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Dr. Halpern-Felsher is a developmental psychologist whose research has focused on cognitive and psychosocial 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. Her research has been instrumental in changing how providers discuss sexual risk with adolescents and has influenced national policies regulating adolescent and young adult tobacco use. As part of the Tobacco Center's of Regulatory Science (TCORS), she is the PI on an NIH/NCI and FDA-funded longitudinal study examining adolescents’ and young adults’ perceptions regarding as well as initiation, continuation, and cessation of current and new tobacco products, including e-cigarettes and smokeless tobacco. Dr. Halpern-Felsher is also the founder and director of the Tobacco Prevention Toolkit, an online curricular aimed at reducing and preventing youth tobacco use. 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, and again in their 2017 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 risk behavior. She has served on the Board of Directors of the Society for Adolescent Health and Medicine and currently serves on the Council for the Society for Pediatric Research (SPR), and Co-Chairs the SPR Mentoring Committee. In 2007, Dr. Halpern-Felsher became one of the Program Directors for the NIH/NIDDK-funded Short-Term Research Experience for Underrepresented Persons (STEP-UP), High School Program. She has received two NIH 5-year grants to coordinate this program thus far. For this Step-Up Program, Dr. Halpern-Felsher mentors and supervises 22-25 junior and senior high school students each year. These high students are recruited throughout the country, and conduct their 8-10 weeks of research in their hometown. In addition to mentoring high school students, Dr. Halpern-Felsher has been a mentor to over 75 graduate and medical students and postdoctoral fellows.
Tobacco 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.1-5 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 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; and 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. We will address these gaps, and develop and test our model by accomplishing three specific aims. Using a longitudinal cohort design with a sample of 1,000 ninth graders followed through high school and another sample of 1,000 young adults followed for five years: Aim 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. Aim 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. Aim 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.
With initial funding from TRDRP and CDE, and additional funding from CVS Health Foundation, we have developed The Tobacco Prevention Toolkit (tobaccopreventiontoolkit.stanford.edu). This Toolkit is free and available online, accessible to anyone who wishes to use it. The goals of the Toolkit are for middle and high school students to: (a) understand basic information about tobacco products, including e-cigarettes, hookah, cigars, and smokeless and the harm they cause; (b) gain awareness of strategies manufacturers of tobacco products employ to increase use among adolescents through flavors and deceptive and creative marketing strategies; and (c) gain skills to refuse experimentation and use of all tobacco products. The Toolkit contains information on the history of and trends in tobacco use, immediate and long-term health risks of each tobacco product, effects of nicotine and nicotine addiction, the appeal of tobacco including flavors and marketing, poly tobacco use, and ways to resist using tobacco. The Toolkit has six modules containing a set of lessons with interactive activities ranging from the history of tobacco to industry manipulation tactics to resistance skills activities. The six modules are: (1) The Addiction Module, which focuses on biological, physiological, and psychological aspects and behavioral consequences of nicotine addiction. (2) The E-Cigarette/Vapes Module, which contains the latest information countering misperceptions about e-cigarettes, information on the anatomy of the various e-cigarette/vape products, advertising and marketing schemes to entice new and/or young users, flavors and ingredients, third-hand effects, and health outcomes. (3) The Hookah and Cigar/Cigarillo Module, which contains the latest information countering misperceptions about hookah and cigars, information on the anatomy of hookah and cigar products, advertising and marketing schemes to entice new and/or young users, flavors, ingredients, and health outcomes. (4) The Smokeless Tobacco Module, which contains the latest information countering misperceptions about smokeless tobacco, information on advertising and marketing schemes to entice new and/or young users, flavors, ingredients, and health outcomes. (5) The Positive Youth Development (PYD) Module, which provides a description of PYD, in-depth information about PYD strategies, sample activities, and resources. (6) The School Policies Module, which provides schools with tools necessary to develop, promote, and maintain a tobacco-free campus and resources to disseminate policies and procedures to parents/guardians and encourage them to participate in tobacco prevention efforts at home. The Toolkit also contains training materials, teacher crash courses, fact sheets, resources, and the latest information and activities countering common myths and misperceptions about different tobacco products. Activities were designed to deliver content and materials in an engaging and interactive manner. In addition to the activities, there are numerous exercises, PowerPoint presentations with teacher notes, and associated Kahoot! quizzes (Kahoot! is a free online game-based learning platform) throughout, so teachers can assess learning and retention.
