Project TNT comprises 10 core lessons and 2 booster lessons, all 40-50 minutes in duration. The core lessons are designed to be taught over a 2-week period but may be spread out over as long as 4 weeks. Booster lessons, which are taught 1 year afterward, are intended to be delivered over 2 consecutive days but may be taught 1 week apart. The curriculum uses a wide variety of activities to encourage student involvement and participation. Activities include games, videos, role-plays, large and small group discussion, use of student worksheets, homework assignments, activism letter writing, and a videotaping project. The two-lesson booster program summarizes previously learned material and discusses how this material might be used in daily living.
Quality of Research
Review Date: September 2007
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Dent, C. W., Sussman, S., Stacy, A. W., Craig, S., Burton, D., & Flay, B. R. (1995). Two-year behavior outcomes of Project Towards No Tobacco Use. Journal of Clinical and Consulting Psychology, 63(4), 676-677. 
Sussman, S., Dent, C. W., Burton, D., Stacy, A. W., & Flay, B. R. (1994). Developing school-based tobacco use prevention and cessation programs. Thousand Oaks, CA: Sage.
Sussman, S., Dent, C. W., Stacy, A. W., Hodgson, C. S., Burton, D., & Flay, B. R. (1993). Project Towards No Tobacco Use: Implementation, process and post-test knowledge evaluation. Health Education Research, 8(1), 109-123.
Sussman, S., Dent, C. W., Stacy, A. W., Sun, P., Craig, S., Simon, T. R., et al. (1993). Project Towards No Tobacco Use: 1-year behavior outcomes. American Journal of Public Health, 83(9), 1245-1250.
Wang, L. Y., Crossett, L. S., Lowry, R., Sussman, S., & Dent, C. W. (2001). Cost-effectiveness of a school-based tobacco-use prevention program. Archives of Pediatrics and Adolescent Medicine, 155(9), 1043-1050.
Supplementary Materials Meshack, A. F., Hu, S., Pallonen, U. E., McAlister, A. L., Gottlieb, N., & Huang, P. (2004). Texas Tobacco Prevention Pilot Initiative: Processes and effects. Health Education Research, 19(6), 657-668.
Project TNT, University of Southern California. (1998). Project Towards No Tobacco Use student workbook. Santa Cruz, CA: ETR Associates.
Outcomes
| Outcome 1: Tobacco use |
|
Description of Measures
|
Tobacco use was measured using a self-report questionnaire assessing lifetime tobacco use and frequency of use.
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Key Findings
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The study assigned 48 junior high schools to one of four Project TNT treatment conditions or a usual care control condition. One Project TNT treatment condition exposed students to the full Project TNT curriculum. The other treatment conditions tested independent implementations of three Project TNT curriculum components targeting factors that influence tobacco use: normative social influence (e.g., peer offers to use tobacco as a form of acceptance), informational social influence (e.g., advertising or pro-tobacco-use statements by peers), and knowledge of the physical consequences of tobacco use. Students in the usual care control condition were exposed to the typically occurring antitobacco efforts implemented in their schools.
From posttest to 1-year follow-up:
- Although tobacco use generally increased in the sample, students in the physical consequences, informational social influence, and full curriculum conditions showed smaller increases in trial cigarette use (6.1%, 7.1%, and 7.3%, respectively) than students in the control and normative social influence conditions (9.3% and 10.2%, respectively) (p < .05).
- Students in the full curriculum, physical consequences, and informational social influence conditions showed smaller increases in weekly cigarette use (2.0%, 2.6%, and 3.2%, respectively) than students in the normative social influence and control conditions (5.3% and 5.6%, respectively) (p < .05).
- Students in the full curriculum, physical consequences, and normative social influence conditions showed smaller increases in trial smokeless tobacco use (1.7%, 2.4%, and 2.6%, respectively) than students in the informational social influence and control conditions (3.5% and 4.1%, respectively) (p < .05).
- While students in the full curriculum condition showed a decrease in weekly smokeless tobacco use (0.4%), use increased among students in the normative social influence, informational social influence, control, and physical consequences conditions (0.3%, 0.5%, 0.5%, and 0.6%, respectively) (p < .05).
From posttest to 2-year follow-up:
- Although tobacco use generally increased in the sample, students in the physical consequences, informational social influence, full curriculum, and normative social influence conditions showed smaller increases in trial cigarette use (13%, 15%, 16%, and 17%, respectively) than students in the control condition (23%) (p < .05).
- Students in the full curriculum condition also showed smaller increases in weekly cigarette use (4%) than students in the control group (9%) (p < .05).
- While students in the physical consequences condition showed no change in trial use and a decrease in weekly use (1%) of smokeless tobacco, students in the control condition showed an increase in use (7% and 1%, respectively) (p < .05).
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Studies Measuring Outcome
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Study 1
|
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Study Designs
|
Experimental
|
|
Quality of Research Rating
|
3.3
(0.0-4.0 scale)
|
| Outcome 2: Cost-effectiveness |
|
Description of Measures
|
Data were collected to estimate life years (LYs) saved, quality-adjusted life years (QALYs) saved, and lifetime medical costs saved, discounted 3% annually as recommended by the Panel on Cost-Effectiveness in Health and Medicine. Program costs incurred during the 2-year implementation of Project TNT were included as intervention costs. All costs were in 1990 dollars to correspond with the time of the intervention. The cost-effectiveness of Project TNT was compared with that of the control scenario and was assessed in terms of the cost per LY saved and the cost per QALY saved.
