School-Based Lung Cancer and Tobacco Use Education and Prevention Program Among Elementary Students

Andria Caton, MSN, OCN, CHPN, Northeast Georgia Medical Center, discusses the implementation of and responses to an evidence-based tobacco use education an prevention program implemented to combat high rates of lung cancer in Barrow County, Georgia, comparied with the surrounding counties. They included 9 Barrow County elementary schools

This research was presented at the 50^th Annual Oncology Nursing Society (ONS) Congress in Denver, Colorado.

“Over time, knowledge gained through the implementation of TAR Wars in Barrow County will likely result in decreased combustible and non-combustible tobacco use, e-cigarette and vaping use,” Caton wrote. “Likewise, programs like TAR Wars and community collaborations will decrease the rates of preventable cancers and other tobacco-related illnesses for Barrow County.”

Transcript:

I am Andria Caton and I had the opportunity to present a project that I've been working on for the last 7 years in a northeast Georgia County, Barrow County. My regular job is an assistant nurse manager at Northeast Georgia Medical Center in Gainesville, Georgia. If you're not familiar with the state of Georgia, it's about an hour north of Atlanta.

If you weren't there, I'd like for you to know some of the significance around the project work, Barrow County has significantly higher incidents of lung cancer and mortality than a lot of other Georgia counties. We have higher rates of smoking than counties surrounding us and our Georgia students overall, although I didn't have the data specifically for Barrow County, but Georgia in particular has higher rates of e-cigarettes and noncombustible tobacco than other states in the south mainly.

Some of the incidence rates, like I mentioned, if you go from a 100,000 people, Barrow for incidence of lung cancer has 80.7 out of 100,000 thousand develop lung cancer, compared to Georgia, that has 56.8 and the US has 53.1. So that just kind of lets you know, and you can always find all that information about your own state and your own county. You can drill down a county on the Cancer State Profiles, the SEER data, and that's where I get all my data. It's really pretty interesting to go into. What we did was starting about 7 years ago, implement a evidence-based program called Tar Wars. It was from the American Academy of Family Practitioners, AAFP. I delivered it for 2 straight years and then we hit COVID and we did it virtually. Now we have sustained the program by using school nurses and teachers all since then.

We delivered it to 9 Barrow County elementary schools. This is a fourth and fifth grade kid program, and it's dedicated to not talking about cancer, which I'm an oncology nurse through and through. It's not talking about cancer, it's talking about cost and social media pressure, peer pressure, appearance, and things that would be more concerning to a fourth to fifth grader than the development of cancer or cardiac disease for that matter. It included pre and post program surveys. Just simple, true and false questions for the kids to answer. We also did a poster and art contest. I love the PDSA, plan, do, study, act, to guide my work, almost any quality project or any study.

What we did for the last 7 years was 2000 fourth and fifth graders participated every year for the last 7 years, 100% of the 9 schools participated. We shared the results of the knowledge gains with each school overall over the 7 years. We had highest knowledge gains from the students that they reported what were in understanding more about e-cigarettes and vaping, and then about tobacco advertising because I think that we don't realize how much that they target young people.

Why did I do it? One, because I love kids. I'm not a pediatric nurse, work with adults. But once you see the impact of tobacco and you see that people start tobacco at early ages, we know that getting to them is important: Getting to kids so that they never start smoking in the first place. Decreasing, combustible and non-combustible tobacco use in Barrow County is important. Continued partnership with school nurses and teachers to address these concerns and many other concerns as we all know, health concerns that students face. Then using our data to direct the interventions that we did and the response and the questions to direct and refine future interventions.

Hopefully, and it won't happen in my lifetime, but hopefully we'll see decreases in preventable cancers in that population where right now there seems to be a little bit of health inequity in those regions.

Just to mention, I couldn't do the project without letting you know that there were some challenges. You can only imagine what it was like to go through 2000, it was actually like 4,000, pre and post-test responses from fourth and fifth grade students. The circles that we had for true and false, they sometimes would do half, sometimes they just put a dot. It was just difficult to understand exactly what they were meaning. In 2020, since we were virtual, we transferred all that to a SurveyMonkey and they did so much better with the SurveyMonkey than pencil, and paper surveys. Every year we provided that information to the schools and so they could see each individual school could see their students' data.

Some of the highlights, I think poster contests because as you well know that when you're educating adults or children that a lot of them learn differently. We thought that having a poster contest might enable them to express their feelings about tobacco or to see how much they've learned. Again, another outlet for the students to be able to highlight their feelings and their concerns about tobacco and what they could do as young people to maybe stop vaping and smoking in the future and was a highlight of the whole project.

The American College, the American Lung Association, the American Academy of Family Practitioners, the National Cancer Institute, and then we obtained a lot of that data about the tobacco stuff from our own community health needs assessment in our region in 2016 and in 2019. It's pretty much data-driven, why we needed to do it. Obviously, you can think it could be done in any school at any time, but we found it out of the 13 counties we served, it was the county that seemed like it needed the most help because of the high incidence and mortality of lung cancer. Thank you.

Source:

Caton A. TAR Wars Over Time. Presented at Oncology Nursing Society Congress; April 9-13, 2025. Denver, CO.