California's School-Based Tobacco Use Prevention Program After Proposition 56: Results From a Statewide Evaluation

PURPOSE: California's longstanding, comprehensive tobacco control program includes the school-based Tobacco-Use Prevention Education (TUPE) program. Following passage of Proposition 56 in 2016, TUPE was expanded. This study investigated whether exposure to TUPE programming after Proposition 56 was associated with decreased youth tobacco use. METHODS: Data from the 2019-2020 California Student Tobacco Survey, a state-representative survey of students in grades 8, 10, and 12, were used. The survey was conducted in 358 schools. A total of 160,106 students (49,244 from TUPE-funded schools and 110,862 from non-TUPE-funded schools) were included in this study. The association of TUPE programming with student tobacco use was examined using logistic regression, controlling for the effects of personal and school variables. RESULTS: Students from TUPE and non-TUPE schools had similar rates of exposure to tobacco-related advertising, whether promoting vaping (16.4% vs. 16.8%, respectively), discouraging vaping (36.3% vs. 38.7%), promoting smoking (11.4% vs. 11.4%), or discouraging smoking (27.6% vs. 29.4%; all p's > 0.05). However, TUPE students were more likely to receive school-based education against tobacco use (71.0% vs. 63.8%; p < 0.001) and to participate in antitobacco activities (15.2% vs. 10.6%; p < 0.001). After controlling for the effects of personal and school variables, TUPE students were less likely to use tobacco (6.5%) than non-TUPE students (8.1%; p = 0.012). DISCUSSION: TUPE students were exposed to more school-based educational messaging and participated in more tobacco-related prevention activities. The greater focus on tobacco in TUPE-funded schools was associated with lower rates of tobacco use among their students.