Planning and evaluating tobacco use interventions for minority school children.

Abstract

This dissertation consists of three separate papers. The first paper is a meta-analysis of seven published and two unpublished surveys on the prevalence of smokeless tobacco use among Native American school children. This review describes and discusses the survey methods, prevalence, duration and intensity of smokeless tobacco use, and health effects documented in these studies. Prevalence of regular smokeless tobacco use ranged from 18 percent in K-6th graders to 55.9 percent in 9th-10th graders. Comparisons made to non-Native survey data demonstrate the severity of the problem in Native American communities. Thus, the need for intervention was established. The second paper is the evaluation of a teaching unit intended to prevent school children in grades K-3 from using tobacco products. A total of 1,324 children from three state sites and three Indian Health Service sites participated in the pilot test of the teaching unit. The evaluation design was a randomized untreated control group with pretest and posttest. Overall, there were no statistically significant improvements in knowledge, attitudes, or behavior. It was concluded that a three session teaching unit is not an intense enough intervention in communities where smokeless tobacco use is prevalent. The third paper explores the process of designing innovations in the health promotion field using the program from the second paper as a case study. The organizational and policy contexts in which the program was executed are discussed to illustrate common problems in health promotion program planning. Alternative organizational structures that would better suit innovation are described. It is concluded that bureaucratic health agencies should consider "matrix" or "open" forms of organizational structure for the design of health promotion/disease prevention interventions. The common theme of the three papers is the problem of tobacco use among minority school children, with an interest in the design of effective interventions for the future. The design of such programs will best be accomplished in an organizational setting that is conducive to innovation.