Reach Lab

Tobacco companies (including e-cigarette/vape companies) have developed and implemented advertising and marketing efforts to reduce perceptions of harm associated with tobacco use, increase perceptions that tobacco is socially acceptable, and ultimately encourage and sustain use of tobacco. These marketing strategies have particularly focused on changing perceptions and increasing tobacco use among adolescents and young adults. There are gaps in the science concerning:

1. How perceptions influence tobacco use among adolescents and young adults, including changes in patterns of tobacco use from initiation to regular use, cessation, relapse, product switching, or dual/poly use
2. The role of pro- and anti-tobacco messages on perceptions of new tobacco products such as e-cigarettes, small cigars (little cigars and cigarillos), smokeless tobacco, snus, dissolvables, compressed tobacco, and emerging products that come on the market during the course of this research
3. The specific mechanisms by which marketing messages change tobacco-related perceptions, perceived acceptability of the product, and tobacco use behaviors

Prospective, longitudinal studies using frequent assessments and comprehensive measures of tobacco use, perceptions, and marketing are needed in order to provide specific scientific evidence about how marketing shapes decisions to use and stop using different tobacco products. This information will inform FDA regulation of the marketing and promotion of conventional, new and emerging tobacco products. This study fills gap in the science base by developing and testing a novel, comprehensive model concerning the relationships among pro- and anti-tobacco marketing messages, perceptions of tobacco risks and benefits, perceived product acceptability, and patterns of tobacco use among adolescents and young adults. Using a longitudinal cohort design with a sample of adolescents followed for five years, the aims of this study are to:

1. Determine adolescents’ and young adults’ perceptions of risk for disease, addiction, and death; acceptability; and benefits of using conventional, new, and emerging tobacco products that come on the market during the course of this research
2. Determine the predictive relationships among perceptions of tobacco-related risks, benefits, and acceptability of tobacco products, and the onset, continuation, cessation, relapse, switching, and dual use of tobacco products
3. Identify contextual factors (exposure to pro-tobacco media, anti-tobacco media, warning labels, and smoking images in the media and on the Internet) that influence perceptions of risks, benefits, acceptability, and subsequent tobacco use. 

This project is funded by Research by grant number 1P50CA180890 from the National Cancer Institute and Food and Drug Administration Center for Tobacco Products. 

School-based tobacco education efforts have had mixed results, with some showing short- and long-term success in reducing tobacco usage, and other programs yielding little or no positive outcomes. Few tobacco prevention programs are developed by first directly asking the stakeholders of these programs (educators, students, and parents) what is missing from school-based tobacco prevention programs, and then incorporating these missing aspects into new prevention messages and delivery strategies.

Applying results from a previous Pilot SARA in which we identified missing health messages, the specific aims of our project are as follows:

1. To develop, test, and implement a toolkit containing a set of youth development modules applied to school-based tobacco control and education efforts. Specifically, we are developing (a) a module for tobacco educators on the principles of youth development, (b) modules for implementing youth development strategies and best practices in the schools, including one on best practices to encourage youth involvement, using peers and near-peers, guiding youth to develop anti-tobacco messages, and guiding youth to create media an advocacy campaigns, and (c) a module that includes tobacco (nicotine) addiction messages to increase understanding and appreciation of nicotine addiction in order to reduce initiation and encourage cessation among youth who discount the addictive nature of tobacco.
2. Develop a module focusing on reducing electronic cigarette use, and
   
3. Develop, test and implement modules for parents, aimed at providing information about school tobacco policies, school tobacco control efforts and messages that parents can use to reinforce and append school messages.

This project is funded by grant numbers 21HT-0002 and 23GT-0010 from the Tobacco-Related Disease Research Program (TRDRP) and the California Department of Education (CDE),  Agreement No. CN120401.

Click here to view the Tobacco Prevention Toolkit Website

Research suggests that 51% of youth in detention centers have used marijuana at least once, and 16% use daily. Tobacco use is also high in this population, with studies showing that 67.5% of adolescent detainees use tobacco, a rate much higher than the national average of 17.2%. Despite the high rates of tobacco and marijuana use among youth in detention center settings, there are few studies that provide information about the unique factors influencing use and co-use of tobacco and marijuana among these high-risk youth. Further, there is little information regarding whether and how such information should be incorporated into interventions that can be implemented within juvenile detention centers, nor is there information regarding what contextual factors specific to the juvenile detention center should be taken into account when considering a clinical intervention in this setting.

