Choose Your Own Design

Based on the survey, you find that indeed smokeless tobacco use is common among students. However, many of the factors that were anticipated to contribute to smokeless tobacco use were not significantly associated. Choose Again

Based on the focus groups, students reported that smokeless tobacco was viewed as a masculine, adult thing to do and that it was particularly popular among students involved in the school's athletics program. Students report that older athletes encourage younger athletes to use smokeless tobacco. Finally, those who use smokeless tobacco are aware of the risks, but do not feel that such health problems will affect them unless they use tobacco for decades. Choose Again

Evaluation of the program reveals that it increased awareness of the dangers of smokeless tobacco use but did not create behavior change. Students who use smokeless tobacco are still using it, and those who had not used it report no change in their willingness to try it. Choose Again

Your second survey does indeed find some additional factors that were associated with smokeless tobacco use. However, because you never thought to assess participation in athletics as one of your survey variables, you never found out that this was largely a problem among school athletes and that the peer pressure from older student athletes was driving the initiation among younger students. Choose Again

Evaluation of the program revealed that it increased awareness of the dangers of smokeless tobacco use, but did not create behavior change. Students who use smokeless tobacco are still using it, and those who had not used it report no change in their willingness to try it. This is probably because the program was designed without a clear knowledge of what factors contribute to smokeless tobacco use. Choose Again

Evaluation of the program revealed that it increased awareness of the dangers of smokeless tobacco use, but did not create behavior change. Students who use smokeless tobacco are still using it, and those who had not used it report no change in their willingness to try it. This is probably because the program was designed without a clear knowledge of what factors contribute to smokeless tobacco use. Choose Again

Excellent! This Qualitative followed by Quantitative design is an example of an Exploratory Mixed Methods Design. Building on the insights from the qualitative data, your survey was able to determine that indeed smokeless tobacco use was significantly more common among athletes than non-athletes. You also were able to determine that those who experienced peer-pressure were more likely to use smokeless tobacco. Now, you have a strong basis for designing intervention programs; including what students should be targeted and what skills (peer pressure resistance) should be targeted for the intervention to have maximum efficacy. Choose Again

Students who do not use smokeless tobacco had little to report about it. They too reported that they saw this mostly as an behavior engaged in by some athletes. Also, they too reported that they were aware of the risks but beleived that the health problems were unlikely to affect young people. Problem: The second round of focus groups did not add much to your knowledge. You still have no indication of how many students are using smokeless tobacco, and you still have not documented whether the insights from the focus groups (e.g., athletes, peer pressure, perceived risk) are associated with tobacco use. Choose Again

Evaluation of the program reveals that it did increase the awareness of the health consequences of even short-term smokeless tobacco use. However, it did not lead to any increase in their intention to quit using smokeless tobacco. This suggests that awareness of the risk alone was not sufficient to change their behavior. To confirm which of the qualitative insights were associated with smokeless tobacco use or intention to quit might have helped prevent this. Choose Again

Based on the survey, you find that indeed smokeless tobacco use is common among students. However, many of the factors that were anticipated to contribute to smokeless tobacco use were not significantly associated, including perceived health consequences. Although this latter finding explains why your first intervention program did not change behaviors, you still are unclear on what factors contribute to smokeless tobacco use or how to change their behavior. Choose Again

Based on the focus groups, students reported that smokeless tobacco was viewed as a masculine, adult thing to do and that it was particularly popular among students involved in the school's athletics program. Students report that older athletes encourage younger athletes to use smokeless tobacco. Finally, those who use smokeless tobacco are aware of the risks, but do not feel that they such health problems will affect them unless they use tobacco for decades. This explains why your first program to increase perceived risk did not change behavior. However, it is still unclear how many students and how many student athletes use smokeless tobacco, and whether these insights from the focus groups are indeed significantly associated with smokeless tobacco use. Choose Again

Evaluation of the program reveals that it increased awareness of the dangers of smokeless tobacco use but did not create behavior change. Students who use smokeless tobacco are still using it, and those who had not used it report no change in their willingness to try it. This is probably because the program was designed without a clear knowledge of what factors contribute to smokeless tobacco use. Choose Again