Evaluation of the Be Vape Free Curriculum of the Tobacco Prevention Toolkit

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Electronic cigarettes (e-cigarettes, e-cigs, vapes, ENDS) are the most widely used tobacco product among adolescents, aged 12-18. Despite clear connections between e-cigarette use, nicotine addiction, and physical and mental health outcomes, adolescents continue to harbor misperceptions about e-cigarettes, perpetuated by exposure to marketing and flavors, and a lack of understanding about their harms and addictive properties. While schools have historically provided a key venue in which to implement tobacco prevention programs, most school-based tobacco prevention programs focus on conventional cigarette smoking only, have had mixed results, and have several gaps in their educational content on e-cigarettes. Further, studies have rarely determined if there are specific groups for whom e-cigarette prevention and cessation programs are, and are not, helping. Using a community-based participatory research approach, we developed the “Be Vape-Free” Curriculum, a free 5-session school-based education, prevention, and reduction (de-escalation) program for middle and high school students. This curriculum is part of and includes the most effective components of the Tobacco Prevention Toolkit, a free online comprehensive tobacco prevention program used by thousands of schools and educators across the United States, having reached more than 1.7 million middle and high schools students. Aligning with the NIH Stage Model for Behavioral Intervention Development, we have addressed 3 of the 6 stages needed to adequately develop, evaluate, refine, and fully implement and disseminate our Be Vape-Free Curriculum. Thus, the Specific Aims of this project are to: (1) Determine whether the Be Vape-Free Curriculum is effective in increasing middle and high school students’ knowledge of e-cigarettes and resistance to using, and decreasing their positive attitudes towards and intentions to use e- cigarettes; (2) Determine whether the Be Vape-Free Curriculum is effective in changing middle and high school students’ actual use of e-cigarettes (including preventing initiation, continuation, escalation; encouraging decreased use and cessation; and use of e-cigarettes with other tobacco and marijuana products); and (3) Examine the heterogenous treatment effects (HTE) of the intervention, identifying both those who benefit the most and those who do not benefit from the curriculum. We will employ a cluster-randomized trial, stepped- wedge design, with 60 middle and 60 high schools in California (n=10,800 students). Schools will be randomized to either the treatment (Be Vape-Free Curriculum) or delay-in-treatment arm (i.e., standard health education first year and Be Vape-Free curriculum in second year), with all students followed for another 12 months. The timing of this proposed research is extremely important as we have outstanding momentum, have established an extensive team of school and community partners and stakeholders, have numerous schools already interested in using the Be Vape-Free Curriculum, and have garnered tremendous support from the California Department of Education and schools.