Improving School-Parent Coordination to Prevent Nicotine Use among Rural Youth - PROJECT SUMMARY Nicotine and tobacco use [hereafter, nicotine use (NU)] is higher among rural youth, with variation by product type, contributing to the greater burden of lung cancer, cardiovascular disease, and chronic lower respiratory diseases among rural populations. In Arkansas (AR), where 41% of residents live in rural areas, tobacco use and tobacco-caused diseases exceed national averages. NU among AR high school students (25%) surpasses the national average (18%), driven in part by low adoption and implementation of NU prevention programs. This R34 will adapt a NU prevention program for rural settings and identify community- centered implementation strategies, generating key outputs to be evaluated in a future R01 hybrid type 2 effectiveness-implementation trial focused on reducing NU and chronic disease risk among rural youth. NU prevention is most effective when both schools and families are engaged. However, a lack of school- parent coordination around NU prevention is a major deterrent to schools implementing NU prevention programs. Yet, no US studies have evaluated coordinated school-parent NU prevention programs that include a focus on vaping. Home-based anti-nicotine socialization (home smoking/vaping bans, parent-child communication about NU, restrictions on child tobacco access at home, and parental knowledge about child activities) is effective at preventing youth NU, even if parents use nicotine, and complements school-based prevention by addressing home-based risk factors, which is critical among rural youth with greater exposure to and risk from home-based risk factors. Our preliminary data establish the critical need to improve the uptake of school and family NU prevention programs in AR through a coordinated school-parent approach. Our long-term goal is to reduce NU and the risk of cardiovascular disease, lung disease, and cancer among rural youth by improving the uptake of a coordinated school-parent NU prevention program. Our project objective is to use community-engaged implementation science and best practices in NU prevention to 1) establish and pilot an intervention that integrates evidence-based family and school NU prevention strategies and 2) pilot implementation strategies that address adoption and implementation challenges in rural settings. Our hypothesis is that our novel school-parent NU prevention intervention will be feasible, acceptable, and appropriate, produce changes in youth NU risk, and—together with our implementation plan—enhance uptake by rural AR schools and parents, ultimately reducing youth NU. Specifically, we will conduct formative work with rural school professionals, 6th graders, and parents in Aim 1, refine a coordinated school-parent NU intervention and identify implementation strategies in Aim 2, and then conduct a preliminary evaluation of the intervention and implementation strategies in Aim 3. Our work has strong potential to increase school and parent NU prevention intervention uptake, resulting in less NU and chronic disease risk among rural youth.
