A pilot stratified cluster randomized trial of school-based e-cigarette and other tobacco product use prevention for Pacific Island youths: An evaluation of the Fuetsan Manhoben curriculum.

introductionE-cigarette use among young adolescents in Guam, and potentially other regions of the US-Affiliated Pacific Islands (USAPI), is markedly higher than among similarly aged adolescents in the general US population. The objective was to test the pilot version of a school-based e-cigarette and other tobacco product curriculum, named

methodsThe intervention involved 4 video-based, culturally tailored lessons delivered in the classroom by health educators. A stratified cluster-randomized design was used to assign 8 public middle schools to either the intervention or the control condition. Six classrooms in each school participated in the study. Participants (n=269) in the intervention condition received the 4-lesson curriculum, whereas participants (n=269) in the control condition did not receive any intervention. Participants in both conditions provided data at pretest, post-test (4 weeks later), and at follow-up at 3 months. The current analyses pertain only to e-cigarette-related outcomes. Wald tests were utilized to determine the statistical significance of fixed effects within the negative binomial and logistic regression frameworks.

resultsAt immediate post-test, the intervention did not have statistically significant effects on openness to using e-cigarettes (incidence rate ratio, IRR=0.79; 95% CI: 0.42-1.49, p>0.05), e-cigarette use initiation (OR=O.96; 95% CI: 0.42-2.19, p>0.05), or past-30-day e-cigarette use (IRR=0.90; 95% CI: 0.77-1.06, p>0.05). At follow-up at 3 months, the intervention also did not have statistically significant effects on e-cigarette use initiation (OR=0.70; 95% CI: 0.34-1.45, p>0.05) or past-30-day e-cigarette use (IRR=0.94; 95% CI: 0.82-1.08, p>0.05). However, findings indicated that the intervention reduced openness to using e-cigarettes at follow-up at 3 months (IRR=0.49; 95% CI: 0.28-0.86, p<0.01). That is, being assigned to the intervention condition was associated with 51% decrease in openness to using e-cigarettes at follow-up at 3 months.

conclusionsFour lessons delivered over 4 weeks may not produce immediate short-term preventive effects, except potentially reducing e-cigarette use susceptibility at follow-up at 3 months. Further research is warranted to examine whether expanding the content and duration of the curriculum may result in stronger, more durable effects. Also, future studies should examine whether increasing the follow-up to 6-12 months might capture delayed preventive effects that were not detectable within the shortened, follow-up at 3 months in the current study. CLINICAL

trial registrationThe study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: ID NCT05037656.