High rates of tobacco and areca nut use in Guam and the rest of the U.S.-Affiliated Pacific Islands are of concern, especially in the context of the cancer disparities faced by the USAPI populations. Most tobacco/areca nut users initiate use during adolescence and our data suggests that adolescent tobacco product and betel nut use in Guam are alarmingly high compared to the U.S. nationally. This Project proposes to develop an adolescent tobacco and areca nut use prevention program for Guam youths. If successful, the program may be disseminated to the rest of the USAPI. The program may thus help curb the initiation of tobacco and areca nut use among USAPI adolescents and, by doing so, may reduce the high rates of cancer-related morbidity and mortality faced by the USAPI populations.

Specific Aims:

• Develop a school-based curriculum and a social media based social marketing campaign for tobacco product (i.e., cigarette, e-cigarette, smokeless
  tobacco) and areca nut use prevention among middle school students in Guam.
• Primary: Test the efficacy of the school-based curriculum in a randomized controlled trial. Secondary: Test the effects of the social media-based campaign.