Developing Stanford’s Tobacco Prevention Toolkit to Teach Young People about the Harms of Tobacco Use

Today, Stanford’s Tobacco Prevention toolkit is the leading curriculum for tobacco education among teens and youth around the world. Founder, Dr. Bonnie Halpern-Felsher, is the Marron and Mary Elizabeth Kendrick Professor of Pediatrics at Stanford University and the founder and director of the REACH Lab and tobacco and other substance toolkits. She recently visited our team at the Center for Tobacco and the Environment. While here, she took us through the journey of where it all started. And as is often the case with great ideas, hers began with a few words of advice.

Georg Matt, Bonnie Halpern-Flesher, and Lydia Greiner stand in front of a sign that says Policy Research Center for Tobacco and the Environment.

“’Don’t be a talking head.’”

That is what Stephen Smuin, founder of Odyssey Middle School, said to Halpern-Felsher when she was preparing to present about tobacco prevention to his middle school students.

By not being a “talking head,” Smuin meant being engaging and interactive with the students rather than simply lecturing at them, Halpern-Felsher said. That way, the students would be more open and ready to learn about tobacco. Her presentation at the Odyssey School was back in 2008. She wasn’t a talking head then – and certainly is not now.

After that first presentation, Halpern-Felsher and Smuin worked with Ira Sachnoff, Founder of Peer Resource Training & Consulting, to create a toolkit for teens about the risks of tobacco. They received the first round of funding to develop the toolkit from the Tobacco-Related Disease Research Program in 2009.

“At first, we were just going to create a few lessons, since we learned that other comprehensive tobacco education programs existed,” said Halpern-Felsher, explaining that many who participated in their early focus groups did not think that there was a need for an entire curriculum. The toolkit expanded, though, as the group considered what they wanted to include in it. For example, the group wanted to add information about teens’ brain development and how it related to tobacco use. They also wanted to acknowledge how avoiding tobacco can feel difficult for teens when they are trying to fit in during high school.

“It’s as risky for a teen to say ‘no’ as to say ‘yes,’” Halpern-Felsher said.

Bonnie Halpern-Flesher stands.

The first version of the toolkit, in 2016, included this information, as well as sections on nicotine addiction and activities for both parents and teens to do together. It was a hit, especially in several counties in California, Halpern-Felsher said.  

The first few California counties to pilot test the Toolkit asked Halpern-Felsher and her colleagues if they would make a comprehensive curriculum about smoking and vaping for teens. They agreed. The group also received additional funding from California’s Tobacco-Related Disease Research Program and the CVS Health Foundation.

The group helps to “teach the teacher” how to use the Toolkit, Halpern-Felsher said. From there, teachers can use the skills they learn to teach their students. Other toolkits add extra responsibility to students, teachers, and parents outside of normal class, Halpern-Felsher said, but she and her colleagues wanted to make a resource that was easy to use during class.

By 2017, the e-cigarette company JUUL was becoming very popular. The company was also targeting teens in many of their advertisements, showing young people having fun while JUULing. Tobacco control advocates were worried about children and teens. Even Halpern-Felsher’s daughter and her friends were concerned, asking Halpern-Felsher how she and her colleagues were going to handle JUUL.

“We built really the first JUUL curriculum,” Halpern-Felsher said. JUUL 101 defined what e-cigarettes like JUUL are and how they work as well as how they relate to nicotine addiction.

flyer about the REACH Lab's toolkit

Around 2022, Halpern-Felsher founded the Research and Education to Empower Adolescents and Young Adults to Choose Health (REACH) Lab at Stanford University. All of the toolkits are now a part of the REACH Lab. Since 2022, the REACH Lab has expanded, updating their slides and including scripts for teachers. Today, the REACH Lab’s Tobacco Prevention Toolkits includes a dedicated e-cigarette prevention curriculum called You and Me, Together Vape-free,  an alternative-to-suspension curriculum called Healthy Futures, and a cannabis-focused toolkit.

To reach younger children, the Lab has adapted the original smoking and tobacco curriculum for elementary-age students and created an elementary-focused vaping curriculum as well.

“Third graders are vaping if you didn’t know,” Halpern-Felsher said. She mentioned she did not initially want to make a curriculum for children that young, but she saw a need for it. Big Tobacco has targeted children for e-cigarettes, and everyone – including children, teachers, parents, healthcare providers, and tobacco prevention advocates – need to be knowledgeable about vaping.

The curriculum has been offered to more than 3 million young people. “We are used in every state in the United States and in over 6 countries,” Halpern-Felsher said.

Looking ahead, the REACH Lab plans to continue expanding the curriculums, creating lessons for different vulnerable communities and covering different topics related to tobacco, such as environment-focused lessons. Through such tobacco education efforts, youth and future generations may be able to grow up in a world free of the influence and burden of tobacco use.

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