The Research History behind Oregon Healthy Teens

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Oregon Research Institute: Prevention Research
Project Path: Programs to Advance Teen Health (1984-1989)
Project SixTeen (1990-1995)
Parents and Communities against Tobacco (2000-present)
Department of Human Services-Health Division Statewide Tobacco (1997-present)
Oregon Healthy Teens: ORI in Partnership with State Agencies (2000-present)
Oregon Healthy Teens: a Significant Sample

 

Oregon Research Institute’s Prevention Research

A group of researchers, under the leadership of Senior Scientists Anthony Biglan, Ph.D. and Herb Severson, Ph.D. and Research Scientists Clyde Dent, Ph.D., Judith Gordon, Ph.D., and Shawn Boles, Ph.D., has been working in the area of youth tobacco use prevention research for the past 20 years. Since the early 1980s, this research group has contributed to the understanding of best practices in prevention delivered through schools, parents, health care settings, and community-wide programs. Grants from the National Institutes of Health have made it possible for these researchers to pursue an understanding of how to influence the social context within which children and adolescents make decisions that affect their long-term health and well-being.

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Project PATH: Early School-Based Prevention (1984-1989)

In 1984, ORI received a grant from the National Cancer Institute to develop and field-test a tobacco prevention curriculum for young people in grades 6-12. Researchers evaluated this curriculum, named PATH (Programs to Advance Teen Health), in 48 Oregon middle and high schools, including schools from the Springfield and Portland Public School Districts.

Over the course of the five-year study, they proved the PATH curriculum to be effective; however, the effects were small and the research group felt there still was more that could be done to influence kids to make healthy choices. Simultaneously, researchers all over the country were discovering that a school-based prevention curriculum alone was not enough, and that more comprehensive strategies were beginning to show promise.

The ORI group went back to the NCI with a proposal to expand their prevention efforts to encompass a more comprehensive approach, which would mobilize entire communities to deliver the prevention message. In 1990, ORI received funds from NCI to evaluate their community-wide program in a five-year study. Thus Project SixTeen was born.

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Project SixTeen (1990-2000)

Project SixTeen was a randomized controlled trial in 16 Oregon communities with populations of 15,000 or less. Communities were chosen based on size and demographics, then asked if they were willing to participate in the study. Investigators randomly assigned eight communities to receive the entire community-wide intervention, and randomly assigned the other eight to receive only the school-based curriculum (PATH).

The Oregon communities that chose to participate in Project SixTeen were:

When the ORI research team began developing the community-wide prevention campaign, they identified each of the major influences on kids, then worked to develop a set of activities that would mobilize each of those influences to deliver the prevention message. As a result, the five components of the Project SixTeen community intervention were: (1) Youth Anti-Tobacco Activities (peer influence), (2) Family Communications about Tobacco (parent/family influences), (3) the PATH Curriculum (school influence), (4) Reducing Youth Access to Tobacco (community influence), and (5) Media Advocacy (media influence).

The community-wide program occurred for three years in each of the intervention communities, and was organized and implemented by Community Coordinators who were hired directly from each community. They were people with strong networks and good connections with a cross-section of community leaders and organizations. Project SixTeen had an office and a visible presence in each town where they conducted the program.

Over the course of the five-year study, Project SixTeen proved to be effective. That is, the communities that had the full-blown community-wide intervention showed lower rates of tobacco use among youth than the school-based-only communities, after one year and after three years of intervention. For more information or to receive a journal article about the project’s outcomes, please e-mail ORI.

After the intervention was complete, Project SixTeen received an additional five years of funding to continue follow-up with the students who had entered the study at its inception. That is, the NCI provided funds for the project to continue doing surveys of young people after they had graduated from high school, until they were about 23 years old. Analyses are underway to determine whether the Project SixTeen intervention had lasting effects on tobacco use as these youth moved into adulthood.

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PACT: Parents and Communities against Tobacco (2000-present)

Project SixTeen’s effects were encouraging. However, the results were for the overall program, and did not show which of the five components was most effective in helping kids choose not to use tobacco. The ORI team felt that they could learn more about best prevention practices if they could determine the relative value of those components.

