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Program Highlights

Purpose: School-based cancer prevention and health promotion program for 5th and 7th grade American Indian students (1995).
Age: 0-10 Years (Children), 11-18 Years (Adolescents)
Sex: Female, Male
Race/Ethnicity: American Indian
Program Focus: Tobacco Use Prevention
Population Focus: People who do not Smoke
Program Area: Tobacco Control
Delivery Location: School (K-College)
Community Type: This information has not been reported.
Program Materials

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In the past, strong cultural traditions and living away from the influences of urban life have protected many Southwestern American Indians from some risk factors associated with cancer. This protection, however, is disappearing, and many Native American people are adopting Western lifestyles that often bring unhealthy habits. These lifestyle changes are likely to lead to an increase in cancer risk factors and disease among American Indians in the Southwest.


The Pathways to Health project is a school-based program of cancer prevention and health promotion activities for fifth- and seventh-grade American-Indian students. The program includes a classroom health promotion curriculum, a social influences component, intergenerational activities, storytelling, parent education, school staff training and development, and modification of school meals.

The curriculum includes 16 lessons that focus on preventing smoking and smokeless tobacco use and encouraging children and their families to eat foods with less fat and more fiber. Lessons on peer pressure, classroom visits from grandparents, and family activities are also included.

The 16-session program is implemented during the school year, over the course of two semesters. Teachers are encouraged to combine the intervention curriculum with enrichment activities provided in the curriculum guide.

The study participants were American-Indian children in the fifth and seventh grades.

The program is suitable for implementation in the classroom.

The Pathways to Health 7th grade teacher guide, student workbook, and Native American Foods, Games and Customs manual are required. The program developer has determined that additional materials that are referenced in this program are not required for successful implementation and so these additional materials have not been made available to EBCCP.

The primary purpose of the Pathways to Health study was to develop, implement, and evaluate a curriculum to prevent smoking and the use of smokeless tobacco and to promote a low-fat and high-fiber diet.

The project used a pre-test and post-test design, with schools randomly assigned to one of three groups: (1) curriculum only, (2) curriculum plus family, or (3) control (delayed intervention). The curriculum was based on the following cultural beliefs and values: learning through observation and practice, learning with examples, holistic learning, learning by trial and error, learning cooperatively, and learning through reflection.

Results of the study include the following:

  • Self-reports of smokeless tobacco use and intention to use smokeless tobacco among seventh-grade students show differences between the intervention and control groups.
  • Among those who were not current smokeless tobacco users at pre-test, nearly 92% of intervention students remained non-users at post-test, compared to 82% in the control group.
  • Overall, few intervention seventh-grade students consistently thought they would ever use smokeless tobacco, but a larger proportion of control students continued to think they would use it or were unsure at post-test (52% vs. 62%).
  • No statistically significant differences in pretest/posttest change measures were found among fifth graders' self reports of smoking/intention to smoke.

Graph of study results


Cunningham-Sabo L, Davis SM. (1993). Pathways to Health: A Health Promotion and Cancer Prevention Project for American Indian Youth. Alaska Medicine, 35(4), 275-296.

Davis SM, Cunningham-Sabo L, Lambert LC. (1999). Chapter 7: Pathways to Health: A Cancer Prevention Project for Native American Schoolchildren and Their Families. Native Outreach: A Report to American Indian, Alaska Native, and Native Hawaiian Communities (NIH Publication #98-4341).

Osborn KL, Davis SM, Slattery M, Giuliano A, Teufel NI, Joe J, Ritenbaugh C. (1996). Four Corners Research Consortium for Native Americans and Cancer Research. Cancer, 78(7 Suppl), 1629-1632.

Cunningham-Sabo LD, Davis SM, Koehler KM, Fugate ML, DiTucci JA, Skipper BJ. (1996). Food preferences, practices, and cancer-related food and nutrition knowledge of Southwestern American Indian youth. Cancer, 78(7 Suppl), 1617-1622.

Davis SM, Cunningham-Sabo L. (1999). Chapter 7: "Pathways to Health": a school based cancer prevention project for Southwestern Native American youth. In Weiner D (Ed.), Preventing and Controlling Cancer in North America: A Cross-Cultural Perspective, 85-94. Westport, CT: Praeger.

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Updated: 03/29/2023