Addressing challenges to dissemination of a tobacco prevention program among Deaf and Hard of Hearing youth: New strategies for diverse settings

Deaf and Hard of Hearing (D/HH) youth are at risk for tobacco use. Prevention materials and media messages available to hearing youth are often inaccessible and inadequate for this cultural and linguistic minority population. To address this unmet need, we conducted community-based participatory research to develop and test a tailored deaf-friendly anti-tobacco curriculum through a quasi-experimental design involving four schools for the Deaf over a three-year period (n=511-616 students/year, grade 7-12). Follow-up surveys indicated that the curriculum increased perceived tobacco education exposure and significantly affected tobacco-related practices, attitudes and knowledge. The next step is further dissemination of the program. Dissemination poses particular challenges due to the diverse settings available to reach D/HH youth, which include community agencies serving the Deaf community, schools for the Deaf, and diverse mainstream school settings where, increasingly, D/HH youth receive their education in separate classrooms or through individual placements in classrooms of hearing students. Drawing on the experience of educators who participated in the research and others who have adopted the program, we have developed specific recommendations for facilitating program implementation and enhancing the curriculum's value as an educational tool. We will describe the comprehensive evidence-based program, discuss barriers to dissemination, and consider strategies for addressing these challenges. We will also consider ways in which elements of the curriculum can be adapted for use among other minority youth populations where English may be a second language and low literacy and health literacy may be a problem.