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Easier to prevent than stop by Arnold E. Metz Jr. College of Health Professions Imagine, if you will, a product that makes you feel good.    It’s handy to use, easy to carry around, and relaxes you before, during, and after a crisis. Its use is associated with good times: After a meal in a restaurant, drinking or socializing with friends, even sex.    There's even an element of the “forbidden fruit” to this product.    The psychology of its promotion makes it seem glamorous and sophisticated. What’s more, this product is good for the economy.  It provides farmers with a solid livelihood, and has spawned countless secondary businesses.    What is this wonderful thing?  Why, it's tobacco. Through the years, tobacco has been the topic of innumerable studies, countless cessation projects, and incalculable numbers of New Year’s resolutions.  The fact is, its use is easier (not to mention cheaper) to prevent than to stop. It has been well established that tobacco use typically begins at an early age, and involves many psychosocial variables (including risk taking, self-esteem, and peer social influence).  With these thoughts in mind, the College of Health Professions’ Physician Assistant (PA) program sought funding from the American Cancer Society for a pilot project designed to help Charleston County sixth graders resist the temptation to begin tobacco use. The project, “Keeping South Carolina Children Off Tobacco,” uses one of two methods of tobacco use prevention endorsed by the Centers for Disease Control. The method is called Project TNT or Project Towards no Tobacco Use.  Project TNT involves teaching middle-school children the social skills necessary to resist tobacco, including refusal skills, awareness of social perceptions about tobacco use, and misconceptions about physical consequences. Its curriculum consists of 10, 45-minute sessions using teaching techniques such as role playing, instructive games, video taping, and video presentations.  First-year MUSC physician assistant students, who have been trained by one of the authors of Project TNT, teach the sessions. The first classes are being held at Brentwood Middle School in North Charleston with guidance from the health instruction faculty member, John O. Thomas.  According to Karen Kimm-Brinson, PA student and teaching group leader, the experience has been rewarding. “The children are so impressionable at this age, we can have an important impact on their lives,” she says. Fellow students and group leaders Brian Forbus, Kwanita Hunt, and Michael Overcash echo her sentiments. Success at tobacco use prevention will be difficult to measure for a few years. However, the children’s knowledge base about tobacco use and attitudes about peer negotiations, perceived benefits/barriers, self efficacy, perceived threat to health, and other psychosocial topics will be measured and compared by pre- and post-course surveys.  The data gathered should support a future expansion of Project TNT in the county or state. The MUSC PA Program, with the help of the American Cancer Society and the Charleston County Public Schools, is taking the first small steps toward reducing the serious health risk represented by tobacco.  Thanks to all the PA students who have unselfishly devoted their time to this worthwhile service learning project. Community involvement is more than just another class, it is a satisfying, confidence-building, heart-warming experience, with very real and long-lasting benefits to all involved.