Project Abstract

In collaboration with the University of the South and community partners, we propose to continue our work with Grundy County High School looking at perceptions of tobacco use among youth to understand and develop a high-school based tobacco prevention and cessation program. The proposed project will provide crucial evidence about use of tobacco products in a vulnerable population, and means of reducing these rates, which is well within the goals of the Foundation.

Project Alignment with the Collaborative for Southern Appalachian Studies

Our study aims are consistent with the foundation’s goals of enhancing and engaging in community-based participatory research (CBPR) and qualitative research and analysis. We are very interested in learning how to reduce tobacco addiction in the Appalachian community of Grundy County and encouraging a healthy lifestyle among high school students in southern Appalachia. Once we conduct a school survey, we will have the opportunity to combine the results of the focus groups and the survey to later design and pilot a tobacco cessation intervention in the local high school that can include messaging campaigns to prevent tobacco use and other school-based efforts to change behavior related to tobacco use. The details of this intervention and the interest in student participation will be informed by the survey.

In support of the larger goal of the Collaborative, this proposal supports creation of a continued partnership between the University of the South and Yale University in fostering initiatives focused on public health in southern Appalachia, an area underserved by Sewanee’s current curriculum. Understanding how adolescents perceive tobacco products is the key to developing appropriate communication and education methods to convey information about these products to this high risk group. Our approach of using mixed methods techniques (focus groups and a survey) to address this issue is highly innovative and in line with the aims of the Collaborative. We have already started our collaboration with the Grundy County schools conducting our school-based focus groups. While focus groups allow for in-depth evaluations and the use of open-ended questions and probes to encourage clarification and elaboration, surveys allow for collection of detailed but more generalizable inform =ation from more diverse and larger groups of participants (Creswell & Plano Clark, 2011; O’Cathain, 2010). Using qualitative and quantitative approaches are more adequate in developing a complete understanding of both the nature and magnitude of adolescents’ perceptions about tobacco products.

Our group at Yale also has experience in conducting mixed methods research and analyses. We have conducted numerous middle school and high school focus groups and administered school-wide surveys about tobacco and other modified risk tobacco product use and perceptions (Camenga et al., 2015; Kong et al., 2015, Krishnan-Sarin et al., 2014), co-use of tobacco products (Camenga et al., 2014, Morean et al, 2015), development of health communication messages (Cavallo et al., under review, Kong et al., under review) and interest in an incentive-based cessation program (Morean et al, 2014). Furthermore, with data to support a larger grant, implementation of a pilot program to motivate and encourage abstinence will serve as a platform to begin reducing the public health problem of tobacco use, while providing a future learning opportunity for University students to be trained and mentored in delivering tobacco-specific behavioral interventions in this rural Tennessee school.

One of the fundamental teaching areas in both graduate and undergraduate social sciences programs is research methods. Mentoring students in the complexity of research is important to build students’ research skills. One future possibility is to have Yale faculty partner with a faculty member at the University of the South to teach the process of implementing mixed method research studies. This could include a series of lectures on the elements of focus groups, such as participant recruitment, participant consent, collecting demographic data on simple questionnaires, learning the skills to facilitate an effective focus group, developing a discussion guide, data collection, and analysis using Atlas.ti. It could also include complimentary survey research and development to further inform interventions and provide a framework. I have already provided a course lecture on focus groups at the University of the South in one of Dr. Yu’s undergraduate classes and this cou ld be expanded to a collaborative teaching opportunity with a didactic and experiential component to train students in qualitative and quantitative research methods, such as focus groups and survey design.

Project Impact

This research project will provide an assessment of tobacco use and perceptions to inform a prevention and cessation program. The results of the qualitative portion of the study is being written into a manuscript for publication and will guide us in developing a more comprehensive quantitative look at the tobacco use rates, risk perceptions, and acceptance of a school-wide intervention program to motivate students to become or remain tobacco free. This research will promote greater understanding of the region both within and beyond the school and also have a positive community impact. We will support collaborations between Sewanee and Yale by involving Yale faculty to mentor University students, as well as community partners in a joint research project to build a foundation for development of future efforts. “Community members will realize promised deliverables and community partners will be involved in worthwhile experiences.”