Program Profile: Project Toward No Tobacco Use (Project TNT)

This is a comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use in fifth- to ninth-grade students. This program is rated Promising. The intervention group had a statistically significant reduction in initial use and weekly use of cigarettes and smokeless tobacco at the 1-year follow up, compared with the control group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

Project Toward No Tobacco Use (Project TNT) is a comprehensive, classroom-based curriculum designed to prevent or reduce tobacco use. It is devised to counteract several different risk factors for tobacco use simultaneously, because the behavior is associated with multiple risk factors.

Target Population

Project TNT targets a wide variety of youths who may have different risk factors influencing their tobacco use. It is designed for fifth through ninth grade youths (ages 10–14).

Program Components

Project TNT 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.

Implementing Project TNT involves the following activities:

• A comprehensive, 10-day, classroom-based, social-influences program—plus two booster sessions—that examines media, celebrity, and peer portrayal of tobacco use
• Training in active listening, effective communication, and general assertiveness development, along with methods for building self-esteem
• Education on the course of tobacco-related addiction and diseases; correction of inflated tobacco-use prevalence estimates
• Education on tobacco-specific, cognitive coping skills, and assertive refusal techniques; practicing ways to counteract media portrayals of tobacco use, including social-activism letter-writing to make a public commitment to not using tobacco products
• Use of homework assignments, a classroom competition (i.e., the “TNT Game”), and a two-lesson booster program
• Longitudinal assessment material

Key Personnel

Trained teachers in a classroom setting deliver Project TNT to standard class sizes.

Study

Sussman, Dent, and colleagues (1993) used a five-group, randomized, experimental block design. 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 four different intervention conditions. Three of the intervention conditions were designed to address one component related to preventing tobacco use among students. The first intervention condition addressed normative social influence, which included activities designed to help students develop skills to counteract social pressures related to tobacco use. The second intervention condition addressed informational social influence, which included activities that corrected inflated tobacco prevalence estimates and exposed advertising tactics. The third intervention condition addressed physical consequences of tobacco use, which included activities that countered misperceptions or lack of knowledge in regard to short- and long-term health-related side effects of tobacco use. The fourth intervention condition, which combined the normative social influence, the informational social influence, and the physical consequences conditions into one comprehensive curriculum, was known as Project Toward No Tobacco Use (Project TNT). This CrimeSolutions review only focused on the outcomes of the Project TNT intervention group.

In each of the four intervention conditions, four schools were urban and four rural. The control condition (eight urban and eight rural schools) were assigned to a “standard” curriculum control condition in which students received routine prevention activities provided directly by their school. These activities included 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 the combined Project TNT intervention and the control group through an in-class, 20-page, self-report questionnaire. Outcomes included trial use (defined as initial use) and weekly use of cigarettes and trial and weekly use of smokeless tobacco. 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. All data was aggregated to the school as the unit of analysis at each time point.

Information on material and training costs can be found on the University of Southern California’ s Project Toward No Tobacco Use website: https://tnt.usc.edu/

Information on implementation and fidelity can be found on the University of Southern California’ s Project Toward No Tobacco Use website: https://tnt.usc.edu/

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

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.

Gingiss, Phyllis M., Melynda Boerm, and Cynthia Roberts–Gray. 2006. “Follow-Up Comparisons of Intervention and Comparison Schools in a State Tobacco Prevention and Control Initiative.” Journal of School Health 76:98–103.

Guilamo–Ramos, Vincent, James Jaccard, Patricia Dittus, Bernardo Gonzalez, Alida Bouris, and Stephen Banspach. 2010. “The Linking Lives Health Education Program: A Randomized Clinical Trial of a Parent-Based Tobacco Use Prevention Program for African American and Latino Youths.” American Journal of Public Health 100(9):1641–47.

Meshack, Angela F., Shaohua Hu, Unto E. Pallonen, Alfred L. McAlister, N. Gottlieb, and Philip P. Huang. 2004. “Texas Tobacco Prevention Pilot Initiative: Processes and Effects.” Health Education Research 19(6):657–68.

Metz, Arnold E. Jr., Bernard F. Fuemmeler, and Ronald T. Brown. 2006. “Implementation and Assessment of an Empirically Validated Intervention Program to Prevent Tobacco Use Among African American Middle-School Youth.” Journal of Clinical Psychology in Medical Settings 13:229–38.

Rice, Virginia Hill, Linda S. Weglicki, Thomas N. Templin, Hikmet Jamil, and Adnan Hammad. 2010. “Intervention Effects on Tobacco Use in Arab and Non–Arab American Adolescents.” Addictive Behaviors 35(1):46–4.

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, Carol 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., 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.