Tobacco use is recognized as the number one preventable cause of disease and death in the United States. As such, development of better tobacco-use prevention strategies, utilized by health care providers, is a worthy endeavor. Where it exists, initiation of formal tobacco education within the schools is focused at sixth- to eighth-grade students, the age research has shown when most tobacco experimentation begins, yet well beyond the age when ideas and attitudes are developed in favor of or in opposition to tobacco use. The purpose of this quasi-experimental study was to determine the effect of an early childhood tobacco education program on knowledge and attitudes of fourth-grade students. A convenience sample of 234 students from an elementary school in the southeastern United States was compared to a control group of 4 6 students from an area school of similar size and demographics who had not been exposed to the tobacco curriculum. Bandura's Social Learning Theory and the Neuman Systems Model provided the theoretical frameworks to guide the study. The Tupelo Tobacco Survey, an instrument used to measure scores in knowledge and attitude, was developed from an existing tool by Princeton Health Press. The null hypotheses tested were as follows : There will be no difference in knowledge scores for students who attended and those who did not attend an early education program and there will be no difference in attitude scores for students who attended and those who did not attend an early education program. Descriptive statistics were used and included frequencies, percentiles, and t test for data analysis. A statistically significant difference (p < .001) was found for knowledge test scores, thus the first hypothesis was rejected. The null hypothesis, however, was accepted in statement two, since no difference emerged for attitude scores. This result was attributed to a ceiling effect explained by a preexisting high negative attitude toward tobacco use in both groups of children. The researcher concluded that an early childhood tobacco education is effective as a tobacco-use prevention strategy. There is an obvious role for the advanced practice nurse in the school setting relative to providing this health education foundation. The researcher recommends the incorporation of tobacco education at an earlier age to effectively generate a knowledgeable youth population and promote attitudes consistent with postponement or abstinence of tobacco use onset.


Master of Science in Nursing (MSN)


Graduate Nursing

Degree Date


Publication Number


First Advisor

Dr. Mary Patricia Curtis

Second Advisor

Dr. Linda Sullivan

Third Advisor

Dr. Patricia E. Smyth

Document Type


Included in

Nursing Commons