Evaluating School-Based Tobacco Education Programs
Los Angeles Unified School District
My research focuses on developmental, cognitive and psychosocial factors involved in adolescents’ and young adults’ health-related decision-making, perceptions of risk and vulnerability, health communication and risk behavior. My research has focused on understanding and reducing health risk behaviors such as tobacco use, alcohol and marijuana use, risky driving, and risky sexual behavior. An early study, funded by California’s Tobacco-Related Disease Research Program, involved a prospective cohort design in which 400 male and female adolescents of varying racial/ethnic background were followed from 9th grade through one-year post high school. The ultimate goal of this longitudinal study has been to determine the extent to which adolescents’ perceptions of smoking-related long- and short-term risks and benefits influence adolescents’ and young adults’ initiation, continuation and cessation of smoking. Another study, funded by the National Institute of Child Health and Human Development (NIH), used a prospective cohort design in which over 600 ethnically and socioeconomically diverse male and female adolescents were followed for five years, the aims of this study were to: (1) examine whether the onset of adolescent sexual activity, both with and without condom use, is associated with previous and/or subsequent changes in judgments concerning STD and HIV/AIDS risk; (2) examine whether adolescents’ personal experiences with negative outcomes related to sexual behavior (or lack of such experiences) influence subsequent risk judgments and sexual behavior; (3) determine the extent to which perceived benefits of sexual behavior are related to adolescent sexual behavior, over and above perceived risks; and (4) determine whether knowledge of peers’ experiences with sexual behaviors and related positive and negative outcomes play a role in adolescents’ risk judgments and subsequent sexual behavior. I received additional funding to continue following the sample into young adulthood. The results of this research provides valuable information concerning the relationship between risk judgments and behavior that is expected to be useful to researchers and health practitioners concerned with developing programs to reduce adolescents’ sexual risk. With funding from the William T. Grant Foundation, we conducted qualitative studies on adolescent decision-making, one focusing on sexual decision-making and the other on decisions to use tobacco. These qualitative studies provide for a larger, adolescent-driven perspective on decision-making not always captured by quantitative surveys. We have also completed interviews with 40 adolescents participating in the tobacco study, and are completing additional manuscript shortly. In 2012, I received funding from California’s Tobacco-Related Disease Research Program and the California Department of Education to translate my research findings to the development of novel school-based interventions to prevent tobacco use. Most recently, I received funding from the NIH/FDA (Center for Tobacco Products) to examine adolescent and young adults’ use of and perceptions related to current conventional and new tobacco products, including cigarettes, e-cigarettes, smokeless tobacco, hookahs, and so on. I have also expanded and extended my research to understanding risk behaviors in a larger context of adolescent development as well as within the emerging adult population, as this is a developmental period most often characterized by exploration including health-compromising behaviors. My research and committee work have been instrumental in setting policy at the local, state, and national level.
Evaluation of The Stanford Tobacco Prevention Toolkit
The Stanford Tobacco Prevention Toolkit is a free online curriculum developed for use by
educators and health professionals in providing tobacco-specific prevention education to
middle and high school students. The aims of this study are to determine: (1) whether the
Curriculum is effective in changing middle and high school students' resistance to using
tobacco as well as knowledge of, attitudes towards, and intentions to use different tobacco
products; and (2) whether the Curriculum is effective in changing middle and high school
students' actual use of tobacco in the short-term.
Stanford is currently not accepting patients for this trial.
For more information, please contact Study Coordinator, 415-250-7054.
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