# A pilot stratified cluster randomized trial of school-based e-cigarette and other tobacco product use prevention for Pacific Island youths: An evaluation of the Fuetsan Manhoben curriculum

## TL;DR

A school-based curriculum called Fuetsan Manhoben was tested to prevent e-cigarette use among Pacific Island youths, showing some delayed effects after three months.

## Contribution

The study evaluates a culturally tailored curriculum for e-cigarette prevention among Pacific Island youths using a cluster-randomized trial.

## Key findings

- The intervention did not significantly reduce e-cigarette use initiation or use in the short term.
- At three months, the curriculum reduced openness to e-cigarette use by 51%.
- Four lessons may not be sufficient for immediate preventive effects, suggesting a need for longer or expanded curricula.

## Abstract

E-cigarette use among young adolescents in Guam, and potentially other regions of the US-Affiliated Pacific Islands (USAPI), is markedly higher than among similarly aged adolescents in the general US population. The objective was to test the pilot version of a school-based e-cigarette and other tobacco product curriculum, named Fuetsan Manhoben, on outcomes related to e-cigarette use among Guam middle school students.

The intervention involved 4 video-based, culturally tailored lessons delivered in the classroom by health educators. A stratified cluster-randomized design was used to assign 8 public middle schools to either the intervention or the control condition. Six classrooms in each school participated in the study. Participants (n=269) in the intervention condition received the 4-lesson curriculum, whereas participants (n=269) in the control condition did not receive any intervention. Participants in both conditions provided data at pretest, post-test (4 weeks later), and at follow-up at 3 months. The current analyses pertain only to e-cigarette-related outcomes. Wald tests were utilized to determine the statistical significance of fixed effects within the negative binomial and logistic regression frameworks.

At immediate post-test, the intervention did not have statistically significant effects on openness to using e-cigarettes (incidence rate ratio, IRR=0.79; 95% CI: 0.42–1.49, p>0.05), e-cigarette use initiation (OR=O.96; 95% CI: 0.42–2.19, p>0.05), or past-30-day e-cigarette use (IRR=0.90; 95% CI: 0.77–1.06, p>0.05). At follow-up at 3 months, the intervention also did not have statistically significant effects on e-cigarette use initiation (OR=0.70; 95% CI: 0.34–1.45, p>0.05) or past-30-day e-cigarette use (IRR=0.94; 95% CI: 0.82–1.08, p>0.05). However, findings indicated that the intervention reduced openness to using e-cigarettes at follow-up at 3 months (IRR=0.49; 95% CI: 0.28–0.86, p<0.01). That is, being assigned to the intervention condition was associated with 51% decrease in openness to using e-cigarettes at follow-up at 3 months.

Four lessons delivered over 4 weeks may not produce immediate short-term preventive effects, except potentially reducing e-cigarette use susceptibility at follow-up at 3 months. Further research is warranted to examine whether expanding the content and duration of the curriculum may result in stronger, more durable effects. Also, future studies should examine whether increasing the follow-up to 6–12 months might capture delayed preventive effects that were not detectable within the shortened, follow-up at 3 months in the current study.

The study is registered on the official website of ClinicalTrials.gov

ID NCT05037656