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Key Findings
|
The base-case analysis estimated that the intervention cost $16,403 ($13.29 per student) and that the full Project TNT intervention would prevent 34.9 students from becoming established smokers. As a result, society could expect to save $327,140 in medical care costs, with a total of 23.3 discounted LYs saved and a total of 36.6 discounted QALYs saved. These data translated into a cost savings of $13,316 per LY saved and $8,482 per QALY saved. When medical costs were excluded from the analysis, the estimated intervention cost was $703 per LY saved and $448 per QALY saved.
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Studies Measuring Outcome
|
Study 1
|
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Study Designs
|
Experimental
|
|
Quality of Research Rating
|
3.4
(0.0-4.0 scale)
|
Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
|
Study
|
Age
|
Gender
|
Race/Ethnicity
|
|
Study 1
|
6-12 (Childhood)
13-17 (Adolescent)
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50% Female
50% Male
|
60% White
27% Hispanic or Latino
7% Black or African American
6% Race/ethnicity unspecified
|
Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
|
Outcome
|
Reliability
of Measures
|
Validity
of Measures
|
Fidelity
|
Missing
Data/Attrition
|
Confounding
Variables
|
Data
Analysis
|
Overall
Rating
|
|
1: Tobacco use
|
3.5
|
3.5
|
2.5
|
3.5
|
3.5
|
3.5
|
3.3
|
|
2: Cost-effectiveness
|
3.5
|
3.5
|
3.0
|
3.5
|
3.5
|
3.5
|
3.4
|
Study Strengths The program makes use of a curriculum-based intervention model. Pilot study data were used to fine-tune the measures to ensure their relevance to the population. The cost-effectiveness analysis used a systematic process.
Study Weaknesses Some of the schools in the study had other drug prevention programs in place during the time of the Project TNT intervention, which may have affected the findings. For the cost-effectiveness outcome, the estimates of tobacco use were based on staff estimates and pilot data.
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Readiness for Dissemination
Review Date: September 2007
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Evaluation forms:
- Project TNT Implementation Evaluation
- Project TNT Quality Assurance/Process Evaluation Measures
- Project TNT School Staff Survey
- Project TNT Session Evaluation Form: Teacher Self-Report
- Project TNT Session Observation Form
Program Web site, http://tnd.usc.edu/tnt/
Sussman, S., Barovich, M., Hahn, G., Abrams, C., Selski, E., & Craig, S. (2004). Project Towards No Tobacco Use student workbook. Scotts Valley, CA: ETR Associates.
Sussman, S., Barovich, M., Hahn, G., Abrams, C., Selski, E., & Craig, S. (2004). Project Towards No Tobacco Use teachers guide. Scotts Valley, CA: ETR Associates.
SVE & Churchill Media. (1987). Stand up for yourself: Peer pressure and drugs [VHS]. Chicago, IL: Authors.
University of Southern California Institute for Prevention Research. (n.d.). Tobacco use social images [VHS]. Los Angeles: University of Southern California.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
|
Training and Support
Resources
|
Quality Assurance
Procedures
|
Overall
Rating
|
|
4.0
|
4.0
|
4.0
|
4.0
|
Dissemination Strengths Program materials are well organized and formatted for uncomplicated, real-time implementation. Training is offered by the developer in 1- and 2-day formats and can be arranged for delivery at either the program developer's or the implementer's site. The developer provides customized technical assistance and support to implementers. Process and outcome measures are provided with evaluation guidance to support quality assurance.
Dissemination Weaknesses No weaknesses were identified by reviewers.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
|
Item Description
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Cost
|
Required by Developer
|
|
Teacher's guide
|
$45 each
|
Yes
|
|
Student workbook
|
$19 for five
|
Yes
|
|
Tobacco Use Social Images video
|
$40 each
|
No
|
|
Stand Up for Yourself: Peer Pressure and Drugs video
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$80 each
|
No
|
|
Developing School-Based Tobacco Use Prevention and Cessation Programs (book)
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$61 each
|
No
|
|
1-day, on-site training
|
$1,100-$1,300 for up to 25 participants, plus travel expenses
|
No
|
|
2-day, on-site training
|
$1,800-$2,000 for up to 25 participants, plus travel expenses
|
No
|
|
Student surveys
|
Free
|
No
|
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* Dent, C. W., Sussman, S., Stacy, A. W., Craig, S., Burton, D., & Flay, B. R. (1995). Two-year behavior outcomes of Project Towards No Tobacco Use. Journal of Clinical and Consulting Psychology, 63(4), 676-677.
* Sussman, S., Dent, C. W., Burton, D., Stacy, A. W., & Flay, B. R. (1994). Developing school-based tobacco use prevention and cessation programs. Thousand Oaks, CA: Sage.
* Sussman, S., Dent, C. W., Stacy, A. W., Hodgson, C. S., Burton, D., & Flay, B. R. (1993). Project Towards No Tobacco Use: Implementation, process and post-test knowledge evaluation. Health Education Research, 8(1), 109-123.
* Sussman, S., Dent, C. W., Stacy, A. W., Sun, P., Craig, S., Simon, T. R., et al. (1993). Project Towards No Tobacco Use: 1-year behavior outcomes. American Journal of Public Health, 83(9), 1245-1250.
* Wang, L. Y., Crossett, L. S., Lowry, R., Sussman, S., & Dent, C. W. (2001). Cost-effectiveness of a school-based tobacco-use prevention program. Archives of Pediatrics and Adolescent Medicine, 155(9), 1043-1050.
Meshack, A. F., Hu, S., Pallonen, U. E., McAlister, A. L., Gottlieb, N., & Huang, P. (2004). Texas Tobacco Prevention Pilot Initiative: Processes and effects. Health Education Research, 19(6), 657-668.
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