Tobacco use accounts for over 440,000 total deaths and 170,000 cancer-related deaths every year in the United States. Over 90% of adult smokers began smoking cigarettes as adolescents. According to the 2001 Youth Risk Behavior Survey, 63.9% of adolescents in grades 9 through 12 have tried cigarettes, 28.5% are current smokers (smoking at least 1 day a month), and 13.8% are current frequent smokers (smoking at least 20 days in a month). Of these youth, 1,140 will become daily smokers. Given these statistics, it is clear that eliminating smoking during the adolescent years is important in order to reduce incidences of cancer and other smoking-related negative outcomes. Schools have historically provided a key venue in which to implement tobacco-focused prevention and intervention programs. These school-based programs typically attempt to prevent smoking by conveying information about prevalence rates, risk factors, and risk estimates concerning tobacco-related disease. Most of the focus is on long-term health risks, such as lung cancer and heart disease. Cross-sectional and longitudinal research support these efforts, showing that youth who have smoked perceive lower long-term health risks than youth without such smoking experiences. Historically, however, these intervention strategies have not been very effective. Instead, recent research and our experiences working directly with youth suggest that in order to produce desired decreases in adolescent smoking, a more comprehensive school-based tobacco prevention effort addressing the multiple influences on adolescent smoking is needed. In addition to providing information on long-term health risks associated with smoking, a comprehensive curriculum would also address perceived short-term health risks (e.g., getting into trouble, getting a bad cough), perceived benefits from smoking (e.g., looking cool; looking more grown up), the addictive nature of tobacco use, social norms, perceived images of smokers, and environmental influences such as parental smoking and parental monitoring. Effective tobacco prevention curriculum that addresses these multiple influences has yet to be developed. The ultimate goal of this project is to identify a comprehensive set of topics and strategies for delivery of anti-tobacco messages that can be addressed and implemented in a new school-based tobacco prevention program. The specific aims of this proposal for a pilot Schools-Academic Research Award (SARA) include the following: 1) to solidify a partnership between investigators at the University of California, San Francisco and the Bay Area Peninsula Middle Schools; 2) through focus groups and discussions with middle school administrators, health education teachers, parents, and youth, to identify key factors involved in youth smoking, effects of current intervention efforts, and ways to improve current tobacco prevention curricula; and 3) to develop curricula and delivery strategies that can be incorporated into a comprehensive school-based intervention, to be implemented and evaluated through a full SARA grant proposal. It is expected that the findings from this formative research and the collaborations and relations resulting from this project will lead to the development and implementation of culturally appropriate programs at the school level. The resultant program is expected to be novel not only in content, but also in the methods used to convey anti-tobacco messages to youth. Ultimately, we expect to conduct a randomized control trial to more fully test whether the resultant novel school-based model is effective. Most middle and high schools have limited resources to independently create novel, comprehensive school-based tobacco prevention programs. However, with a consortium of schools participating in this project, and the collaboration with an academic partner, such efforts are feasible and extremely desired.