Research Documents Success of Tar Wars

The Academy's tobacco-free education program for students, Tar Wars, works. That's the conclusion of research involving fifth-graders, their teachers and their Tar Wars presenters. "Family Physicians and Youth Tobacco-Free Education: Outcomes of the Colorado Tar Wars Program" in the November-December issue of the Journal of the American Board of Family Medicine reports on data collected in 2001-02.

The article notes, "The Tar Wars lesson plan is effective in increasing students' understanding about the short-term consequences of tobacco use, cost of tobacco use, truth of tobacco advertising and peer norms."

According to AAFP staff members, from 10,000 to 15,000 family physicians and family medicine residents have presented the Tar Wars curriculum to about 8 million students in 50 states and 14 countries. "Outside of CME, more AAFP members have supported this program than any other Academy program," says Jeffrey Cain, M.D., chief of family medicine at The Children's Hospital in Denver; assistant professor in the family medicine department at the University of Colorado Health Sciences Center, Denver; a Tar Wars co-founder; and principal investigator for the study.

"All the family physicians in Tar Wars want to know, 'Is what we’re doing making any kind of a real difference among the kids?' This study answers with an emphatic 'yes.' We're making an outcomes-based difference," says Cain. "AAFP chapters can use the outcomes from this study in seeking funds for Tar Wars from foundations and other sources that require outcomes-based research."

The study used both quantitative and qualitative evaluations of Tar Wars presentations by family physicians, family medicine residents and other health educators. Researchers compared the results of 2,926 students' pre-tests and 2,766 students' post-tests; the numbers of students taking the two tests varied, but the students' demographics were not significantly different, says the article. Students averaged 8.95 correct responses to 14 pre-test questions, in comparison with 10.23 correct responses to the same 14 questions on the post-test. The increase seen in the number of correct post-test answers to all 14 questions compared with the number of correct pre-test answers was statistically significant, says Cain.

Responses to some questions indicated "a high degree of newly acquired tobacco knowledge," says the article. For example, students could mark "true," "false" or "don't know" in response to the statement "Smoking a pack of cigarettes each day for a year would cost at least several hundred dollars." In the pre-test, 67 percent of students correctly answered "true," compared with 89 percent in the post-test.

For qualitative measures, the researchers interviewed students, teachers and presenters and held focus groups with them. According to an interview transcript, one presenter said, "When you tell them (the students) how many dollars a year cigarettes cost -- $1,000 a year for one pack a day -- that's when you get the 'oohs' around the room."

"Tar Wars makes it clear that tobacco costs a lot, tobacco ads lie to you, and most kids the students' age and most adults don't smoke," said Cain. In addition, "The kids in our focus groups said that besides teaching them new things, Tar Wars covered information they had heard before but taught it in a different way that they found helpful,'' he said.

Elaborating on the concept of Tar Wars as "one component" of comprehensive prevention efforts, Cain asks family physicians not only to keep presenting the Tar Wars curriculum but also to

Cain shared the Tar Wars research during family medicine research presentations at the AAFP Scientific Assembly Sept. 30 in Washington, D.C., receiving the award for "best research presentation overall."