Expanded school-based program linked to lower youth tobacco use rates in California

(Press-News.org) Researchers from University of California San Diego report that an expanded, school-based tobacco prevention program in California was associated with significantly lower rates of smoking and vaping among middle and high school students. The study published in the Journal of Adolescent Health on Jan. 12, 2026, evaluated the impact of California’s Tobacco-Use Prevention Education (TUPE) program following a major funding increase approved by voters in 2016.

Using data from more than 160,000 students statewide, the researchers found that students attending schools receiving TUPE funding were 20% less likely to use tobacco overall and 23% less likely to vape, compared with students in schools without TUPE funding.

“California has one of the most comprehensive tobacco control environments in the country, so demonstrating added impact from a single program is challenging,” said Shu-Hong Zhu, Ph.D., the study’s senior author and professor in the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego. “But even in this active landscape, the TUPE program demonstrated a clear association with reduced youth tobacco use.”

The evaluation focused on the period after passage of Proposition 56, a ballot initiative approved by California voters in 2016 that increased taxes on cigarettes, vapes and other tobacco products. The measure generated new revenue for tobacco prevention efforts, including a substantial expansion of the TUPE program administered by the California Department of Education.

While statewide media campaigns funded through Proposition 56 reached nearly all adolescents in California, TUPE funding supported more intensive, school-based prevention efforts in selected districts. These included classroom education, youth engagement activities and access to tobacco cessation services.

To assess whether TUPE provided additional benefits beyond California’s broader tobacco control program, the research team analyzed data from the 2019–2020 California Student Tobacco Survey, a representative survey of students in grades 8, 10 and 12 conducted in 358 public schools across the state.

Students in TUPE-funded and non-TUPE-funded schools reported similar exposure to tobacco-related advertising, both for and against, and similar perceptions of how easy it was to obtain tobacco products, suggesting they shared a comparable external environment. The key differences emerged within schools.

Students in TUPE-funded schools were significantly more likely to receive tobacco prevention education and to take part in anti-tobacco activities, and these differences were associated with lower tobacco use rates.

Key findings include:

Students in TUPE-funded schools were more likely to receive school-based tobacco prevention education (71.0% vs. 63.8%). They were more likely to participate in anti-tobacco activities such as tobacco-free events or creating tobacco prevention materials (15.2% vs. 10.6%). Overall tobacco use was lower among students in TUPE-funded schools than among students in non-TUPE-funded schools (6.5% vs. 8.1%). Vaping rates, the most common form of youth tobacco use, were also lower (5.4% vs. 7.0%). “These differences may seem modest at first glance, but at the population level, they represent a substantial reduction in risk,” Zhu said. “Most long-term tobacco use begins in adolescence. Preventing even a small percentage of young people from starting can translate into major public health benefits over time.”

The study also found that TUPE-funded schools were more likely to provide students access to counselors or staff trained to address substance use concerns, reinforcing prevention messages beyond the classroom.

Importantly, the association between TUPE funding and lower youth tobacco use remained significant after researchers controlled for factors such as grade level, region, race and ethnicity, parental education, mental health status and whether students lived with someone who used tobacco.

Michael Ong, M.D., Ph.D., a health economist and professor from University of California Los Angeles who was not involved in the research, said: “Studies like this show how important it is to keep investing in strategies that work — and that protect young people from becoming addicted.” Ong chairs the Tobacco Education and Research Oversight Committee, which advises the state on tobacco prevention and control.

Ong added, “Proposition 56 allowed California to strengthen and modernize its tobacco prevention programs at a time when vaping products were rapidly changing the landscape. This study shows that when schools are given the resources to implement sustained, high-quality prevention education, students are more likely to reject these enticing new products.”

The consistency of the study’s findings across multiple measures strengthens the evidence that school-based prevention plays an important role in a comprehensive tobacco control program.

“School-based programs are not a replacement for strong policy and media, but they are a critical complement,” Zhu said. “This study suggests that sustained investment in prevention education at the school level can help protect young people from becoming addicted to tobacco.”

Link to full study: https://www.sciencedirect.com/science/article/pii/S1054139X25008146

Additional co-authors on the study include: Katherine Braden, M.P.H., Yue-Lin Zhuang, Ph.D., Anthony C. Gamst, Ph.D., Joanna Sun, Jijiang Wang, Ph.D., Christopher Anderson, and Carey Blakely at UC San Diego; and Adam G. Cole, Ph.D., Ontario Tech University.

The study was funded by the California Department of Public Health (contract #CDPH-16-10109) and the California Department of Education, Tobacco-Use Prevention Education Office (contract #CN-230054).

Authors report no competing interests.

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