Problem/Objective: An alternative to the pre-test/post-test design is to select evidence-based programs and monitor fidelity. The Ohio Tobacco Prevention Foundation (OTPF) funded school-based and community-based prevention curricula as a primary strategy for youth tobacco use prevention. While grantees were limited to five evidence-based curricula, little is known about the fidelity and delivery of these programs.

Methods: Using curriculum-specific fidelity checklists for five different evidence-based programs, curriculum fidelity was assessed across over 1000 classrooms in the state of Ohio. Fidelity outcomes included percent of activities completed, facilitator perception of delivery, and minutes of contact time. Outcomes were validated through a facilitator-administered teacher survey and a confidential, web-based teacher satisfaction survey.

Results: In spite of published curricula recommending no less than 80% of the curriculum activities, the range of actual activities completed was between 20% and 80%. Reasons for low compliance included lack of time, shifting school priorities, and unexpected school disruptions. Despite all facilitators being trained and committing to deliver the curriculum with full fidelity, the rates of actual fidelity are quite low.

Conclusions: These findings suggest that full fidelity to a published curriculum is difficult, and possibly unrealistic, to achieve outside a research environment. While these results highlight the need to improve fidelity, it may be equally as beneficial to better understand the robustness of each curriculum in order to accommodate the unpredictable nature of real-life settings.