A current project, also funded by the NCI, seeks to expand and update two of the Project SixTeen components, Family Communications about Tobacco and Youth Anti-Tobacco Activities. This current study, named PACT (Parents and Communities against Tobacco), is happening in the communities surrounding 40 Oregon middle schools. PACT uses video and website technology to help deliver the anti-tobacco message, and draws on the Project SixTeen community organization model to mobilize peer and parent influences on youth decision-making.

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Department of Human Services-Health Division Statewide Tobacco (1997-present)

In 1997, Oregon voters passed Measure 44, which added a 60-cent tax to every pack of cigarettes purchased in the state. The measure earmarked two percent of these tax revenues for tobacco use prevention. The Department of Human Services-Health Division (DHS-HD) was charged with administering these prevention funds, so it set about deciding how best to allocate these resources.

Because of ORI’s long history in evaluating tobacco prevention strategies, the DHS-HD called upon Dr. Biglan and his colleagues to advise them in best prevention practices. ORI and DHS-HD developed a plan for the Oregon Statewide Tobacco Prevention Program, which included reducing tobacco advertising, encouraging the adoption of clean indoor air policies, reducing illegal sales of tobacco to minors, providing links to tobacco cessation resources, and developing a full-blown anti-tobacco media campaign. For more information about the Oregon Tobacco Prevention Program, go to DHS-HD's Tobacco Prevention page.

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Oregon Healthy Teens: ORI in Partnership with State Agencies (2000-present)

As the Oregon Statewide Tobacco Prevention Program progressed, DHS-HD and other state agencies became interested in learning more about how well the program was working. In 1999, the National Cancer Institute issued a request for proposals to support statewide studies encouraging collaboration between agencies and organizations. ORI collaborated with DHS-HD, the Oregon Department of Education, and the Office of Alcohol and Drug Abuse Programs to submit a proposal for ORI to evaluate how well the Statewide Tobacco Prevention Program was working to prevent kids from starting to use tobacco. In 2000, NCI awarded this grant, which forms the foundation for Oregon Healthy Teens.

Design of the NCI-funded study is a prospective, nested, three-year longitudinal evaluation to discover the effects of both tobacco control practices and individual risk factors on the prevalence of tobacco use among high school and middle school students. Using a cluster sampling frame compatible with existing state and federal data collection systems, proctored questionnaires, telephone surveys, field probes, and summaries of state and local record systems, data are collected on: (a) classroom-based tobacco prevention programs, (b) tobacco use policy, (c) youth access to tobacco products, (d) youth anti-tobacco activities, (e) family influences on youth tobacco use, (f) youth cessation programs available, (g) exposure to media about tobacco use, and (h) cigarette price. See: Student Questionnaires and Other OHT Questionnaires.

Oregon Healthy Teens not only helps the state understand how well its tobacco prevention efforts are working, but also provides information to all state agencies that provide services to schools and children to help decision-makers allocate resources where they are most needed. Oregon Healthy Teens gives communities the opportunity to understand their strengths and weaknesses in supporting the health and well-being of children. Schools and communities must rely on proven strategies demonstrating need and providing accountability by measuring outcomes to obtain Safe and Drug-Free Schools funding and other grants. The information provided through Oregon Healthy Teens becomes a primary means of accomplishing the task of enhancing local prevention resources.

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Oregon Healthy Teens: A Significant Sample

In the past two years, Oregon Healthy Teens has served 86 districts, 34 counties, and 250 schools, and has surveyed over 28,000 students each year – the most significant sample of adolescent data ever collected in Oregon. The information collected through student questionnaires (of grades 8 and 11) and from various other sources can provide Oregon communities and schools with a clear picture of the proportion of youth growing up successfully and the proportion who are having problems.

OHT’s long-term objective is to build protective community systems that will encourage Oregon kids to choose healthy lifestyles, now and in the future. We all want to see the largest possible proportion of youth arrive at adulthood with the skills, interests, assets, and health habits that will help them to live long, happy, and productive lives in caring relationships with others.

A half century of research has identified problems harmful to the well-being of our youth: cigarette smoking, binge drinking, illicit drug use, antisocial behavior, sexual behavior that risks pregnancy or disease, drunk driving, depression, academic failure, improper diet, and lack of exercise–all of which have not only a social but also a financial cost. A 1998 estimate showed that substance use, antisocial behavior, high-risk sex, high school dropout, and suicide cost Oregon $5 billion that year. The OHT collaborative team shares a vision of reducing these costs by identifying how best to support and assist communities, schools, and young people.

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