The goal of this project is to gather formative information about unique factors contributing to marijuana and tobacco use among high-risk youth. Additionally, this project is a first step in assessing the possible role that the juvenile hall could and should play in addressing tobacco and marijuana use. Ultimately, it is expected that the results from this project will lead to effective programs to reduce tobacco and marijuana use among detained youth. This work is supported by the Stanford Clinical and Translational Science Award (CTSA) to Spectrum (UL1TR001085).

Dr. Halpern-Felsher is a Professor of Pediatrics. She is also the Director of Research and Associate Director of the Fellowship Program in Adolescent Medicine, Department of Pediatrics. Dr. Halpern-Felsher is a developmental psychologist whose research has focused on cognitive, psychosocial and environmental factors involved in adolescents’ and young adults’ health-related decision-making, perceptions of risk and vulnerability, health communication, and risk behavior. Her research has focused on understanding and reducing health risk behaviors such as tobacco use, alcohol and marijuana use, risky driving, and risky sexual behavior. Dr. Halpern-Felsher’s research and committee work have been instrumental in setting policy at the local, state, and national level. In California, Dr. Halpern-Felsher’s research was cited in support of school-based tobacco education initiatives within California’s Tobacco Education Research Oversight Committee’s 2012 Masterplan. This Masterplan sets funding priority areas for research, education and intervention for California. Dr. Halpern-Felsher is also collaborating with the California Department of Education to develop, implement and evaluate new school-based tobacco prevention and education materials. At the national level, Dr. Halpern-Felsher’s research was highlighted in the 2012 Surgeon General Report, ”Preventing Tobacco Use among Youth and Young Adults,” and Dr. Halpern-Felsher contributed to the chapter on Clinical interventions: The role of health care providers in the prevention of youth tobacco use. Dr. Halpern-Felsher has been a member of five Institute of Medicine, National Academies of Sciences committees focusing on adolescent and young adult health and risk behavior. She has served on the Board of Directors of the Society for Adolescent Health and Medicine (SAHM) and on Council for the Society for Pediatric Research (SPR).  She currently Co-Chairs the SPR Mentoring Committee and Chairs the SAHM Taskforce on Parents and Youth.  Dr. Halpern-Felsher was instrumental in getting SRA and SAHM to form partnerships to create a more comprehensive research agenda focusing on adolescent health.

David manages a five-year longitudinal study of California high school students, consisting of bi-annual online surveys examining perceptions of risks and benefits associated with tobacco and tobacco-related products. His focus is on data collection, management and analysis.

Sheila McLaughlin, MFA, is a Project Coordinator in the Division of Adolescent Medicine, Department of Pediatrics, Stanford University. Ms. McLaughlin holds firm to her commitment to assist youth during their high school years to achieve their educational and career goals. Ms. McLaughlin currently is the Project Coordinator for the “National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) Short-term Research Experience for Underrepresented Persons (STEP-UP),” where she gives force to her commitment to youth by facilitating each Step-Up student throughout their internship and by maintaining ongoing relationships among both mentors and alums. Concurrently, Ms. McLaughlin is the Project Coordinator of the “Role of Risk and Benefit Perceptions in Tobacco Control and Product Usage project,” a longitudinal study of adolescent tobacco use. She is responsible for the coordination, tracking and retention of over seven hundred research subjects and has worked with the Program Director to insure project goals are met.

Adrienne is a health educator, having worked both for the University of California, Davis, and, more recently, for a Federally Qualified Health Center in the Bay Area. In her role as a health educator at a school-based health center, Adrienne has worked to empower youth to make healthier decisions around issues such as pregnancy prevention; sexually transmitted infection prevention; alcohol, tobacco, and other drug use reduction; and healthy relationship building through one-on-one health counseling as well as through youth development programs. Adrienne is also a fellow in the Stanford Health 4 All post-baccalaureate certificate program, a program out of the Stanford Prevention Research Center that focuses on prevention of chronic diseases.  She is interning in the lab, helping to develop the Tobacco Prevention Toolkit.  She is ultimately interested in serving youth from marginalized communities in the Bay Area, through the development and implementation of evidence-based health interventions.

