Tobacco prevention efforts rely on an integrated, multifactorial approach to achieve the desired outcomes. Complementary school tobacco-free education programs are not independent processes; rather, they are interlocking pieces of a puzzle that require repetition and reinforcement to be successful. Each of these pieces alone cannot be the single answer to the problem. Collectively, however, their tobacco-free messages are each delivered in a different manner, thus reaching and appealing to more children than one program alone can affect.
Tar Wars is uniquely positioned among tobacco-free education programs geared to youth and has been successful in achieving its desired outcome of increasing students' understanding of the short-term, image-based consequences of tobacco use and the deceptive tactics found in tobacco advertising. Research on the effectiveness of the AAFP-supported program has been conducted and evaluation results have been published.
Tar Wars is consistent with the guidelines for youth tobacco prevention programs as outlined in the CDC's 2000 publication, "Guidelines for School Health Programs to Prevent Tobacco Use," and currently addresses five of the seven implementation guidelines: (2) Instruction, (3) Curriculum, (4) Training, (5) Family Involvement, and (7) Evaluation. Through coalitions and community-wide efforts, some state Tar Wars programs meet all seven.
Conclusions drawn from a quantitative evaluation of the longitudinal impact of Tar Wars showed sustained improvements in students' knowledge and attitudes related to tobacco use. Students exhibited greater recognition of the health effects, cost, and image distortion associated with tobacco use compared to their peer control group. Findings also indicated positive and sustained effects among students following exposure to a one-time, structured tobacco use prevention program compared to peers who had not heard the program. View the published article.
A qualitative evaluation of Tar Wars based on student, teacher, and presenter perspectives found a high level of satisfaction with the program and positive, short-term changes in knowledge of tobacco use. Students indicated an understanding of key program elements, and classroom teachers believed the program was worthwhile and presented unique information. Presenters exhibited enthusiasm for the ease of use and future opportunities for presentation. Constituent chapters involved with Tar Wars were highly satisfied with the program as well. The published article, "Evaluation of a Youth Education Program: Student, Teacher, and Presenter Perspectives," appeared in the October 2000 issue of the Journal of School Nursing (Vol. 16, Issue No. 4). Read the abstract.
Evaluation conducted by the Tar Wars national office utilizes pre- and post-test data to measure knowledge and attitude changes regarding tobacco use. More than 63,000 pre- and post-tests were collected for the 2001-2002 academic year. Overall results from this evaluation showed a 90.9% satisfaction rate with the Tar Wars program. Nearly 90% correctly answered the knowledge-based questions, and 98.9% responded that they would not use tobacco in the coming year. State Tar Wars coordinators are provided with state-specific results for use in their grant applications and other funding opportunities.
Iowa has conducted an evaluation of "Tar Wars With a Twist," which pairs teens with adults to present the Tar Wars program. Results have not been compiled yet; however, a number of other states, including Colorado, California, Idaho, and Indiana are adopting this innovative style of peer-led instruction with favorable results.
Based on the AAFP Practice Profile Survey results, the number of family physicians participating in Tar Wars nearly doubled between 1997 and 1999. A survey conducted at the 1999 Annual Conference of the National Association of School Nurses showed that, of all available tobacco prevention programs, Tar Wars was the most recognized. In addition, some states are conducting their own longitudinal studies as required by their state grants.
Cain JJ, Dickinson WP, Fernald D, Bublitz C, Dickinson LM, West D. Family Physicians and Youth Tobacco-free Education: Outcomes of the Colorado Tar Wars Program. Journal of the American Board of Family Medicine 2006;19:579-589.
Mahoney MC, Bauer JE, Tumiel L, McMullen S, Schieder J, Pikuzinski D. Longitudinal Impact of a Youth Tobacco Education Program. BMC Family Practice 2002;3:3.
Mahoney MC, Stengel B, McMullen S, Brown S. Evaluation of a Youth Tobacco Education Program: Student, Teacher and Presenter Perspectives. Journal of School Nursing 2000;16:16-21.
Mahoney MC, Costley CM, Cain J, Zaiger D, McMullen S. School Nurses as Advocates for Youth Tobacco Education Programs: the TAR WARS experience. Journal of School Health 1998;68:339-341.