David Altman, Ph.D. - US grants

This study is designed to develop an effective, generalizable school and community-based intervention to reduce tobacco use, increase heart- healthy food consumption, and increase aerobic exercise, among 9th grade youth in East San Jose, CA. Both a school-based and a community participation intervention are proposed. Although our previous research in school-based cardiovascular disease (CVD) prevention has been successful in altering risk behaviors, evidence from diverse studies on participation suggest that these effects may be magnified by adding active community participation. In this study, community participation will include activities related to changing the political, environmental, economic, and regulatory factors that influence CVD risk behaviors. A six school efficacy trial using a classroom-based curriculum for CVD prevention has already been funded by the NHLBI. In this grant, we propose adding three additional schools to evaluate the effects of combining a computer-based CVD curriculum with active community participation. Summary of Design and Hypotheses Nine high schools in East San Jose, California (N=approximately 4,500 9th grade students) will assigned randomly to one of three experimental groups: Experimental Group 1 - computer assisted instruction on injury prevention (attention-placebo); Experimental Group 2 - computer assisted instruction on cardiovascular disease prevention (CVD CAI); Experimental Group 3 - computer assisted instruction on cardiovascular disease prevention plus an active community participation program (CVD CAI plus community participation). The work in this proposal will test the primary hypothesis that students in schools that receive the CVD CAI plus community participation intervention will demonstrate significantly more change than students in schools receiving the other two interventions for the following outcomes; (a) increased self-reported tobacco cessation rate among experimental users and decreased initiation rate among non- users; (b) decreased self-reported consumption of dietary fat; (c) increased self-reported aerobic physical activity; (d) increased knowledge of CVD risk factor processes; and (e) increased self-efficacy in taking community health action. Students in schools receiving CVD CAI alone are hypothesized to demonstrate greater change than students in attention-placebo on all variables except self-efficacy in taking community health action. Relevance to Nursing This study is consistent with the overall goals of community health nursing a research and practice. Furthermore, substantial budget cuts for nurses and nursing-related projects both in Santa Clara County (where San Jose resides) and in San Jose schools have highlighted the need to expand the role of nurses from the current situation - providing treatment services to individuals - to broad community-based health promotion and disease prevention. The proposed collaboration on this grant between Stanford University and the School of Nursing at San Jose State University is intended to begin fulfilling this vision.

DESCRIPTION (provided by applicant): This application is for competitive renewal of funding for Tobacco Farmers and Tobacco Control (TFTC I), an R0l currently funded by NCI This study will be conducted in North Carolina, where more tobacco is grown than in all other states combined. In addition, due substantially to public and policy-maker concern about farmers, North Carolina lag far behind other states in tobacco control efforts. The original study (still ongoing) is a randomized intervention trial of 14 major tobacco-producing counties. Seven counties were assigned randomly to receive an intensive community organization and education intervention that encouraged diversification. The seven non-intervention counties served as a no-treatment comparison group. The efficacy of the intervention was evaluated among a cohort of over 1,000 tobacco fanners. In this competitive renewal (TFTC II) we propose to cease implementation of the TFTC I intervention and to monitor its impact, as well as the impact of the tobacco settlement and other tobacco/agricultural policy in the seven treatment and seven comparison counties that participated in TFTC I. In addition, we propose to add a statewide tracking system to the study to evaluate how the settlement is being implemented (and reactions to it), both in the 14 counties we have studied over the past three years and among statewide farmer organizations, health groups, other community organizations, and policy-makers. Specifically, TFTC II will: (a) assess whether tobacco farmers in the seven TFTC I intervention counties, compared to the seven control counties, will be less dependent on tobacco as source of family income; (b) examine the effects of the tobacco settlement on tobacco production and public health interests; (c) document the knowledge, attitudes, and behaviors of tobacco farmers and other tobacco-dependent community stakeholders about the impacts of changes in the tobacco farming sector; (d) collect data from health constituencies, tobacco fanners, tobacco-dependent community stakeholders, and from local, regional and stat economic development interests concerning the chances of successful diversification; and (e) identify areas of tobacco farmer misunderstanding of the impacts of tobacco control programs and tobacco industry business practices and asses; how tobacco control organizations can target these areas of misunderstanding with educational campaigns and other programs. We believe that as farmers become less dependent on tobacco, they will interfere less with tobacco control efforts. We suggest that farmer diversification and the subsequent economic development it produces will decrease public and policy-maker resistance to tobacco control.