Assessing the Pragmatic Effectiveness and Implementation of Click City: Tobacco: A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use

Introduction: Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use. Methods: To evaluate the effectiveness of the updated 5th-grade program within a "real world"setting, we conducted a pragmatic randomized trial with 5th-grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/ cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum. Results: Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (before COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program. Conclusions: Findings suggest that Click City: Tobacco is effective for all 5th-grade students and can be delivered with fidelity across school settings. Implications: The results of a randomized pragmatic effectiveness trial showed that the updated Click City: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th-grade students, particularly for those at high risk. Program effectiveness and lack of differences because of factors such as state, gender, ethnicity, and historical timing have universal implications, suggesting that all students can benefit from this program. Click City: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City: Tobacco is effective and can be easily implemented in schools.