Media Literacy to Prevent Adolescent Smoking

Cigarette smoking is the top cause of preventable death and disease in the U.S., and about 90% of those who die from smoking begin as adolescents. Because smoking-related mass media messages (such as episodes of smoking in films and advertisements) significantly increase adolescent smoking, media literacy, defined as analysis and evaluation of mass media messages, presents a promising new framework for development of innovative school-based tobacco control programs. Media literacy may be more effective than standard tobacco education among the populations that are at greatest risk for smoking, such as African-Americans and the socio-economically disadvantaged, and national organizations have called for use of media literacy to reduce smoking. However, anti-smoking media literacy programs have been neither widely implemented nor well-evaluated. The aims of this project are to determine if a theory-driven, school-based, 3-session anti-smoking media literacy curriculum delivered to 9th grade students can affect clinically relevant factors mediating adolescent smoking according to the widely accepted Theory of Reasoned Action: intention to smoke, smoking behavior, attitude toward smoking, and norms involving smoking. It is hypothesized that, compared with those exposed to a currently accepted school-based smoking prevention program, students exposed to the media literacy program will develop more negative attitudes toward smoking, a more negative sense of smoking norms, less intention to smoke, and less smoking. We also expect that the curriculum will improve smoking media literacy scores as measured by a reliable, valid scale. Over two years, eight high schools will be recruited to randomize all 9th grade health classrooms to receive either the 3-session media literacy anti-smoking curriculum or a currently accepted anti-smoking program of equivalent length. This recruitment will occur via two prominent community organizations responsible for anti-tobacco programming in 50 local school districts. Experienced health educators will be trained in implementation of both experimental and control curricula. Outcome measures, demographic data, and other important covariates will be collected by a questionnaire given three times: at baseline, immediately post-intervention, and after one year. Questionnaire items are reliable, valid, and pilot-tested. Process evaluation will be conducted to assess implementation fidelity, to confirm or refute the findings of the quantitative assessment, to help explain outcome data, to refine the intervention, and to inform future replications of the curriculum. Given the substantial nationwide morbidity and mortality due to tobacco use, the role of mass media messages in adolescent initiation of smoking, and the potential power of media literacy as an agent for health behavior change, it is essential to study the utility of media literacy in altering smoking behaviors and antecedents in this age group. If media literacy programs are successful in buffering the impact of mass media on adolescent smoking, similar interventions can be developed to prevent other harmful behaviors related to mass media messages.