Elevating the Community Voice about Tobacco-Related Issues through Mixed-method Research

Tobacco use remains the single most preventable cause of disease, disability, and death in the United States. Alarmingly, tobacco product use among youth is increasing. The 2020 National Youth Tobacco Survey indicated that among high school students who currently use e-cigarettes, 22.5% use these products every day, and 9.4% of middle school students use these products every day. Early intervention through school-based education is key to shaping youth behaviors around tobacco use by equipping young people with the knowledge to make informed decisions. 

Recognizing the invaluable role of school-based interventions in the prevention of tobacco use initiation in youth, the U.S. Food and Drug Administration (FDA) Center for Tobacco Products (CTP) seeks to develop new, robust educational offerings for middle and high school educators on the topic of tobacco use prevention that can be implemented in virtual and in-person classroom settings. 

Primary audience of FDA CTP’s Education Outreach Program: middle and high school educators and students. Secondary audience: parents/guardians, school administrators, school nurses, and counselors—all of whom educate youth in some capacity. 

How We Did It — Mixed Methods Research

To support the evolving needs of educators and expand the reach of tobacco use prevention messaging for youth, IQ Solutions is working with FDA CTP to lead a mixed methods effort, which includes: 

• Needs Assessment. A systematic, comprehensive assessment of state-level tobacco policies, health education standards, and current tobacco use prevention curricula available to middle and high schools in all 50 states. 
• Focus Groups. Recruitment, moderation, and analysis of 18 online focus groups with 91 health educators representing 28 states to inform ways FDA CTP can expand its current collection of tobacco use prevention materials for use by middle and high school educators. We used NVivo to analyze focus group transcripts and received Institutional Review Board and Office of Management and Budget approval. 
• Survey. Development, recruitment, fielding, and analysis of a survey with 434 middle and high school educators to assess their use of, and experiences with, FDA CTP/Scholastic Vaping Education (The Real Cost of Vaping) resources used during the 2019‒2020 and 2020‒2021 academic years. We used Chi-squared and Fisher’s exact tests to examine differences in results by grade band, geographic type, subject taught, and socioeconomic status. We received Institutional Review Board and Office of Management and Budget approval.

Exploratory Conversations with Key Audiences  

Through the implementation of our three-pronged mixed methods approach, IQ Solutions gleaned key recommendations and insights to inform FDA CTP’s materials development and promotion strategies—identifying opportunities to improve content development, delivery, and use in schools. Findings from the Needs Assessment on state-level tobacco curriculum policies revealed many critical educational resource needs that can be filled through the development of FDA CTP’s new tobacco use prevention materials. In particular, the assessment identified a need for educational materials addressing the health consequences of vaping, resources focused on decision-making, and materials that involve students in an interactive manner. 

Exploratory conversations with middle and high school health educators specific to their needs and challenges with tobacco use prevention education pointed to notable insights that FDA CTP can apply to its materials development strategy. Specifically, health educators do not currently have the support they need to teach a skills-based tobacco use prevention curricula and are eager to access an evidence-based prevention curriculum with hands-on activities that engage students and whose design offers students the ability to understand the relevance of tobacco in their daily lives.