Richard Ceballos graduated from UC Berkeley in Fall 2013 with a B.A. in Integrative Biology. While attending UC Berkeley, he dedicated his time to serving underrepresented communities at Alta Bates Medical Center and Berkeley High School. In these settings he realized his strength in being able to connect and empower lives through science. Shortly after graduating, he was able to continue such passionate volunteer work by serving as a HIV counselor for Alliance Health Project at UCSF. This shaped his motivation to pursue a career that includes counseling/therapy, education, and prevention for at-risk populations. He was also employed at UCSF as a Clinical Research Coordinator and was able to lead a novel study on vaping in adolescents. This marked the beginning of his work around tobacco prevention and education. During his time at UCSF, Richard was also gaining clinical experience as a lab assistant in an IVF laboratory in San Francisco. As the Project Coordinator of this study, he hopes to utilize his professional skills and passion for education to lead the distribution of the Tobacco Prevention Toolkit and ensure that its materials are accessible and the most up to date for educators.

Anabel is a Research Associate, Director of Communications and Lab Manager in the Division of Adolescent Medicine, Department of Pediatrics at Stanford University. Anabel graduated from the University of California Merced with a degree in Psychology and Sociology. During her undergraduate education, she interned at multiple healthcare centers, which developed her passion for community health. Anabel has previously worked at local health care centers and hospitals in the Bay Area, including Lucile Packard Children’s Hospital at Stanford. As a Research Coordinator, Communications Director and Lab Manager, Anabel’s focus is survey development and analysis, data collection, compiling progress reports on research and impact, managing social media platforms, and assisting with overall management and coordination.

Dr. Marcia Monica Zorrilla is a Public Health Specialist and Director of Positive Youth Development of the Halpern-Felsher Lab in the Division of Adolescent Medicine, Department of Pediatrics, at Stanford University School of Medicine.  Dr. Zorrilla is a bi-lingual (Spanish/English) / bi-cultural Master Certified Health Education Specialist (MCHES) with 25 years of clinical experience working in the adolescent health, youth development, and school-based health care fields.  She is the staff and mentor of the young people who make up the Youth Advisory Board for the Tobacco Prevention Toolkit and Cannabis Awareness & Prevention Toolkit.  Additionally, she is involved in curriculum development and conducting trainings for educators, health providers, parents, and youth advocates on the toolkits.  Dr. Zorrilla has a DrPH in health promotion and education from the Loma Linda University School of Public Health and an MPH in community health education from New York University.  Her dissertation focused on mental health literacy, depression, and helping seeking intention among young adults in San Francisco.

Dr. Shivani Mathur Gaiha is a postdoctoral fellow in Dr. Halpern-Felsher’s lab. Through her Ph.D., Shivani developed and evaluated an arts-based educational program to reduce mental-health-related stigma in India. The program had a large, significant and positive effect on participants - they were more willing to live, work, live nearby and continue relationships with people living with mental health problems. Her interdisciplinary Ph.D. research at the London School of Hygiene and Tropical Medicine was supported by the PHFI-UKC Welcome Trust Capacity Strengthening Award (2014-18). In 2017, she received the LSHTM Public Engagement Small Grant to strengthen schoolteachers’ understanding of mental health problems. Previously, Shivani designed, implemented and evaluated health communication and behavior change initiatives at the Public Health Foundation of India from 2008-2014. In Dr. Halpern-Felsher’s lab, Shivani focuses on adolescents' risky behaviors, especially patterns of use and perceptions about novel tobacco products such as electronic cigarettes, cannabis, and other substances. She uses mixed-methods experimental and implementation research to design impactful real-world programs and methodologies to bring about health-promoting behavior change. Shivani designs new studies to assess patterns and perceptions of youth related to substance use and evaluate school-based prevention interventions, including the Tobacco Prevention Toolkit and the Cannabis Awareness and Prevention Toolkit. She is particularly interested in investigating the mental health effects of the use of electronic cigarettes and other new tobacco devices, given that the nature of delivery and concentration of addictive substances, including marijuana, are rapidly changing. In addition to her research, she enjoys teaching webinars and sessions on research methods to high school and college students.