The Fuetsan Manhoben Curriculum: Effects on Risk Perceptions and Intentions Regarding Tobacco and Betel Nut Use Among Adolescents in Guam.

Background: While there are known high rates of tobacco and betel (areca) nut use in the U.S.-Affiliated Pacific Islands (USAPI), there have been limited efforts at preventing the initiation of tobacco and betel nut among those living in the region, particularly, adolescents. To meet this need, Fuetsan Manhoben (FM)-a culturally tailored, school-based tobacco and betel nut use prevention curriculum-was developed for adolescents in Guam, a USAPI in the Western Pacific. Method: A pilot randomized controlled trial was conducted to examine the efficacy of FM. Guam public middle school students were randomly assigned to either the FM intervention (n = 269) or a control (n = 269) condition. Data were collected at baseline, posttest (4 weeks after baseline), and 3-month follow-up. Results: At posttest, FM had a statistically significant positive direct effect on risk perceptions of both cigarettes and betel nut. Also, risk perceptions of both cigarettes and betel nut measured at posttest inversely predicted intent to use cigarettes and betel nut at follow-up. FM also had an indirect effect on reducing intent to use betel nut at follow-up through its immediate and prior effect on betel nut use risk perceptions at posttest. Conclusions: The results provide initial support for the efficacy and feasibility of FM.