CALIFORNIA’S expanded school tobacco prevention efforts were associated with lower levels of tobacco use among adolescents, according to new survey data from more than 160,000 students. The findings are relevant for clinicians supporting smoking and vaping prevention in young people, particularly as school environments remain central to early intervention.
How School Tobacco Prevention Was Strengthened
California’s Tobacco-Use Prevention Education (TUPE) programme has been a cornerstone of the state’s tobacco control strategy for decades. In 2016, Proposition 56 increased tobacco taxes and directed additional funding to prevention initiatives, including TUPE. This expansion allowed more schools to deliver structured education, prevention messaging and antitobacco activities.
The study analysed responses from the 2019–2020 California Student Tobacco Survey, which included students in grades 8, 10 and 12 from 358 schools. Around one-third attended TUPE-funded schools, while the remainder were in schools without TUPE funding.
What the Survey Reveals About Youth Tobacco Use
Exposure to tobacco-related advertising, including media promoting or discouraging smoking and vaping, was similar regardless of TUPE funding status. This suggests that broader environmental messaging alone did not explain differences in behaviour.
By contrast, students in TUPE-funded schools were more likely to report receiving school-based education against tobacco use and participating in antitobacco activities. After adjusting for personal characteristics and school-level factors, tobacco use was lower among TUPE students (6.5%) compared with those in non-TUPE schools (8.1%).
The analysis used logistic regression to account for potential confounders, strengthening confidence in the observed association. However, as an observational study, it cannot confirm a direct causal effect.
Clinical Relevance of School Tobacco Prevention
The findings underline the importance of school-based interventions as part of a wider tobacco prevention landscape. Even when exposure to smoking and vaping promotion is similar, structured school tobacco prevention within schools appears to be associated with lower reported use.
Clinicians may find it helpful to ask adolescents about the prevention education they receive at school and to reinforce consistent messages during consultations. At a population level, the results support continued investment in comprehensive, school-based tobacco prevention programmes to complement clinical advice and community-level tobacco control measures.
Reference
Zhu SH et al. California’s school-based tobacco use prevention program after proposition 56: results from a statewide evaluation. J Adolesc Health. 2026; DOI:10.1016/j.jadohealth.2025.11.024.
