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Research ArticleOriginal Research

Family Physicians and Youth Tobacco-free Education: Outcomes of the Colorado Tar Wars Program

Jeffrey J. Cain, W. Perry Dickinson, Douglas Fernald, Caroline Bublitz, L. Miriam Dickinson and David West
The Journal of the American Board of Family Medicine November 2006, 19 (6) 579-589; DOI: https://doi.org/10.3122/jabfm.19.6.579
Jeffrey J. Cain
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W. Perry Dickinson
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Douglas Fernald
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Caroline Bublitz
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L. Miriam Dickinson
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David West
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Article Figures & Data

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    Figure 1.

    Tar Wars Pretest Questions.

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    Figure 2.

    Tar Wars Post-test Questions.

Tables

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    Table 1.

    Demographics of Student Populations: Pre- and Post-test χ2 Analysis Results*

    Demographic Variable:Pretest (n, percentage of total) N = 2929Post-test (n, percentage of total) N = 2766
    Age (years)
        9 years old38 (1.3)40 (1.5)
        10 years old1047 (35.8)924 (33.4)
        11 years old1620 (55.4)1513 (54.7)
        12 years old173 (5.9)160 (5.8)
        13 years old15 (0.5)24 (0.9)
        Missing33 (1.1)105 (3.8)
    Race
        White2236 (76.4)2067 (74.7)
        Other368 (12.6)325 (11.8)
        Missing322 (11.0)374 (13.5)
    Ethnicity
        Hispanic529 (18.1)452 (16.3)
        Not Hispanic2159 (73.8)1949 (70.5)
        Missing238 (8.1)365 (13.2)
    Gender
        Boy1475 (50.4)1360 (49.2)
        Girl1416 (48.4)1297 (46.9)
        Missing35 (1.2)109 (3.9)
    Smoker in Household
        Yes975 (33.3)950 (34.4)
        No1904 (65.1)1792 (64.8)
        Missing47 (1.6)47 (0.9)
    Current tobacco user
        Yes10 (0.3)22 (0.8)
        No2774 (94.8)2725 (98.5)
        Missing142 (4.9)19 (0.7)
    • * No statistically significant differences between pre- and post-tests demographically, P > .05.

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    Table 2.

    Student Responses to Knowledge Questions on Pre- and Post-Test: Hierarchical Model Results

    QuestionCorrect ResponsePret Test N = 2929Post- Test N = 2766P Value
    Correct (%)Don’t Know (%)Correct (%)Don’t Know (%)
    1. Smoking causes bad breathTrue92.85.298.70.9<0.001
    2. Smokers have yellow teethTrue86.98.696.91.8<0.001
    3. Cigarettes which that contain low tar are safeFalse77.020.486.511.5<0.001
    4. Smokers have clean- smelling clothesFalse88.26.192.62.2<0.001
    5. Smoking decreases the amount of air that gets into your lungsTrue84.710.091.44.4<0.001
    6. Smoking a pack of cigarettes a day would cost over several hundred dollars per yearTrue66.928.189.35.3<0.001
    7. Tobacco users are cool, sexy, and popularFalse92.54.694.13.10.009
    8. Some people use tobacco because their friends doTrue89.45.792.93.9<0.001
    9. Smoking is relaxingFalse58.833.167.019.6<0.001
    10. Advertisers tell the truth about tobacco useFalse57.928.280.510.4<0.001
    11. Tobacco companies can use TV as a way of advertisingFalse14.317.330.48.5<0.001
    12. G-rated movies are used by tobacco companies to sell tobaccoTrue8.337.944.623.0<0.001
    13. It is against the law for tobacco companies to advertise to kidsTrue63.823.265.316.0<0.001
    14. What percentage of kids your age do not use tobacco every week?About ∼95%59.8NA70.7NA<0.001
    • View popup
    Table 3.

    Direct Quotations from Qualitative Interviews of Students, Teachers, and Presenters

    RespondentQuotation
    Students“I was way off. I thought more adults than 9thth graders smoke, and I thought no 5th graders smoke.”
    “If you smoke cigarettes, you are buying your own death.”
    “When you’re older, then you get more peer pressure and you need more help saying ‘No.’”
    “You could tell she [the doctor] knew what she was talking about”o. She was speaking from experience.”
    Teachers“I think the Tar Wars presentation is a real important part of our overall health curriculum because that really points out to kids the risks of smoking and of using chewing tobacco and also the good things that happen to them if they don’t smoke or use tobacco. So, probably 50% of my students’ parents smoke, and, so I think it’s kind of important that my students are given an objective view of the smoking and chewing tobacco, and, hopefully, they will make their own decisions when they get of the age to use those products.”
    “The smell of it and the cost of it. That appalled them. One of my little kids went home and told his mother that if she quit smoking, that they’d have enough money to buy good food.”
    “The advertisements they always find interesting because they like to see how they’re being tricked. But then, some of the facts that he gave, about when people start smoking or, you know, the percentage of kids in the 9th grade who are smoking, it’s kind of shocking to them they can’t believe it.”
    “When he did the breathing through the straw and there was some running and jumping and then realizing they couldn’t breathe while they do sports. We have some children who are really interested in sports and they are everywhere. And, realizing how important it is to run fast, ski hard and kick that soccer ball, they wouldn’t be able to breathe very well; I think that really got to them.”
    Presenters“When you tell them how many dollars a year cigarettes cost. A thousand dollars a year for one pack a day. That’s when you get the ‘oohs’ around the room. We talk about what else they can buy with that much money.”
    “ ‘We’ve heard it all, we’ve done the DARE program, we know all there is to know about smoking, you’re not telling us anything new,’ [the students say]; and it wasn’t until they actually heard the beginning of the presentation that they were really willing to sit and listen, because they realized, oh, this is a little different than what we’ve heard before.”
    “… they also like any messages I give them that are new or … that they didn’t know about. For example, one of the facts that we talk about is that tobacco companies pay movie-making companies to put smoking or cigarettes in there. And, man, especially even in kids movies and, like, the kids go, ‘Whoa!’ They didn’t know that and so they were impressed by the power of the tobacco company.”
    “The thing that surprised and personally amazed me, was their estimates of smoking prevalence in society.… They estimated that 25% to to 40% of high-schoolers and 60% of adults are smoking now.”
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The Journal of the American Board of Family Medicine: 19 (6)
The Journal of the American Board of Family Medicine
Vol. 19, Issue 6
November-December 2006
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Family Physicians and Youth Tobacco-free Education: Outcomes of the Colorado Tar Wars Program
Jeffrey J. Cain, W. Perry Dickinson, Douglas Fernald, Caroline Bublitz, L. Miriam Dickinson, David West
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 579-589; DOI: 10.3122/jabfm.19.6.579

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Family Physicians and Youth Tobacco-free Education: Outcomes of the Colorado Tar Wars Program
Jeffrey J. Cain, W. Perry Dickinson, Douglas Fernald, Caroline Bublitz, L. Miriam Dickinson, David West
The Journal of the American Board of Family Medicine Nov 2006, 19 (6) 579-589; DOI: 10.3122/jabfm.19.6.579
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