The research behind UP2U.
Developed at the University of Virginia and supported by the National Cancer Institute, UP2U is grounded in established behavioral theory, with preliminary findings from a 520-student pilot study.
Who created UP2U?
University of Virginia
Center for Tobacco Prevention and Control Research
Lead Investigator: Melissa A. Little, PhD, MPH
Study Coordinator: Dylan Allanson
Phone: +1 (434) 260-9517
Email: UP2U@virginia.edu
Supported by.
UP2U is funded by the National Cancer Institute and the National Institutes of Health. Participation is at no cost to schools or students.
Grounded in established theory.
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Prototype/Willingness Model
UP2U targets adolescent decision-making through the "reactive pathway" — the social reaction process by which willingness to use a substance, rather than deliberate intention, predicts initiation behavior. UP2U content is designed to reduce willingness among susceptible non-users and to interrupt the reactive pathway at the point of social exposure.
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Social Norms Theory
UP2U uses corrective social norms messaging to address overestimations of peer tobacco use. When students learn that approximately 85% of peers are not using, the goal is more accurate social perception — which the Prototype/Willingness Model predicts will reduce willingness to initiate.
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RE-AIM Framework
Program development and evaluation are structured using RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to support real-world, sustainable delivery in school settings.
Pilot findings.
From a pilot study of UP2UTeacher with 520 9th grade students across Virginia public high schools. These are immediate post-session findings only. Long-term outcomes are pending full-scale RCT follow-up.
of willing non-users shifted to "unwilling to use" immediately following the UP2UTeacher session
of current users shifted to "unwilling to use" immediately following the session
9th grade students in the pilot cohort
In the pilot study, significant increases in perceived harm and addictiveness of tobacco and nicotine products were also observed immediately post-session. At 12-month follow-up, pilot participants showed a 32.1% relative reduction in TNP initiation compared to control — a clinically meaningful finding, though the study was not powered to reach statistical significance.
Current phase.
UP2U is currently being evaluated in a full-scale, 3-arm cluster Randomized Clinical Trial (RCT) funded by the National Cancer Institute.
The trial compares three conditions across 27 Virginia public high schools (N≈9,050 students): (1) UP2UTeacher + UP2UDigital combined, (2) UP2UTeacher alone, and (3) a no-treatment control. The primary outcome is tobacco and nicotine product initiation at 12-month follow-up among baseline non-users. A secondary aim evaluates the added benefit of UP2UDigital as a reinforcing component — its independent efficacy has not yet been separately published. Results are pending.
Why this model matters for schools.
Most prevention programs fail not because they lack evidence — but because schools can't realistically implement them under real-world conditions of competing priorities, limited time, and inadequate resources.
UP2U was designed from the start to survive these conditions. The teacher-led session requires one class period, no multi-session training, and fits within what is already mandated for Health and PE. The digital reinforcement component uses smartboards already in 92% of U.S. classrooms, delivered during the attendance transition — approximately 5 minutes that exist in every school regardless of subject, schedule, or staffing. No additional student devices, accounts, or instructional time are required.
This delivery structure was designed to be content-agnostic — the same framework could potentially carry evidence-based health content across topics in resource-constrained schools, though UP2U is currently being tested only in the context of tobacco and nicotine prevention. TNP prevention is the testing ground; the scalable delivery model is the broader contribution.
Study information.
This study is conducted by the University of Virginia Center for Tobacco Prevention and Control Research.
Participation is voluntary and anonymous.
Research Disclaimer. UP2U is currently under evaluation. Statistics on this site reflect data from a 520-student pilot study unless otherwise noted. Pilot findings are preliminary and do not establish long-term efficacy. UP2UDigital is being evaluated as a reinforcing component of the full program; its independent benefit has not been separately published. This site provides public awareness information about an ongoing research study. It does not constitute medical advice or clinical recommendations.
Contact for research information.
For questions about the study, school participation, or research methodology, reach the team directly.
+1 (434) 260-9517
University of Virginia Center for Tobacco Prevention and Control Research