title: Diffusion of innovations in schools: a study of adoption and implementation of school-based tobacco prevention curricula.
abstract: OBJECTIVE
  The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process.
  
  
  METHODS
  The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions.
  
  
  METHODS
  The study was conducted in North Carolina.
  
  
  METHODS
  All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample.
  
  
  METHODS
  An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted.
  
  
  METHODS
  Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%.
  
  
  RESULTS
  Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation.
  
  
  CONCLUSIONS
  While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.
authors.affiliation: Center for Health Promotion Research and Development, School of Public Health, University of Texas-Houston Health Science Center, USA.
authors.forename: L K
authors.initials: LK
authors.lastname: McCormick
authors.forename: A B
authors.initials: AB
authors.lastname: Steckler
authors.forename: K R
authors.initials: KR
authors.lastname: McLeroy
mesh_terms: D000293:Adolescent; D003479:Curriculum; D004059:Diffusion of Innovation; D006801:Humans; D009657:North Carolina; D015397:Program Evaluation; D012572:School Health Services; D000074606:Smoking Prevention