.78 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Friends Approval of Smoking
Students indicated their perception of friends' approval of their smoking of each of three levels of cigarettes, trying, smoking a few, and smoking a few a day. Responses to each item ranged from yes (1) to no (3). Summing the three levels ranged from 3 to 9, with a higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Friends Approval of Smoking | -.10 score on a scale | Standard Deviation 0.78 |
| Control | Change in Perception of Friends Approval of Smoking | .01 score on a scale | Standard Deviation 0.92 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Friends Approval of Vaping
Students indicated their perception of friends' approval of their vaping of each of three levels of cigarettes, trying, vaping a few, and vaping a few a day. Responses to each item ranged from yes (1) to no (3). Summing the three levels ranged from 3 to 9, with a higher score indicating a better outcome.
Time frame: baseline; six weeks
Population: Students nested within schools.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Friends Approval of Vaping | -.14 score on a scale | Standard Deviation 0.93 |
| Control | Change in Perception of Friends Approval of Vaping | .04 score on a scale | Standard Deviation 1.11 |
Comparison: Data were anlyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Addiction From Smoking
Change in perception of risk of getting addicted to smoking as a result of five levels of smoking, ranging from one time to a a pack of cigarettes a day for five years. Responses for each level were on a five-point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of the five items ranged from 5 to 25. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Addiction From Smoking | 2.27 score on a scale | Standard Deviation 5.905 |
| Control | Change in Perception of Risk of Addiction From Smoking | .72 score on a scale | Standard Deviation 6.045 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Addiction From Vaping
Perception of risk of getting addicted to vaping as a result of vaping five levels of increasing quantities of e-cigarettes, ranging from one time to a 20 times a day for 5 years. Responses for each level were on a five-point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Addiction From Vaping | 2.49 score on a scale | Standard Deviation 5.92 |
| Control | Change in Perception of Risk of Addiction From Vaping | .73 score on a scale | Standard Deviation 5.98 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Cumulative Consequences of Smoking
Perception of risk of getting three diseases (lung cancer, serious breathing diseases, and heart disease) as a result of three levels of cigarettes, one, a few cigarettes a day for two years, a pack of cigarettes a day for two years. Responses for each disease and each level ranged from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of nine items ranged from 9 to 45. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Cumulative Consequences of Smoking | 1.60 score on a scale | Standard Deviation 8.365 |
| Control | Change in Perception of Risk of Cumulative Consequences of Smoking | -.09 score on a scale | Standard Deviation 8.38 |
Comparison: Data were analyzed using a gneral linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Cumulative Consequences of Vaping
Perception of risk of getting three diseases (lung cancer, serious breathing diseases, and heart disease) as a result of three levels of e-cigarettes, one time, a few times a day for two years, Twenty or more times a day for two years'. Responses for each disease and each level ranged from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of nine items ranged from 9 to 45. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested with schools, which are randomized to condition. Students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Cumulative Consequences of Vaping | 3.05 score on a scale | Standard Deviation 8.41 |
| Control | Change in Perception of Risk of Cumulative Consequences of Vaping | .35 score on a scale | Standard Deviation 8.335 |
Comparison: Data were anlayzed using a general linear mixed model with students nested within schools and schools within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Difficulty Quitting Smoking
Perception of risk of difficulty quitting smoking as a result of vaping five levels of increasing quantities of cigarettes smoked, ranging from one cigarette to a a pack of cigarettes a day for 5 years. Responses for each level were on a five-point scale ranging from Very easy (1) to Very difficult (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score meant a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Difficulty Quitting Smoking | 2.39 score on a scale | Standard Deviation 4.485 |
| Control | Change in Perception of Risk of Difficulty Quitting Smoking | .19 score on a scale | Standard Deviation 4.865 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schols and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Difficulty Quitting Vaping
Perception of risk of difficulty of quitting vaping as a result of vaping five levels of increasing quantities of e-cigarettes vaped, ranging from one time to a 20 times a day for 5 years. Responses for each level were on a five-point scale ranging from Very easy (1) to Very difficult (5). Items were summed to form a scale. The total scale ranged from 5 to 25. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Difficulty Quitting Vaping | 2.38 score on a scale | Standard Deviation 4.645 |
| Control | Change in Perception of Risk of Difficulty Quitting Vaping | .16 score on a scale | Standard Deviation 4.97 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Second-hand Smoke Exposure
Perception of the risk of getting four diseases (breathing problems, asthma, ear infections heart disease, and lung disease or cancer) as a result of being often around someone who smokes. Responses for each disease are on a five point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of five items ranged from 4 to 20. A higher score means a better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Second-hand Smoke Exposure | 3.00 score on a scale | Standard Deviation 4.05 |
| Control | Change in Perception of Risk of Second-hand Smoke Exposure | .90 score on a scale | Standard Deviation 3.905 |
Comparison: Data were analyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Second-hand Vape Exposure
Perception of the risk of getting each of four diseases (breathing problems, asthma, ear infections , and lung disease or cancer) as a result of being often around someone who vapes. Responses for each disease are on a five point scale ranging from no chance (1) to certain to happen (5). Items were summed to form a scale. The total scale of four items ranged from 4 to 20. The follow-up measure was subtracted from the baseline measure, with a higher score indicating a favorable outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although the school was the unit of randomization, the student is the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Second-hand Vape Exposure | 3.27 score on a scale | Standard Deviation 4.195 |
| Control | Change in Perception of Risk of Second-hand Vape Exposure | 1.02 score on a scale | Standard Deviation 3.955 |
Comparison: Data were anlyzed using a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Smoking Each Cigarette
Risk of smoking each cigarette was measured by two items indicating what would happen to a 12 year old who started smoking, every cigarette smoked hurts them a bit and The very next cigarette probably won't hurt their bodies. The response scale was a five-point scale ranging from strongly agree (1) to strongly disagree (5). The scale consisted of summing both items with the former item reversed scored. Scale scores ranged from 2 to 10. A higher score indicated a more favorable outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Although schools are the unit of randomization, students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Smoking Each Cigarette | .68 score on a scale | Standard Deviation 1.65 |
| Control | Change in Perception of Risk of Smoking Each Cigarette | .19 score on a scale | Standard Deviation 1.665 |
Comparison: Data were analyzed uisng a general linear mixed model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis
Secondary
Change in Perception of Risk of Vaping Each E-cigarette
Risk of vaping each e-cigarette was measured by two items indicating what would happen to a 12 year old who started vaping, every e-cigarette vaped hurts them a bit and the very next e-cigarette probably won't hurt their bodies. The response scale was a five-point scale ranging from strongly agree (1) to strongly disagree (5). The scale consisted of summing both items with the former item reversed scored. Scale scores ranged from 2 to 10. A higher score indicated a more better outcome.
Time frame: baseline; six weeks
Population: Students are nested within schools. Schools are the unit of assignment while students are the unit of analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Change in Perception of Risk of Vaping Each E-cigarette | .78 score on a scale | Standard Deviation 1.685 |
| Control | Change in Perception of Risk of Vaping Each E-cigarette | .24 score on a scale | Standard Deviation 1.725 |
Comparison: Data were analyzed using a general linear model with students nested within schools and schools nested within condition.p-value: <0.001Mixed Models Analysis