RTI International is a trade name of Research Triangle Institute

1. Are We Reaching the Groups Most in Need Barri Burrus, Ph.D., Maria Girlando; BA, Brett Loomis, Ph.D., Kristin Arnold, MSPH RTI InternationalPresented atNorth Carolina’s Health & Wellness Trust Fund’s Annual MeetingOctober 13, 2010, Charlotte, NC 3040 Cornwallis Road ■ P.O. Box 12194 ■ Research Triangle Park, NC 27709 Phone 919-541-6852 Fax 919-541-6683 e-mail mcf@rti.org RTI International is a trade name of Research Triangle Institute

2. Overview • Challenges identifying the youth most likely to use tobacco • Youth that initiate smoking after high school • Groups that cross ethnic and racial categories • Types of youth to reach depends on the intervention • Approaches to reach youth at risk

3. Challenging to identify youth at risk for tobacco • Identifying racial and ethnic groups at risk for tobacco use • Identifying groups that cross racial and ethnic categories, such as LGBT and LSES populations • Need to look beyond the numbers

4. Challenging to identify youth at risk for tobacco • Often focus on current smokers to try to categorize “types” of considered “at-risk” • While prevalence of use varies somewhat by racial and ethnic groups, important to remember that smokers can be found across all groups.

5. Who Smokes in the U.S.?

6. Smoking Prevalence by Race, Ethnicity, and Socioeconomic Status

7. Age of Initiation by Race, Ethnicity, and Socioeconomic Status

8. Smoking Prevalence of U.S. Cohort Born in 1984-1985 - Millennials

9. How Do We Know Who to Try to Reach?

10. How do we know who to try to reach? • Statistics help guide us to priority groups. • Preceding table shows us we need to work with all groups and not assume youth are not susceptible after high school age. • Focus of groups most at risk for initiation appears to shift post 18 • What other information is needed to refine interventions for reaching those most at need?

11. What types of youth do we need to reach? • Answer depends in part on the purpose of why we are trying to reach them • Three common types of intervention activities: • Direct intervention to reach individuals (e.g., mass media campaign) • Empowering youth as messengers for policy makers and other community leaders (e.g., doctors) • Engaging and training youth as messengers to reach at-risk peers

12. What types of youth do we need to reach for these activities? • Direct intervention to reach individuals (e.g., mass media campaign) • Seek to reach youth at risk for tobacco use • Empowering youth as messengers for policy makers and other community leaders (e.g., doctors, school administrators) • Variety of youth can be effective. “Model students” may be very effective for this type of intervention.

13. What types of youth do we need to reach for these activities? • Engaging and training youth as messengers to reach at-risk peers • “Model students” probably not effective messengers for these youth • Need youth messengers that “at-risk” perceive as their “leaders” or “messengers”

14. Approaches for reaching at-risk youth • Proactive peer nomination • Edgy interventions

15. Take home action items • Reach across racial and ethnic groups • Who is your current TRU group • Apply steps from tomorrow’s session to reach different groups

16. Take home action items • Focus on reaching at risk youth • Who are the youth using tobacco in your community? • Talk with students and teachers about who are the peer leaders for those groups currently using tobacco • Develop strategies to help reach those at-risk groups