Using Innovation for Teen Tobacco Control In Culturally Diverse Populations:

Background:  Tobacco use typically begins during adolescence, and smoking prevalence among this population remains unacceptably high.  To effectively educate teens about tobacco dangers, it is critical to deliver information in a relatable and familiar format.  Thus, there is a need to employ modern, interactive multimedia technology to reach culturally diverse adolescents to combat teen smoking. 

Program background:  ASPIRE began in 2000 as an NCI-funded research project which used CD-ROM-based curriculum for smoking prevention and cessation aimed at 1,600 inner city high school students in Houston, Texas.  The study proved to be effective in preventing tobacco use and was expanded to an Internet version that was widely disseminated throughout the community in 2004.  In 2008, a more customized version of the website was created by adding pre- and post-test capabilities. The existing ASPIRE program uses animations, videos, and interactive activities to communicate the facts about smoking and tobacco use, as well as, offers skills to adopt a tobacco-free lifestyle. 

Evaluation Methods and Results:  ASPIRE was launched nationally in 2008 in 16 states.  Participating schools requested site customization so that the program better aligns with school curriculum requirements and has metrics for evaluating results.  Consequently, ASPIRE includes: five educational modules, pre- and post-test surveys, quizzes after each module, a certificate of completion, and a reporting system with grades.  States across North America use ASPIRE to: 1) complement existing health, science and physical education curricula, 2) offer as an "alternative to suspension" for teens who violated the no-tobacco possession law, 3) assign to students as an extra credit assignment.  Participating groups encompass:  school districts, a Department of Health, cancer centers, volunteer centers, youth advocacy groups, a health insurance provider, community outreach centers and tobacco prevention specialists.  ASPIRE participation includes: 21 states, 8 prospect states, more than 200 sites, nearly 7,000 program participants.   Results show a nearly 20% increase in overall tobacco knowledge between pre- and post-test results. 

Conclusions:  ASPIRE demonstrates an age-appropriate, user-friendly online tool that effectively educates teenagers about the dangers of tobacco in two languages.  It also achieves varied interest in program participation as well as in various settings.  Additionally, initial ASPIRE research also proved that a large number of less acculturated Hispanics were unable to be reached due to a language barrier.  This fact, coupled with knowledge that Hispanics are the fastest growing U.S. population and that Hispanic youth tobacco use has recently increased, resulted in the creation of the Spanish version of ASPIRE in January 2011. ASPIRE Spanish will allow program participation in Spanish-speaking countries.

Implications for research and/or practice:  The continued goal is to expand ASPIRE dissemination to additional national and international audiences.  Future collaborations could provoke cultural adaptations in other languages.  Program content will also need to include any new developments in tobacco research and behaviors.